intestinal diorders

Question 1

what are the causes of appendicitis in adults vs children ?

Answer 1

adults : fecaliths
children : lymphoid hyperplasia

Question 2

what is the presentation associated with appendicitis ?

Answer 2

begins mid epigastric - around the umbilicus
moves to the RLQ
classic location: mcburneys point

Question 3

what does the term acute abdomen refer to ?

Answer 3

acute onset of abdominal pain
rebound tenderness

Question 4

what is the consequence of. not making a diagnosis of acute abdomen ?

Answer 4

perforation of abdominal viscus - peritonitis

Question 5

what is a diverticulum and where does it happen ?

Answer 5

pouch extending from the GI tract ( false diverticulum)
at the vasa recta of the colon - usually in the sigmoid colon

Question 6

what is the main cause of diverticulosis ?

Answer 6

constipation in association with a low fibre diet

Question 7

what are the complications of diverticular disease ?

Answer 7

lower GI bleeding
formation of an abscess
diverticulitis

Question 8

what is the classic presentation of diverticulitis ?

Answer 8

left sided appendicitis
fever , increased WBC
occult blood in stool

Question 9

what is the presentation of diverticulitis that has become an infected abscess ?

Answer 9

diverticulitis that doesn’t improve with antibiotics

Question 10

what type of fistula is associated with diverticulitis ?

Answer 10

colovesicual fistula
present with pneumoaturia , dysuria

Question 11

what are the complications of diverticulitis ?

Answer 11

abscess
bowel perforation
fistula
perforation

Question 12

when are adhesions seen ?

Answer 12

ficrous scars seen after surgery

Question 13

what are the complications associated with adhesions ?

Answer 13

infertility
bowel obstruction
chronic abdominal pain

Question 14

what is intusseception ?

Answer 14

telescoping of the intestine

Question 15

what is the presentation of intussusception, where does this usually happen ?

Answer 15

currant jelly
common in children
happens at the ileocecal junction

Question 16

what is the lead point associated with intussusception ?

Answer 16

potential lead points:
meckel’s diverticulum
lymphoid hyperplasia (peyers pacthes enlarged in gastroenteritis)
adults: tumor

Question 17

what is the association between lymphoid herplasia and intsussception ?

Answer 17

enlargement of peyers patches after a bound of viral gastroenteritis ( associated with adenovirus infection)

Question 18

what is volvolus and where does it occur ?

Answer 18

twisting of the bowel around the mesentry
occurs at the sigmoid colon or cecum

Question 19

what are the classic findings of sigmoid volvulus ?

Answer 19

dilated sigmoid
airless rectum

Question 20

what si the association of volvulus in the elderly vs in children ?

Answer 20

elderly - mean age of 70
children - secondary to meckel

Question 21

where is bowel obstruction more common and what is the presentation ?

Answer 21

common in the small intestine
abdominal pain , nausea and vomiting
inability to pass stool of flatus

Question 22

what are the different causes of bowel obstruction in the small bowel vs in the large bowel ?

Answer 22

small bowel - ABC
adhesions
bulge ( hernia)
cancer

large bowel - tumor
adhesions
volvulus

Question 23

what are the findings in X ray for bowel obstruction ?

Answer 23

dilated bowel loops
air fluid levels

Question 24

what is hirschprungs disease what is the associated pathophysiology ?

Answer 24

congenital disease
associated with absent ganglion cells, derived from the neural crest , failure to migrate
associated with down syndrome
abnormal peristalsis of colon
RET mutation in the rectum

results in obstruction due to a lack of peristalsis

Question 25

what is the presentation of hirschprung ?

Answer 25

failure to pass meconium billious vomiting abdominal distention no stool in rectal vault

Question 26

what is the classic finding in barium imaging of hirschprung disease ?

Answer 26

transition zone cone shaped

Question 27

how is a diagnosis of hirschprung made ?

Answer 27

rectal suction biopsy need to see the submucosa no ganglion cells

Question 28

what is the treatment of hirschprung ?

Answer 28

colon resection

Question 29

what does the term ileus mean and what are the common causes ?

Answer 29

lack of bowel peristalsis usually due to certain meds - usually narcotics post operative ileus is most common

Question 30

what is ogilvie syndrome, mc patient and mc cause?

Answer 30

a type of pseudo obstruction dilated colon in the absence of a lesion usually in hospitalized patients or patients that are in nursing homes most common cause is usually narcotics

Question 31

what is iBS ?

Answer 31

fuctional bowel disorder pain that improves with defecation change in frequency of stool

Question 32

what is necrotizing enterocolitis ?

Answer 32

neonatal disorder ( 1st month of life) associated with intestinal necrosis and obstruction usually in the terminal ileum or the colon can lead to perforation

Question 33

what is the major risk factor associated with necrotizing entercolitis ?

Answer 33

prematurity and low birth weight on formula feed

Question 34

what is the clinical classic case associated with necrotizing fascitis ?

Answer 34

premature baby in the NICU abdominal distention nausea and vomiting

Question 35

what is the classic x ray finding associated with necrotizing fascitis ?

Answer 35

pneumoperitoneum portal venous gas pneumatosis intestinalis

Question 36

what is the treatment for necrotizing fascitis ?

Answer 36

bowel rest antibiotics often surgery

Question 37

what is angiodysplasia and where is it commonly found ?

Answer 37

aberrant blood vessels in the GI tract common in the cecum and right side of the colon

Question 38

what is the cause of angiodysplasia and what is the most common finding ?

Answer 38

caused by : high wall stress presents with lower GI bleeding

Question 39

what is hereditary hemorrhagic telangiectasia ?

Answer 39

autosomal dominant vascular disease tenelgectasia through the GI tract

Question 40

what is the presentation of hereditary hemorrhagic telengectasia ?

Answer 40

nose bleeds GI bleeding iron deficiency

Question 41

what are the rare complications associated with HHT ?

Answer 41

AVM malformation

Question 42

what sign is seen on CT is shown in intussusception ?

Answer 42

target sign

Question 43

what is the main lead point in intussusception ?

Answer 43

children - meckels diverticulum, small bowel wall hematoma adults - intraluminal mass/tumor

Question 44

what is seen on examination of a patient with intussusception . ?

Answer 44

sausage shaped mass in the right abdomen

Question 45

what are the diseases associated with the occurance of angiodysplasia ?

Answer 45

end stage renal disease non willibrand disease aortic stenosis