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clin med > gi 3.3 > Flashcards

gi 3.3 Flashcards

1
Q

Internal hemorrhoids

tissue

A

Columnar epithelium

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2
Q

nerve endings in internal or external hemorrhoids

A

external

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3
Q

Internal hemorrhoids

sx

A

Bleeding, protrusion, seepage/soilage, staining, pruritus

RARELY painful

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4
Q

Internal hemorrhoids

grade classification

A

Grade 1- non prolapsing
Grade 2- reduce on own
Grade 3-reduce manually
Grade 4-irreducible

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5
Q

Internal hemorrhoids

grade trmt

A

Grade 1- RBL or sclerotherapy
Grade 2-RBL
Grade 3- RBL or hemorrhoidectomy
Grade 4- hemorrhoidectomy

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6
Q

Internal hemorrhoids

trmt

A

High fiber, fluids, fiber supplements, stool softener

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7
Q

External hemorrhoids

tissue

A

Squamous epithelium

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8
Q

External hemorrhoids

sx

A

Protrusion, Soilage, Staining, pruritus

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9
Q

External hemorrhoids

trmt

A

Symptomatic relief- sitz bath, stool softeners, pain meds
Excision
Thrombectomy

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10
Q

most Anal fissures are anterior or posterior

A

posterior

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11
Q

Anal fissures

location

A

Distal to dentate line

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12
Q

Anal fissures

causes

A

Crohns, malignancy, TB, syphilis, CMV, HIV, trauma (large hard stool or diarrhea)
Hypertonic/stastic anal sphincter
Ischemia
Chronic: may be from sentinel skin tags, hypertrophic papilla, exposed IAS, hyperspastic IAS, anal stenosis, fistula

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13
Q

Anal fissures

sx

A

Pain, spasm, bleeding, soilage, difficult pooping

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14
Q

Anal fissures

trmt

A 
Symptomatic relief- sitz bath, stool softeners, pain meds
Topical NTG
Botox
Lateral internal sphincterotomy
Anoplasty
Fissurectomy
Anal stretch
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15
Q

acute Anorectal suppuration

A

abscess

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16
Q

chronic Anorectal suppuration

A

fistula

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17
Q

Anal abscesses

types

A

Perianal, intersphincteric, ischiorectal (MC), supralevator

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18
Q

Anal abscesses

sx

A

Pain, swelling, drainage, bleeding, constipation, urinary difficulties

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19
Q

Anal abscesses

trmt

A

Drain abscess

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20
Q

Anal fistulae

types

A

Intersphincteric (MC), transsphincteric, suprasphincteric, extrasphincteric

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21
Q

Anal fistulae

trmt

A

fistuloplasty/ectomy, anoplasty, fibrin glue

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22
Q

Rectal prolapse

sx

A

Incontinence, constipation, protrusion, bleeding, discharge, sensation of incomplete emptying, rectal pressure/tenesmus

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23
Q

Rectal prolapse trmt

A

Repair abdomen

Perineal repair

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24
Q

May only be able to see on toilet

A

Rectal prolapse

25
Q

Fecal incontinence types

A

Pseudo Incontinence- soilage, frequency, urgency
Overflow incontinence
Diarrheal states
Sphincter disruption- dt anorectal procedure, trauma to pelvic floor, or pseudo neuropathy

26
Q

Fecal incontinence PE

A

Inspect
DRE
Endoscopy

27
Q

Fecal incontinence trmt

A

Treat underlying condition
Fix constipation
Biofeedback therapy

28
Q

Condyloma acuminata causes

A

Sexually transmitted

HPV

29
Q

Condyloma acuminata risks

A

Homosexual males
Doing anal
Immunosuppression, HIV

30
Q

Condyloma acuminata sx

A

Visible palpable warts, pruritus, soilage, bleeding, wetness, discomfort

31
Q

Condyloma acuminata trmt

A

Stop Podophyllin, Bichloroacetic acid, trichloroacetic acid bc they can cause it
Must treat partners as well or it wont go away

