Intestinal Pathology Flashcards
What is the best diagnostic test for diagnosing acute diverticulitis
Abdominal CT scan
____ is contraindicated in the setting of acute diverticulitis as it may cause perforation
Sigmoidoscopy
Colonoscopy
This study can detect strictures or inflammation in ulcerative colitis or Crohn disease
Barium contrast enema
Pt with a h/o chronic constipation & low-fiber diet presents with LLQ abdominal pain, fever, nausea/vomiting, and leukocytosis.
Pt endorses some urinary urgency & dysuria.
Abdominal CT scan revealed increased inflammation in pericolic fat, bowel wall thickening, soft tissue masses (phlegmons) and pericolic fluid.
Diagnosis?
Acute diverticulitis
(inflammation s/t microperforation of diverticulum)
- urinary urgency & dysuria due to bladder irritation from an inflamed sigmoid colon.
- CT Abd is the best diagnostic test for diverticulitis
Management of Acute Diverticulitis (2)
Bowel Rest (NGT, NPO, IVFs) ABxs (Flagyl or Cipro)
Intra-abdominal ____ usually present with subacute fever, focal abdominal tenderness, and weight loss.
abscesses
Severe, uncontrolled inflammation in Crohn disease can lead to a ___ of the small bowel resulting in SBO.
Presents with BILIOUS emesis, severe abdominal pain, and obstipation.
fibrotic stricture
__ is commonly used to treat Crohn disease.
Tumor necrosis factor
adalimumab/Infliximab
Occurs when small bowel motility is disrupted, leading to intestinal dilation, obstipation, and bilious emesis. Develops after an insult that “stuns” the bowel like
recent intra-abdominal surgery or high-dose opioids.
Adynamic ileus
*presents similar to SBO
Adynamic ileus
develops after an insult that “stuns” the bowel like
recent ____ or high-dose ____.
intra-abdominal surgery
opioids
Perianal ____ can occur with Crohn disease. Present as subacute fever & a swollen mass w/ tenderness, erythema and induration of the overlying skin.
abscesses
Other perianal manifestations of Crohn disease include ___, which present with malodorous, purulent fecal drainage as well as pain and itchiness.
Fistulae
The external opening of a fistula should be visible on inspection
Colonic pseudo-obstruction (obstruction without a mechanical cause) aka Ogilvie syndrome is initially managed with bowel rest, ___ & ____
Electrolyte correction
Rectal Tube
Presents with pneumaturia, fecaluria, or findings consistent with urinary tract infection.
MCC of ___ is Diverticulitis.
Colovesical fistula
*CT Abd with oral or rectal contrast confirms diagnosis by showing contrast in the bladder with thickened colonic and vesicular walls.
MCC of Colovesical fistula is ____
Diverticulitis
Diagnosis of toxic megacolon requires ___ of colonic dilation >6 cm, along with manifestations of systemic toxicity (fever, leukocytosis, hemodynamic instability).
radiographic evidence (CT Abd)
Rapid compression of the duodenum against the vertebral column during blunt abdominal trauma may result in a ___.
duodenal hematoma
*Hematoma expansion can progressively obstruct the duodenal lumen, causing a delayed (24-48 hr) presentation of worsening emesis.