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.
Exploratory laparotomy is indicated when patients with Blunt Abd Trauma have:
Peritonitis (rigidity, rebound tenderness)
or
HD instability (SBP <90 mm Hg) with evidence of ____.
Intra-abdominal bleeding (intraperitoneal free fluid).
Often diagnosed in asymptomatic pts with high ALP and gamma-glutamyl transpeptidase (GGT) levels (cholestatic pattern).
Primary sclerosing cholangitis
MRCP findings of multifocal intrahepatic and extrahepatic biliary strictures with segmental dilations are diagnostic of ____.
Primary sclerosing cholangitis
A ___ is recommended at the time of diagnosis of Primary sclerosing cholangitis because many patients also have IBD.
colonoscopy
Common in older individuals and presents with dull, LLQ pain; nausea and vomiting; alteration in bowel habits; and (sometimes) irritative bladder symptoms (eg, dysuria, frequency) or sterile pyuria.
Acute diverticulitis
A colonoscopy reveals mild erythema and small, shallow ulcers in the rectum and sigmoid colon.
Diagnosis?
Ulcerative Colitis
Initial management for mild Ulcerative Colitis is with ___, for induction/maintenance therapy.
5-aminosalicylic acid (5-ASA)
Mesalamine/Sulfasalazine/Balsalazide
___ enemas or suppositories are used in patients with UC confined to the rectosigmoid
whereas
____medications are needed for more extensive disease.
_____ are used for acute disease flares or severe chronic disease.
Mesalamine
oral 5-ASA (Mesalamine/Sulfasalazine/Balsalazide)
Corticosteroids → can be given topically (enema) or systemically (prednisone)
Colonic Ischemia most commonly involves watershed areas like:
- ____ between the SMA and IMA.
- ____ between the sigmoid artery and superior rectal artery.
splenic flexure
rectosigmoid junction
___ is characterized by acute abdominal pain and lower gastrointestinal bleeding.
Typically follows an episode of hypotension and most commonly affects arterial watershed areas.
Ischemic colitis
- CT scan may show a thickened bowel wall
- Colonoscopy can confirm the diagnosis
___ can confirm the diagnosis of Ischemic colitis
Colonoscopy
Patients with IBD-induced TM should receive intravenous ___
corticosteroids
___ typically affects patients with recent travel from endemic regions (Asia, Africa, South America).
It may cause pulmonary (cough, eosinophilic pneumonitis) or intestinal (abdominal pain, nausea/vomiting, malnutrition) manifestations.
Complications include obstruction of the small bowel or hepatobiliary tree (cholangitis, pancreatitis).
Treatment includes ___ (2).
Ascariasis
albendazole/mebendazole
Ascariasis complications include (2)
SBO hepatobiliary obstruction (cholangitis, pancreatitis).
[Procedure] can be used to treat reducible prolapsed internal hemorrhoids that fail to respond to conservative treatment (hydrocortisone cream).
Rubber band ligation
Hemorrhoids usually appear as blue or purple bulges rather than an erythematous mass with concentric rings (rectal prolapse).
Pt post bowel surgery presents with watery diarrhea abdominal pain, and bloating. Bowel sounds are normal and pt has flatus.
Dx and treatment (2)?
Small intestinal bacterial overgrowth (SIBO)
Neomycin + Rifaximin
Thrombosed external hemorrhoids usually appear as purple or blue anal bulges below the dentate line and may cause severe pain. Although conservative management (fiber, stool softeners, topical anti-inflammatories and antispasmodics) is usually indicated, patients with ___ should undergo hemorrhoidectomy under local anesthesia.
severe pain
Infrared coagulation, rubber band ligation, and sclerotherapy are all used to treat symptomatic ___ hemorrhoids that fail conservative management
nonthrombosed internal
Which diagnostic imaging is now typically performed when appendicitis is suspected on clinical presentation?
CT Abd/Pelvis
w/contrast
____ is recommended for treatment of complicated diverticulitis with abscess formation with a fluid collection ≥3 cm.
CT-guided percutaneous drainage
& give antibiotics
Uncomplicated diverticulitis in stable patients can be managed in the outpatient setting with bowel rest, ___, and observation.
Hospitalization and ____ are recommended for patients with uncomplicated diverticulitis who are elderly, immunosuppressed, have high fever or significant leukocytosis, or have significant comorbidities.
oral antibiotics
IV antibiotics
Complicated diverticulitis refers to diverticulitis associated with an abscess, perforation, obstruction, or fistula formation.
For management of diverticulitis complicated by abscess:
A fluid collection <3 cm can be treated with: ____
A fluid collection ≥3 cm is be treated with: ____
IV ABxs and observation
(with surgery for pts with worsening sxs)
IV ABxs and CT-guided percutaneous drainage.
(If sxs are not controlled within a few days, then do surgical drainage and debridement)
[Treatment] is generally reserved for patients with Diverticulitis cx by fistulas, perforation with peritonitis, obstruction, or recurrent attacks of diverticulitis
Sigmoid resection
MBO typically causes ___ bowel sounds.
illeus typically causes ___ bowel sounds.
KUB in MBO shows ___
KUB in illeus shows ___
hyperactive
hypoactive
dilated loops of bowel with air-fluid levels and a clear transition point
dilated loops of bowel only
Adenocarcinoma in the __ side of the colon may obstruct the flow of stool, leading to altered bowel habits; visible hematochezia and pencil thin stools is common.
left (sigmoid)
Chronic constipation and colonic dysmotility are risk factors for this closed-loop obstruction
Sigmoid volvulus
segment of sigmoid colon twists on its mesentery
Adenocarcinoma in the __ side of the colon, obstructive symptoms are uncommon.
It commonly present with occult bleeding and iron-deficiency anemia.
right (cecal)