32
Q

SCC
BCC
Pagets disease
Bowen’s disease

where are these anal neoplasms located

A

anal margin

33
Q

where are these anal neoplasms located

Epidermoid carcinoma
SCC
TCC
Cloacogenic carcinoma
Basaloid carcinoma
Adenocarcinoma
Malignant melanoma
Sarcoma
A

anal canal

34
Q

Anal neoplasms sx

A

Bleeding, pain, mass, pruritus, discharge

35
Q

Anal neoplasms trmt

A

Remove it
Abdominal perineal resection
Radiotherapy
Chemo

36
Q

Pruritus ani?

A

Anal itching and burning from excoriation, secretions, and irritant

37
Q

Pruritus ani causes

A

Bad hygiene, cleaning too much, soilage, foods, obesity

38
Q

Pruritus ani trmt

A

Change hygiene, change diet
Psyllium- bulks up stools
Treat cause
Stop scratching

39
Q

Hidradenitis suppurativa?

A

Infection of apocrine sweat glands

40
Q

what does Hidradenitis suppurativa cause?

A

Causes abscesses and sinus tract formation

41
Q

location of Hidradenitis suppurativa

A

Occurs in neck, axilla, groins, genitals, scalp

42
Q

Hidradenitis suppurativa

risks

A

Obese, heavy sweaters, african american, irritatin, trauma

43
Q

Hidradenitis suppurativa

trmt

A

Good hygiene
incision and drain abscess
cut it out

44
Q

Pilonidal disease cause

A

Congenital- remnants in medullary canal, developmental dermal inclusions
Acquired- rxn to imbedded hair, hair follicle infections

45
Q

Pilonidal disease risks

A

Hirsutism
Chronic trauma
Deep intergluteal fold

46
Q

Pilonidal disease sx

A

Acute: pilonidal abscess
Chronic: pilonidal sinus

47
Q

Pilonidal disease trmt

A

Excision, cystostomy, cleft closure

48
Q

Refer any anorectal disorder to specialist if

A

anorectal disorder is unclear or pt does not respond to trmt

49
Q

Primary sclerosing cholangitis (PSC)?

A

Chronic progressive inflammation, fibrosis, and stricturing of medium and large ducts in intra and extra hepatic biliary tree that leads to fatigue

50
Q

Associated with UC

A

Primary sclerosing cholangitis (PSC)

51
Q

“Beading of bile ducts”

A

Primary sclerosing cholangitis (PSC)

52
Q

2 goals of trmt:

Primary sclerosing cholangitis (PSC)

A

Slow and reverse disease progression- many drugs don’t succeed
Manage disease and complications

53
Q

Primary sclerosing cholangitis (PSC)

trmt

A

Ursodeoxycholic acid (UDCA) is best
Endoscopic therapy to dilate or stent the stricture
ATB if cholangitis
Transplant

54
Q

Primary biliary Cirrhosis?

A

Chronic progressive disease where T cells destroy small intrahepatic bile ducts

55
Q

Primary biliary Cirrhosis

cause

A

Unknown

56
Q

Primary biliary Cirrhosis

sx

A

Asymptomatic

Fatigue, pruritus (from hyperbilirubinemia), RUQ pain, arthropathy

57
Q

Primary biliary Cirrhosis

pe

A

May be normal
Hypopigmentation, excoriation (from itching), jaundice
Late stage: ascites, clubbing, edema

58
Q

Primary biliary Cirrhosis

labs

A 
\+ antimitochondrial antibodies (AMA)
Inc LFT esp. Alk phos
Histology shows Asymmetric destruction of bile ducts
Do liver biopsy, MRCP, ERCP
Need all 3 to dx
59
Q

Primary biliary Cirrhosis

trmt

A

No widely acceptable trmt
Treat underlying sx: itching, bone disease, hyperlipidemia
Ursodiol if caught early
Cholestyrene resin reduces pruritus
Liver transplant if they think you’ll die within a year

clin med (35 decks)

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