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clin med > gi day 3 > Flashcards

gi day 3 Flashcards

1
Q

Acute appendicitis

cause

A

Unknown
Maybe obstruction of lumen with feces or lymphoid hyperplasia
E coli and bacteroides- fecal organisms

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2
Q

Acute appendicitis

sx

A

RLQ pain at McBurney’s point (btwn ASIS and umbilicus)
VN, anorexia
Constipation
Diarrhea if perforated

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3
Q

Acute appendicitis

pe

A

Low grade fever, tachycardia
RLQ tenderness with rigidity, guarding, and rebound
Rovsing’s sign- RLQ is tender when LLQ is palpated
Psoas sign- pain with extension of R leg
Obturation sign- pain on internal rotation of flexed R thigh

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4
Q

Acute appendicitis

dx

A

PMN leucocytosis
High CRP
UA- WBC and RBC; no bacteriuria
US and CAT scan are best

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5
Q

Appendix carcinoid ?

A

Firm, yellow, bulbar mass usually located at the tip

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6
Q

Appendix carcinoidtrmt

A

Less than 1cm → Benign so do appendectomy

Over 2 cm → malignant so do right colectomy

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7
Q

MC site of GI carcinoid-

A

SI and rectum

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8
Q

Adenocarcinoma of Appendix presentation

A

acute appendicitis

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9
Q

Adenocarcinoma of Appendix trmt of choice

A

Trmt of choice: Right hemicolectomy

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10
Q

Meckel’s Diverticulitis presentation

A

appendicitis

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11
Q

Meckel’s Diverticulitis?

A

diverticulum in terminal ileum

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12
Q

Meckel’s Diverticulitis

rule of 2

A

2% of pop
2 cm wide at base
2 ft proximal to ileocecal valve

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13
Q

If you go in to take the appendix out and see it is normal but the base of the cecum is involved, check for___

A

crohns

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14
Q

congenital Meckel’s Diverticulitis

A

all layers on mesenteric border

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15
Q

acquired Meckel’s Diverticulitis

A

dt high internal pressure, located at mesenteric border

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16
Q

Diverticular disease mc areas afffected and where on body

A

L side/ sigmoid disease MC in West like USA and canada

R side disease MC in East like Japan, China, Korea

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17
Q

RARE in Africa

A

Diverticular disease

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18
Q

MC at sigmoid colon
2nd MC at descending colon
in us

A

Diverticular disease

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19
Q

2 types Diverticular disease

A

Classic- HAS muscle abnormality; in left colon of elderly; pain, inflammation, perforation, fistulae
Bleeding- NO muscle abnormality, painess

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20
Q

Diverticular disease?

A

Outpouching of the colon
Shortening of sigmoid and wall thickening dt inc elastin content of teniae
Pericolic inflammation and fibrosis from micro and macro perforation

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21
Q

Diverticular disease seen on microscope?

A

On microscope: inflammation with PMN leukocytes and pericolonic inflammation; mucosal and luminal hemorrhage seen

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22
Q

Diverticular disease sx

A

Usually none
Seen by accident on Ba enema, colonoscopy, or CT scan
Vague LLQ abd pain, anorexia, nausea, constipation or diarrhea

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23
Q

Diverticular disease dx

A

MUST get colonoscopy to r/o colon CA

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24
Q

Diverticular disease trmt

A

High fiber diet- 25-30 grams a day
Demerol (analgesics) is agent of choice- dec intraluminal pressure
ATB to cover gram + and - bacteria

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25
Q

Acute diverticulitis sx

A

Persistent LLQ pain
Radiates to back, groun, and suprapubic region
Constipation or diarrhea
Low grade fever
Dysuria, urgency, and frequency if near bladder
Malaise in elderly pts

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26
Q

Acute diverticulitis pe

A 
LLQ tenderness
Rigidity, guarding, and rebound tenderness
Vague tender mass
Distension or ileus
Psoas abscess- groin or thigh swelling
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27
Q

Acute diverticulitis dx

A

CT is best- pericolic inflammation, abscess, wall thickening, ureteric obstruction, fistulae
DONT do colonoscopy in acute phase

28
Q

Acute diverticulitis trmt

A 
Bowel rest
ATB- cover gram + and - bacteria
Do frequent abd exams
Drain abscesses only if over 2 cm
Endoluminal colonic wall stenting if pt has no peritoneal signs and obstruction is present
29
Q

Fistula?

