Inflammatory Bowel diseases

Question 1

Inflammatory bowel disease includes

Answer 1

ulcerative colitis and crohn’s

Question 2

differences of ulcerative colitis and crohn’s onset

Answer 2

C-gradual, UC- sudden or gradual

Question 3

differences of ulcerative colitis and crohn’s distribution

Answer 3

C-mouth to anus, skip areas, UC- distal to proximal, no skip

Question 4

differences of ulcerative colitis and crohn’s depth of lesion

Answer 4

C- trasmural, UC- mucosal

Question 5

differences of ulcerative colitis and crohn’s symptoms

Answer 5

C- diarrhea/pain, UC- bloody, pus, diarrhea, tenesmus

Question 6

differences of ulcerative colitis and crohn’s complications

Answer 6

C-fistulas, toxic megacolon, colon CA, UC: toxic megacolon and colon cancer

Question 7

Ulcerative cholitis

Answer 7

chronic recurrent disease, starts at rectum and moves proximally, contained within colon, toxic megacolon and malignancy are more likely in UC than C, smoking is protective

Question 8

Symptoms of UC

Answer 8

inflammatory diarrhea, tenesmus, pain in LLQ (rare), weight loss, malaise, fever

Question 9

Diagnosis of UC

Answer 9

CBC: anemia, ESR: increased, Albumin: decreased, Xray will show colonic dilatation, diagnostic is colonoscopy (avoid in severe) or sigmoidoscopy

Question 10

Treatment of UC

Answer 10

topical or oral aminosalicylates, corticosteroids, immunomodulators, surgery can be curative

Question 11

Crohn’s disease

Answer 11

cause is unknown, genetic predispostion, involves: s/l colon, mouth, esophagus, stomach, but mostly terminal ileum and r colon, not usually rectum, has skip areas

Question 12

Symptoms of Crohn’s

Answer 12

abdominal cramps, chronic diarrhea,

Question 13

Diagnosis of crohn’s

Answer 13

anemia, increased ESR, electrolyte imbalances colonoscopy, biopsy, granuloma common

Question 14

Treatment of Crohn’s

Answer 14

acute: oral corticosteroids, Maintenance: mesalamine, MTX, smoking cessation, B12, folate, Vit D, surgery is not curative

Question 15

Toxic megacolon

Answer 15

Emergency, extreme dilatation and immobility of colon, Hirschsprung’s disease, ulcerative colitis, Crohn’s. and infectious causes

Question 16

Symptoms of toxic megacolon

Answer 16

fever, prostration, severe cramps, abd distention

Question 17

Diagnosis of Toxic megacolon

Answer 17

rigid abd, rebound tenderness, xray shows colon dilatation

Question 18

Treatment of Toxic megacolon

Answer 18

Decompression of the colon, fluid and electrolyte balances

Question 19

Ischemic bowel disease

Answer 19

Acute or chronic, >50 yo, intestinal infarction is more common in the small bowel than large, shock is common

Question 20

Acute mesenteric ischemia

Answer 20

emergency, high mortality, arterial embolus/thrombus, venous thrombosis, sudden onset of severe abd pain

Question 21

Chronic mesenteric ischemia

Answer 21

blood supply is present but insufficient, abd angina and pain 10-30 min after eating, relieved by squatting or lying down

Question 22

Diagnosis of ischemic bowel

Answer 22

Ct to rule out other abd causes, diagnostic is colonoscopy

Question 23

Treatment of ischemic bowel disease

Answer 23

surgery to revascularize intestine, hydration

Question 24

Intussusception

Answer 24

invagination of proximal segment of bowel into portion distal to it, most common in children

Question 25

Symptoms of intussusception

Answer 25

children: colick, stoll will contain blood and mucus (jelly stool), abd pain, sausage like mass adults: crampy, no blood, abd pain, mass is rare

Question 26

Diagnosing intussusception

Answer 26

children:barium or air filled most diagnostic, adult: barium enema should not be used, Xray is not specific, CT best, usually found in surgery

Question 27

Treatment of intussusception

Answer 27

hospitalized, air or barium enema may be curative, surgery or resection

Question 28

Common small bowel obstruction

Answer 28

adhesions, hernias, neoplasm, inflammatory bowel disease, volvulus

Question 29

Common large bowel obstruction

Answer 29

neoplasm, strictures, hernias, volvulus, intussusception, fecal impaction

Question 30

Symptoms of small bowel obstruction

Answer 30

abd pain, distention, vomiting of partially digested food, opstipation, high pitched bowel sounds, later bowel is silent

Question 31

Symptoms of large bowel obstruction

Answer 31

distention and pain, may be febrile, tachy, shock

Question 32

Diagnosing bowel obstruction

Answer 32

CMP: decreased electrolytes, upright CT shows air fluid levels

Question 33

Treatment of bowel obstruction

Answer 33

NPO, NG, IV fluids, monitoring, surgery likely with large intestine

Question 34

Volvulus

Answer 34

emergency, twisting of bowel on self, sigmoid or cecal area, ischemia can lead to gnagrene, peritonitis and sepsis

Question 35

Symptoms of bowel volvulus

Answer 35

Cramping abd pain and distention, tachy, nausea, vomiting, obstipation, fever, severe pain

Question 36

Diagnosing Volvulus

Answer 36

xray shows colonic distension

Question 37

Treatment of volvulus

Answer 37

immediate decompression to avoid ischemia, endoscopic depression with surgeon stand by

Question 38

Diverticular disease

Answer 38

Diverticulosis are pocket formations, diferticulitis is infection, >60% >60 have, 20% are asymptomatic, 20% have acute

Question 39

Symptoms of diverticular disease

Answer 39

sudden onset in LLQ, fever, nausea, diarrhea, blood

Question 40

Diagnosing diverticular disease

Answer 40

occult blood, elevated WBC, X ray to rule out free air, CT if pt does not respond to therapy, barium enema avoided

Question 41

Treatment diverticular disease

Answer 41

antibiotic treatment (Cipro, flagyl), pt education on diet, and meds

Question 42

Treatment of severe diverticulitis

Answer 42

hospitalization, IV antibiotics, NPO, NG tube, surgical management

Question 43

Appendicitis

Answer 43

obstruction of appendix leads to inflammation and infection, commonest cause of fecalith and ER surgery, 10-30 yo, 10% of pop, 20% of pt develop peritonitis and perforation

Question 44

Symptoms of appendicitis

Answer 44

progressive, intermittent periumbical pain, than RLQ localization, nausea and anorexia, vomiting/diarrhea, low grade temp

Question 45

Diagnosis of appendicitis

Answer 45

increased WBC, blood and leukocytes in UA, abdominal CT w/ contrast