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pance re-up > GI Precision & Pearls #2 > Flashcards

GI Precision & Pearls #2 Flashcards

1
Q

By definition, toxic megacolon is…

What are some symptoms of this condition?

A

Nonobstructive colonic dilation > 6 cm + signs of systemic toxicity

-Profound bloody diarrhea, vomiting, pain, diarrhea
-Distention
-Fever, AMS, tachycardia, hypotension, dehydration, peritonitis signs

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2
Q

You need three things to diagnose a patient with toxic megacolon. Name them.

A

-Abdominal radiographs
-3 of the following: fever, pulse > 120, leukocytosis, anemia
-1 of the following: dehydration, AMS, hypotension, lyte abnormalities

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3
Q

Treatment for toxic megacolon

A

-Supportive: decompression with NG tube, bowel rest, ABX (Metro + Ceftriaxone)
-Correct fluid/electrolyte problems
-Steroids if UC is the cause

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4
Q

Diverticulosis is outpouchings due to herniation of mucosa into the wall of the colon. What are some risk factors for this condition?

Symptoms?

A

Constipation, low fiber, obesity

-May be asymptomatic
-Painless hematochezia (MCC of lower GI bleed)

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5
Q

What is the MCC of a lower GI bleed?

A

Diverticulosis

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6
Q

Diverticulosis is MC an incidental finding on a colonoscopy. However, if the bleed is NOT seen on colonoscopy, what diagnostic can you do for this condition?

A

Radionuclide imaging (tech-99)

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7
Q

Treatment for diverticulosis

A

-Most spontaneously resolve
–Resuscitation (2 large bore IV lines/blood products if needed)
-high fiber diet, bran, Psyllium

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8
Q

On the other hand, diverticulitis is infection/inflammation of the diverticulum. What part of the colon does this MC occur in?

What are the symptoms of this condition?

A

Sigmoid colon

LLQ pain, fever, change in bowel habits, n/v

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9
Q

What imaging study is done for diverticulitis?

What oral ABX are used in treatment for diverticulitis?

A

CT scan
-Labs show leukocytosis

Oral ABX: Metro + Cipro/Levofloxacin for 7-10 days

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10
Q

With diverticulitis, when should you admit the patient?

A

If complicated (abscess, fistula, perforation) = CT guided percutaneous drainage

If uncomplicated with high risk (sepsis, high fever, old age, immunocompromised)

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11
Q

A small bowel obstruction, or blockage of the small intestine, MC occurs due to what? Other etiologies, though, include…

A

Post-surgical adhesions (MC)

Others: Malignancy, hernias, volvulus, intussusception

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12
Q

Symptoms of a small bowel obstruction include CAVO, as well as…

A

Crampy abdominal pain
Abdominal distention
Vomiting
Obstipation (no flatus)

-High pitched tinkles on auscultation
-Visible peristalsis (early) –> hypoactive bowel sounds (late)

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13
Q

Diagnostics done for a small bowel obstruction. What is shown on them?

Upright abdominal XR:

CT scan:

A

XR: multiple air fluid levels in a step ladder appearance

CT: transition zone = dilated loops with contrast to area without contrast

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14
Q

Management for nonstrangulated and strangulated small bowel obstruction

A

Nonstrangulated: NPO, IVF, bowel decompression

Strangulated: Surgery!

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15
Q

A paralytic ileus is ________. A few etiologies of this are

A

-Decreased peristalsis without mechanical obstruction

-Postoperative state, Opioids, DM, hypothyroidism, hypokalemia, hypercalcemia

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16
Q

What are the symptoms of a paralytic ileus (how does it differ from a SBO)?

A

Decreased or absent bowel sounds, symptoms like SBO

-However, this is painLESS

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17
Q

What do abdominal XR’s show for a paralytic ileus?

A

Dilated loops of bowel without a transition zone (there is no mechanical obstruction in this case)

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18
Q

Treatment for a paralytic ileus?

A

Supportive: NPO, electrolyte and fluid replacement

NG suction if persistent nausea/vomiting

Encourage walking to get the bowels moving!

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19
Q

What is intussusception? Where does it MC occur?

A

Telescoping of an intestinal segment into adjoining segment –> obstruction

Ileocolic junction

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20
Q

Intussusception is the MCC of bowel obstruction in kids < 4 years old. What are risk factors associated with this condition? What is the MCC of this?

A

Children, males, post infections

Idiopathic (MCC), Meckel Diverticulum, Foreign body, Tumors

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21
Q

What symptoms are associated with intussusception?

What diagnostics should you do and what is seen on them?

