intestinal diorders Flashcards
what are the causes of appendicitis in adults vs children ?
adults : fecaliths
children : lymphoid hyperplasia
what is the presentation associated with appendicitis ?
begins mid epigastric - around the umbilicus
moves to the RLQ
classic location: mcburneys point
what does the term acute abdomen refer to ?
acute onset of abdominal pain
rebound tenderness
what is the consequence of. not making a diagnosis of acute abdomen ?
perforation of abdominal viscus - peritonitis
what is a diverticulum and where does it happen ?
pouch extending from the GI tract ( false diverticulum)
at the vasa recta of the colon - usually in the sigmoid colon
what is the main cause of diverticulosis ?
constipation in association with a low fibre diet
what are the complications of diverticular disease ?
lower GI bleeding
formation of an abscess
diverticulitis
what is the classic presentation of diverticulitis ?
left sided appendicitis
fever , increased WBC
occult blood in stool
what is the presentation of diverticulitis that has become an infected abscess ?
diverticulitis that doesn’t improve with antibiotics
what type of fistula is associated with diverticulitis ?
colovesicual fistula
present with pneumoaturia , dysuria
what are the complications of diverticulitis ?
abscess
bowel perforation
fistula
perforation
when are adhesions seen ?
ficrous scars seen after surgery
what are the complications associated with adhesions ?
infertility
bowel obstruction
chronic abdominal pain
what is intusseception ?
telescoping of the intestine
what is the presentation of intussusception, where does this usually happen ?
currant jelly
common in children
happens at the ileocecal junction
what is the lead point associated with intussusception ?
potential lead points:
meckel’s diverticulum
lymphoid hyperplasia (peyers pacthes enlarged in gastroenteritis)
adults: tumor
what is the association between lymphoid herplasia and intsussception ?
enlargement of peyers patches after a bound of viral gastroenteritis ( associated with adenovirus infection)
what is volvolus and where does it occur ?
twisting of the bowel around the mesentry
occurs at the sigmoid colon or cecum
what are the classic findings of sigmoid volvulus ?
dilated sigmoid
airless rectum
what si the association of volvulus in the elderly vs in children ?
elderly - mean age of 70
children - secondary to meckel
where is bowel obstruction more common and what is the presentation ?
common in the small intestine
abdominal pain , nausea and vomiting
inability to pass stool of flatus
what are the different causes of bowel obstruction in the small bowel vs in the large bowel ?
small bowel - ABC
adhesions
bulge ( hernia)
cancer
large bowel - tumor
adhesions
volvulus
what are the findings in X ray for bowel obstruction ?
dilated bowel loops
air fluid levels
what is hirschprungs disease what is the associated pathophysiology ?
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
what is the presentation of hirschprung ?
failure to pass meconium
billious vomiting
abdominal distention
no stool in rectal vault
what is the classic finding in barium imaging of hirschprung disease ?
transition zone
cone shaped
how is a diagnosis of hirschprung made ?
rectal suction biopsy
need to see the submucosa
no ganglion cells
what is the treatment of hirschprung ?
colon resection
what does the term ileus mean and what are the common causes ?
lack of bowel peristalsis
usually due to certain meds - usually narcotics
post operative ileus is most common
what is ogilvie syndrome, mc patient and mc cause?
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
what is iBS ?
fuctional bowel disorder
pain that improves with defecation
change in frequency of stool
what is necrotizing enterocolitis ?
neonatal disorder ( 1st month of life)
associated with intestinal necrosis and obstruction
usually in the terminal ileum or the colon
can lead to perforation
what is the major risk factor associated with necrotizing entercolitis ?
prematurity and low birth weight
on formula feed
what is the clinical classic case associated with necrotizing fascitis ?
premature baby in the NICU
abdominal distention
nausea and vomiting
what is the classic x ray finding associated with necrotizing fascitis ?
pneumoperitoneum
portal venous gas
pneumatosis intestinalis
what is the treatment for necrotizing fascitis ?
bowel rest antibiotics
often surgery
what is angiodysplasia and where is it commonly found ?
aberrant blood vessels in the GI tract
common in the cecum and right side of the colon
what is the cause of angiodysplasia and what is the most common finding ?
caused by : high wall stress
presents with lower GI bleeding
what is hereditary hemorrhagic telangiectasia
?
autosomal dominant vascular disease
tenelgectasia through the GI tract
what is the presentation of hereditary hemorrhagic telengectasia ?
nose bleeds
GI bleeding
iron deficiency
what are the rare complications associated with HHT ?
AVM malformation
what sign is seen on CT is shown in intussusception ?
target sign
what is the main lead point in intussusception ?
children - meckels diverticulum, small bowel wall hematoma
adults - intraluminal mass/tumor
what is seen on examination of a patient with intussusception
. ?
sausage shaped mass in the right abdomen
what are the diseases associated with the occurance of angiodysplasia ?
end stage renal disease
non willibrand disease
aortic stenosis