A

Connection between 2 organs

30
Q

what fistula is mc

A

colovesical fistula- btwn bladder and colon

31
Q

Fistula

sx

A

Depend on type of fistula

May get frequent UTI with colovesical

32
Q

Fistula

dx

A

Radiology

33
Q

Fistula

trmt

A

surgery

34
Q

Hemorrhage?

A

Chronic injury to vasa recta

Stops on its own in most pts

35
Q

Hemorrhage

dx

A

Bleeding scan and angiography

36
Q

Hemorrhage

trmt

A

Resection or colectomy

37
Q

2 types of SBO

A

mechanical and ileus

38
Q

BS in mechanical SBO

A

hyperactive

39
Q

BS in ileus

A

no BS

40
Q

when is sbo MC

A

post op

41
Q

Small bowel obstruction cause

A

Usually mechanical- Most are post op adhesions
Intraluminal- FB, gallstones, meconium (ileus in babies)
Intramural- tumors, crohns with strictures
Extrinsic- adhesions, hernias, carcinomatosis, SMA syndrome

42
Q

Small bowel obstruction sx

A

Colicky abdominal pain, NV, obstipation

Abdominal distension

43
Q

Small bowel obstruction pe

A

Strangulation, pain out of proportion

44
Q

Small bowel obstruction dx

A

High WBC, acidosis
AA series
CT with contrast

45
Q

Small bowel obstruction dx order

A
  1. Determine if its mechanical or ileus
  2. Cause?
  3. Partial or complete?
  4. Simple vs. closed loop vs strangulation
46
Q

Small bowel obstruction trmt

A

NPO and NG tube
Fluid
Dont operate if partial SBO, early post op, crohns, carcinomatosis
Operate if complete SBO, closed loop or strangulation, no improvement with non op trmt, no previous abdominal surgery

47
Q

Small bowel obstruction prevention

A 
Good surgical technique
Careful handling tissue
Minimal exposure of FB
Minimally invasive technique ex: laparoscopy
Hyaluronidase based agents
48
Q

Ileus- ?

A

temporary motility disorder reversed after you fix what caused it

49
Q

Intestinal pseudo obstruction- AKA olgivies syndrome

A

not temporary; irreversible intestinal dysmotility associated with chronic disorders
SNS overriding PSNS

50
Q

ileus cause

A

MC post op, infection and inflammation, electrolyte abnormalities (K and Mg), drugs

51
Q

ileus sx

A

NV, no gas or BM

52
Q

ileus dx

A

XRAY- diffuse SI and colonic distension

53
Q

ileus trmt

A

Treat cause- electrolytes, infections…

Nutrition support TPN while recovering

54
Q

ileus prevention pre op

A

U opioid receptor antagonist Alvimopan
No prescription pain meds to 5 days
Epidural anesthesia

55
Q

ileus prevention intra op

A

Minimally invasive surgery such as laparoscope
Careful when handling bowel
Don’t overload fluids

56
Q

ileus prevention post op

A 
Feel early
Walk
Epidural analgesia
No excessive iv fluids
Correct lytes
Continue Alvimopan
NSAIDS for pain
57
Q

SI recovery after op

A

24 hrs

58
Q

stomach recovery after op

A

48 hrs

59
Q

colon recovery after op

A

3-5 days

60
Q

to check for an ileus you cant just listen for bs… gotta do this too

A

ask about gas and bm

61
Q

Colonic pseudo obstruction aka Ogilvie’s syndrome acute located here

A

colon only

62
Q

Colonic pseudo obstruction aka Ogilvie’s syndrome

chronic lication

A

colon and SI

63
Q

Colonic pseudo obstruction aka Ogilvie’s syndrome

sx

A

Abdominal distension

64
Q

Colonic pseudo obstruction aka Ogilvie’s syndrome

pe

A

Tympanitic, nontender

65
Q

Colonic pseudo obstruction aka Ogilvie’s syndrome

dx

A

XR- colon is over 12 cm in diameter

66
Q

Colonic pseudo obstruction aka Ogilvie’s syndrome

trmt

A

Colonoscopy with decompression tube placement
NPO, NG tube, IV fluids, correct lytes, dc all meds that inhibit bowel motility
IV neostigmine- stimulates gut to contract

clin med (35 decks)

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