A

Triad: Vomiting + Abdominal pain + Passage of blood per rectum (currant jelly stools)

-Sausage shaped mass in RUQ
-Emptiness in RLQ (Dance’s Sign)
-Pull knees to chest due to pain

US (initial) = target/donut sign
Air or contrast enema: diagnostic and therapeutic

22
Q

Management for intussusception

A

-Fluid and electrolyte replacement then
-Pneumatic or hydrostatic NG decompression
-Admit for observation

23
Q

A volvulus is twisting of part of the bowel at the mesenteric attachment site. This MC involves what two parts of the colon?

A

Sigmoid colon or cecum

24
Q

Symptoms of a volvulus in an adult.

Symptoms in a neonate

A

-Tympanic abdomen, tenderness, crampy pain, distention, n/v, colicky
-Fever, tachycardia, guarding, rigidity

Neonate: non bilious vomiting within first weeks of life

25
Q

What diagnostics can you do for a volvulus and what is seen?

A

Abdominal CT: bird beak appearance at site of volvulus

Abdominal XR: bent inner tube = U shaped appearance. Closed loop with loss of haustral markings

Contrast enema: bird beak appearance

26
Q

Treatment for volvulus

A

-Endoscopic decompression (proctosigmoidoscopy)

Then, elective surgery due to recurrence

27
Q

What is acute mesenteric ischemia?

What is the MCC and what are other causes?

Symptoms of mesenteric ischemia?

A

Abrupt onset of small intestine hypoperfusion

Emboli from A-fib (MC)

Others: Thrombotic (atherosclerosis) = Superior mesenteric artery MC, shock, vasopressors, cocaine

Symptoms: Severe abdominal pain out of proportion (poorly localized), n/v, diarrhea

28
Q

Initial diagnostic for acute mesenteric ischemia

Definitive diagnostic

Labs show leukocytosis and lactic acidosis (elevated lactate is associated with ischemia)

A

CT angiography initially

Arteriography definitive

29
Q

Management for acute mesenteric ischemia

A

-Surgical revascularization (embolectomy, angioplasty with stent, etc.)
-Possible resection
-Anticoagulation if associated with A-fib

30
Q

Explain the pathology behind chronic mesenteric ischemia

MC it is due to atherosclerotic disease

A

Decreased supply of blood during times of increased demand (eating)

31
Q

Symptoms of chronic mesenteric ischemia

A

-Chronic dull abdominal pain worse after meals
-Aversion to eating (anorexia) –> weight loss

32
Q

Again, the definitive diagnostic for chronic mesenteric ischemia is….

Treatment?

A

Angiography

Revascularization is the treatment

33
Q

Inflammatory bowel disease includes UC and Crohn’s Disease. What are some risk factors for these conditions?

A

Ashkenazi Jews, 15-35 years old, genetics, infections, western diet, Smoking, Meds (NSAIDs, OCPs, hormone replacement)

34
Q

When thinking about IBD as a whole, what are some extra-intestinal symptoms you should watch for?

A

Anterior uveitis/iritis

Osteoporosis, MSK pain

Erythema nodosum

B12 deficiency

35
Q

Explain the following for Ulcerative Colitis

-Where it takes place
-Is rectum always involved?
-How deep?
-Symptoms (location)
-Smoking risk
-What is seen on colonoscopy
-What is seen on Barium study
-Labs
-Treatment (is surgery curative as well)

A

-Limited to colon (begins in rectum with contiguous spread, proximally to colon)
-Rectum ALWAYS involved
-Mucosa and submucosa only
-LLQ pain, colicky, tenesmus, bloody diarrhea
-Smoking decreases risk
-Colonoscopy: uniform inflammation and pseudopolyps
-Barium: Stovepipe sign = decreased haustral markings
-Labs: P-ANCA
-Treatment: MILD: Topical 5-aminosalicylic acid (ASA) +/- Topical corticosteroids; SEVERE: Oral glucocorticoids + high dose 5-ASA + topical steroids
-Surgery is curative in this condition

36
Q

Explain the following for Crohn’s Disease

-Where it takes place
-Is rectum always involved?
-How deep?
-Symptoms (location)
-Smoking risk
-What is seen on colonoscopy
-What is seen on Barium study
-Labs
-Treatment (is surgery curative as well)

A

-Any segment of the GI tract (from mouth to anus)
-MC in terminal ileum
-Transmural (includes all layers)
-RLQ pain, crampy pain, diarrhea (no blood). Perianal disease: fistulas, granulomas, B12/iron deficiency
-Colonoscopy: skip lesions and cobblestone appearance
-Barium: String sign
-Labs: ASCA
-Treatment: 5-ASA (Mesalamine) or oral glucocorticoids; SEVERE: Azathioprine, Methotrexate, anti-TNF (-mab) drugs
-Surgery NOT curative in this condition

37
Q

Name some symptoms of IBS, as well as some Alarm Symptoms

Although this is a diagnosis of exclusion, what is the ROME IV Criteria and what are the components of it?

