GI part III Flashcards
A volvus is….
Rotation of bowel looks around a fixed point. May be the cause of a SBO. Typically due to congenital abnormalities or adhesions.
TX of SBO
- NG tube decompression
- If complete or strangulated: Surgery
Most common site of Large Bowel Obstruction?
Sigmoid colon
Dx of LBO
Abd X ray
Barium Enema
What is Toxic Megacolon?
A rare life threatening form of Ulcerative Colitis
SS of Toxic Megacolon?
Toxic colitis, fever, tachycardia, abd distention, signs of peritonitis
Abd X ray shows what with Toxic Megacolon?
Dilated colon . 6 cm
Patient presents with severe anal pain and bleeding with defecation, think…?
Anal fissure
First line tx for anal fissure?
Fluid and Fiber
(stool softeners, bulking agents, and sitz baths)
may require Internal anal Sphincterotomy if conservative measures fail
A patient wiht severe continuous throbbing anal pain that is worse with ambulation and straining and on exam you see a very tender palpable mass in the external perianal area, think of?
Anorectal Abscess/fistula
Tx of Anorectal Abcess/Fistula
Surgical Drainage, may develop a fistula-in-ano
What 2 things that an anal fissure off midline might suggest?
Crohn’s, Syphillis, HIV, Neoplasm
Abcess in Sacrococcygeal cleft?
Pilonidal disease
Zollinger-Ellison Syndrome is also known as a…?
Gastrinoma
Diagnosis of Celiac Disease?
Endoscopic Bx
Abdominal exam with pain out of proportion to exam, think?
Intestinal Ischemia
Painless bright red blood per Rectum, you shoud think?
Hemorrhoids
What is more painful? Internal or External Hemorrhoids?
External (Below dentate line) painful
Dx of Hemorrhoids
Anoscopy
male 15-40 presenting with small midline pits or abscesses near the midline of the coccyx or sacrum with a draining abcess think of?
Pilonidal disease
Polyps most common in the….?
distal colon and rectum, dx with colonoscopy
they have neoplastic potential
2 types of Hiatal hernias?
Paraesophageal and Sliding
Sliding Hiatal Hernias are due to
decreased resting pressure in the LES
Paraesophageal hiatal hernias are often asymptomatic but require?
Nissen Fundoplication
Risk factors for a Ventral Hernia?
- Prior Abd surgery
- Poor surg technique
- wond infxh
- age
- obesity
2 types of Inguinal Hernias?
1) Indirect
2) Direct
Indirect hernias are typically?
2 to congenital hernias and typically present in the first year of life.
What is more likely to pass into the scrotum, Direct or Indirect hernias?
- Indirect Hernia
Indirect Inguinal Hernias?
Occur later in life, when increased intra-abdominal pressure and dilated internal inguinal ring allow abdominal contents to enter the cavity
Direct Hernias?
2 to a result of weakness of the transversalis fascia in Hesselbach’s Triangle
What is more likely to become incarcerated or strangulated, Direct or Indirect?
Indirect
Hernia that appears as a symmetric, circular swelling at the external ring but dissapears when pt supine is…..
Direct Hernia
Indirect hernias
Descends into the scrotum, elliptical swelling in inguinal ring that does not reduce easily
Most common vessel blocked in Intestinal Ischemia?
Superior Mesenteric Artery
2 viral organisms of Infx diarrhea?
Rotavirus and Norwalk
Nausea, vomitting, abdominal pain, then diarrhea s/p 1-6 hours after eating Mayonnaise containing foods?
Staph Aureus–self limiting, supportive care
Wattery diarrhea with epigastric pain 24 hours after eating canned foods—resolves in 24 hours?
Clostridium perfringens–self limiting
Severe diarrhea and fluid loss after drinking bad water or seafood—-RICE water diarrhea?
Vibrio Cholerae: Abx–Doxycycline or TCN agents of choice
Abd pain, fever, small volume bloody diarrhea associated with Poultry, Seafood, daycare centers?
Sigella species: Trimeth-Sulfa or Floroquinolones—lasts about 7 days
High fever, diarrheak, abd pain s/p eating poultry, eggs, playing with reptiles?
Salmonella species: Third gen cephalo or fluoroquinolones
Severe diarrhea, abd pain, N and V s/p eating undercooked beef (Burger etc)
E coli (0157:H7)
Name a protozoal infectious diarrhea–bad water?
Entamoeba Histolytica: Treat with Metronidazole
Prozoal water with animal vector like beaver–diarrhea with mucus but no blood?
Giardia Lamblia: Treat with Metronidazole
Niacin or B3 deficiency?
Pellagra (flushing, hyperglycemia, liver damage)
Beriberi is?
Thiamine (B1) deficiency: Lethargy, Ataxia
PKA
Phenylketonuria: An inborn error of metabolism-autosomal recessive
If untreated, can cause severe mental retardation, hyperactivity, seizures, light complexion and eczema
Positive Fecal Leukocyte indicates
Colonic inflammation: inflammatory diarrhea. Shigela, salmonella, D Diff, etc……
