GI module 3b

Question 1

What are the two forms of pyloric obstruction?

Answer 1

Infantile hypertrophic pyloric stenosis (IHPS) (congenital)

Adult/acquired pyloric obstruction (Acquired)

Question 2

signs and symptoms of IHPS (congenital PS)

Answer 2

Infant 2-3 weeks begins projectile vomiting (several feet) for no reason

Question 3

Pathophysiology of IHPS

Answer 3

hypertrophied pyloric sphincter

Question 4

etiology of IHPS

Answer 4

unknown - ? hormones

Question 5

TX for IHPS

Answer 5

Pyloromyotomy

Question 6

Cause of Acquired Pyloric Obstruction?

Answer 6

severe peptic ulcer or tumor in area

Question 7

s/s of acquired pyloric obstruction?

Answer 7

epigastric discomfort/fullness w/ eating that progresses to severe

Question 8

tx for acquired pyloric obstruction

Answer 8

address cause of obstruction

Question 9

What are the 5 different kinds of mechanical obstruction?

Answer 9

Adhesions
Herniation
Intussusception
Volvulus
Tumor growth

Question 10

Define obstructive adhesions

Answer 10

Fibrous scar tissue adheres to intestinal loops

Question 11

What is the MC type of mechanical SI obstruction?

Answer 11

Adhesions

Question 12

What is the 2nd MC type of Mechanical SI obstruction?

Answer 12

Herniation

Question 13

What is most commonly a bowel obstruction of infants and young children?

Answer 13

Intussusception-more common in ileocecal area

Question 14

What is the definition of a volvulus

Answer 14

intestine twists upon itself

Question 15

What is the MC cause of LI obstruction?

Answer 15

Tumor growth

Question 16

What is one functional obstruction (physiological obstruction)

Answer 16

Paralytic ileus

Question 17

Define paralytic ileus

Answer 17

Obstruction that results when peristalsis stops

Question 18

What are possible causes of an ileus?

Answer 18

Narcotics
HTN meds
ABD, spine, joint surgery
Injury/trauma
Infection/peritonitis
MI
Imbalance of lytes
D/o of muscle function
Mescenteric ischemia

Question 19

TX strategies for ileus?

Answer 19

NG tube decompress pressure in GI
Address underlying cause
Surgery if conservative tx unsuccessful

Question 20

What is the other name for Congenital Aganglionic Megacolon?

Answer 20

Hirschsprung’s Disease

Question 21

Etiology of Hirschsprung’s dz?

Answer 21

Birth defect -ganglionic cells of the LI fail to develop

Question 22

What is the functional result of Hirschsprung’s Dz?

Answer 22

Impaired motility of colon - poor coordination/ability to contract muscle
Impacted/trapped stool, infection, inflammation, constipation

Question 23

Name the 2 different kinds of Hirschsprungs dz

Answer 23

Short-segment-rectosigmoid colon

Long segement-regions proximal to rectosigmoid also involved

Question 24

Tx for Hirschsprung’s dz

Answer 24

Decompress colon - serial rectal irrigation-surgical removal of involved intestinal segment

Question 25

What are the 2 different forms of IBD?

Answer 25

Ulcerative colitis | Crohn Dz

Question 26

Peak onset of Crohn's

Answer 26

15-25 and then again up to age 40

Question 27

Pathophys of Crohns

Answer 27

Inflammation extends through all layers of intestinal wall Granulomatous inflammation occurs Skip lesions may occur can effect entire GI system

Question 28

Pharaceutical tx of crohns

Answer 28

``` Antiinflammatory drugs Salyscylate Corticosteroids Infliximabe Immune suppressors ABX ```

Question 29

Surgical tx.

Answer 29

Intestinal resection | colostomy/ileostomy

Question 30

What is different about the inflammation of UC as compared to crohns

Answer 30

UC inflammation only extends mucosa-not through all layers like Crohn's UC always involves rectum and proximally to contiguous sections of colon-Crohn's can effect ANYWHERE along the GI tract

Question 31

What are the 3 common regions of UC?

Answer 31

Ulcerative proctitis Proctosigmoiditis Pancolitis

Question 32

What percent of pt's with diverticulitis are asymptomatic?

Answer 32

85%

Question 33

Pathophys of diverticulosis

Answer 33

Colonic muscle wall weak where vessels penetrate Multiple diverticuli present Most common in sigmoid

Question 34

Tx of Diverticulosis

Answer 34

High fiber diet | Avoid high residue foods (anecdotal studies)

Question 35

What is the difference between diverticulosis and diverticulitis

Answer 35

Diverticulosis is just out pockets of the intestinal wall, Diverticulitis is inflammation of colonic diverticula!

Question 36

What is the most common etiology of colorectal cancer?

Answer 36

Adenomatous polyp

Question 37

Why is colorectal cancer so easy to detect early.

Answer 37

It is easy to assess with scope | Slow growth down the star toward deeper layer of mucosa

Question 38

RF for colorectal ca

Answer 38

AGE over 50 PMH of inflammatory dz Family hx lifestyle related risks