A

Abdominal pain with altered bowel habits, diarrhea/constipation alternating, pain relieved with defecation

Alarm: GI bleeding, anorexia, weight loss, dehydration

ROME IV: Abdominal pain 1 day/week for the last 3 months, plus 2 of the following 3
–Related to defecation
–Change in stool frequency
–Change in stool appearance

38
Q

What is the treatment for IBS (initially, for constipation, and for diarrhea)

A

Initially: Lifestyle and diet changes (low fat, high fiber, unprocessed foods). Sleep hygiene. No smoking.

Constipation: Fiber, Psyllium, Poly-Glycol

Diarrhea: Loperamide, Dicyclomine

39
Q

What is the pathophysiology of celiac disease (Sprue)?

What are the symptoms that occur as a result of this patho?

Remember the skin finding as well…

A

Autoimmune-mediated inflammation of the small bowel due to reaction with alpha-gliadin in gluten foods –> loss of villi –> malabsorption

Diarrhea, bloating, pain, growth delays

Dermatitis herpetiformis: pruritic, papular rash on extensor surfaces, neck, trunk, scalp

40
Q

Screening diagnostic for celiac

Definitive diagnostic for celiac

A

-Transglutaminase IgA antibodies (endomysial IgA antibodies)

Small bowel biopsy = atrophy of the villi

41
Q

Treatment for celiac disease

A

-Gluten free diet (wheat, rye, barley)
-Vitamin Supplementation

42
Q

Explain the types of colon polyps

-Pseudopolyps:
-Hyperplastic:
-Adenomatous:

A

Pseudopolyps due to IBD are not cancerous

Hyperplastic: low risk of malignancy (MC non neoplastic type)

Adenomatous: MC neoplastic type.
–Tubular Adenoma: MC type. Least risk
–Villous Adenoma: highest risk

43
Q

Name three genetic disorders that predispose you to having colon polyps

A

Lynch Syndrome = MC
FAP: 100% risk before age 40
Peutz-Jegher’s: benign transform to malignant

44
Q

Most colorectal cancers arise from adenomatous polyps. What are other risk factors associated with colon cancer?

What are some PROTECTIVE factors?

A

RF: Age > 50, UC, diet (low fiber, high red meat), obesity, FH, smoking, EtOH

Protective: Physical activity, Aspirin, NSAIDs

45
Q

Explain the three genetic disorders to colon polyps

-Lynch Syndrome
-FAP
-Peutz-Jeghers

A

-Lynch: Nonpolyposis CRC. Due to loss of function of DNA mismatch repair genes

FAP: mutation of APC gene. Adenomas in childhood. Cancer by 45 years old 100% chance. Colectomy prophylatically is recommended.

Peutz-Jeghers: hamartomatous polyps, mucocutaneous hyperpigmentation, risk of breast and pancreatic cancer

46
Q

Symptoms of colorectal cancer

A

-Fatigue, weakness (iron deficiency anemia)
-Change in bowel habits, bleeding, abdominal pain
-large bowel obstruction (CRC MCC)
-Right side (proximal): Chronic bleeding
-Left side (distal): bowel obstruction, change in stool diameter

47
Q

What is the diagnostic of choice for CRC?

What is the best tumor marker for colon cancer?

A

Colonoscopy with biopsy

CEA

48
Q

What is seen on barium enema if the patient has colon cancer?

A

Apple core lesion

49
Q

Treatment for colon cancer

A

Surgical resection then chemotherapy if localized

Palliative chemotherapy if metastatic

50
Q

Describe the screening recommendations for colon cancer

For an average risk, family history risk, Lynch Syndrome, FAP

A

-Screened until age 75

-Average Risk
–Fecal occult test (annually at 50)
–Colonoscopy Q10 years of Flex Sigmoidoscopy Q5

-1st degree relative with colon cancer > 60 years old
–Fecal occult test (annually at 40)
–Colonoscopy Q10 years

-1st degree relative with colon cancer < 60 years old
–Fecal occult test (annually at 40 or 10 years before diagnosis)
–Colonoscopy: Every 5 years

-Lynch Syndrome
-Start at 20-25 years old via colonoscopy Q1-2 years

-FAP
-Start at 10-12 years with flexible sigmoidoscopy yearly!

pance re-up (76 decks)

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