Intestinal Pathology

Question 1

What is the best diagnostic test for diagnosing acute diverticulitis

Answer 1

Abdominal CT scan

Question 2

____ is contraindicated in the setting of acute diverticulitis as it may cause perforation

Answer 2

Sigmoidoscopy

Colonoscopy

Question 3

This study can detect strictures or inflammation in ulcerative colitis or Crohn disease

Answer 3

Barium contrast enema

Question 4

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?

Answer 4

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

Question 5

Management of Acute Diverticulitis (2)

Answer 5

Bowel Rest (NGT, NPO, IVFs)
ABxs (Flagyl or Cipro)

Question 6

Intra-abdominal ____ usually present with subacute fever, focal abdominal tenderness, and weight loss.

Answer 6

abscesses

Question 7

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.

Answer 7

fibrotic stricture

Question 8

__ is commonly used to treat Crohn disease.

Answer 8

Tumor necrosis factor

adalimumab/Infliximab

Question 9

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.

Answer 9

Adynamic ileus

*presents similar to SBO

Question 10

Adynamic ileus
develops after an insult that “stuns” the bowel like
recent ____ or high-dose ____.

Answer 10

intra-abdominal surgery

opioids

Question 11

Perianal ____ can occur with Crohn disease. Present as subacute fever & a swollen mass w/ tenderness, erythema and induration of the overlying skin.

Answer 11

abscesses

Question 12

Other perianal manifestations of Crohn disease include ___, which present with malodorous, purulent fecal drainage as well as pain and itchiness.

Answer 12

Fistulae

The external opening of a fistula should be visible on inspection

Question 13

Colonic pseudo-obstruction (obstruction without a mechanical cause) aka Ogilvie syndrome is initially managed with bowel rest, ___ & ____

Answer 13

Electrolyte correction

Rectal Tube

Question 14

Presents with pneumaturia, fecaluria, or findings consistent with urinary tract infection.

MCC of ___ is Diverticulitis.

Answer 14

Colovesical fistula

*CT Abd with oral or rectal contrast confirms diagnosis by showing contrast in the bladder with thickened colonic and vesicular walls.

Question 15

MCC of Colovesical fistula is ____

Answer 15

Diverticulitis

Question 16

Diagnosis of toxic megacolon requires ___ of colonic dilation >6 cm, along with manifestations of systemic toxicity (fever, leukocytosis, hemodynamic instability).

Answer 16

radiographic evidence (CT Abd)

Question 17

Rapid compression of the duodenum against the vertebral column during blunt abdominal trauma may result in a ___.

Answer 17

duodenal hematoma

*Hematoma expansion can progressively obstruct the duodenal lumen, causing a delayed (24-48 hr) presentation of worsening emesis.

Question 18

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 ____.

Answer 18

Intra-abdominal bleeding (intraperitoneal free fluid).

Question 19

Often diagnosed in asymptomatic pts with high ALP and gamma-glutamyl transpeptidase (GGT) levels (cholestatic pattern).

Answer 19

Primary sclerosing cholangitis

Question 20

MRCP findings of multifocal intrahepatic and extrahepatic biliary strictures with segmental dilations are diagnostic of ____.

Answer 20

Primary sclerosing cholangitis

Question 21

A ___ is recommended at the time of diagnosis of Primary sclerosing cholangitis because many patients also have IBD.

Answer 21

colonoscopy

Question 22

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.

Answer 22

Acute diverticulitis

Question 23

A colonoscopy reveals mild erythema and small, shallow ulcers in the rectum and sigmoid colon.
Diagnosis?

Answer 23

Ulcerative Colitis

Question 24

Initial management for mild Ulcerative Colitis is with ___, for induction/maintenance therapy.

Answer 24

5-aminosalicylic acid (5-ASA)

Mesalamine/Sulfasalazine/Balsalazide

Question 25

___ 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.

Answer 25

Mesalamine oral 5-ASA (Mesalamine/Sulfasalazine/Balsalazide) Corticosteroids → can be given topically (enema) or systemically (prednisone)

Question 26

Colonic Ischemia most commonly involves watershed areas like: 1. ____ between the SMA and IMA. 2. ____ between the sigmoid artery and superior rectal artery.

Answer 26

splenic flexure rectosigmoid junction

Question 27

___ is characterized by acute abdominal pain and lower gastrointestinal bleeding.  Typically follows an episode of hypotension and most commonly affects arterial watershed areas.

Answer 27

Ischemic colitis * CT scan may show a thickened bowel wall * Colonoscopy can confirm the diagnosis

Question 28

___ can confirm the diagnosis of Ischemic colitis

Answer 28

Colonoscopy

Question 29

Patients with IBD-induced TM should receive intravenous ___

Answer 29

corticosteroids

Question 30

___ 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).

Answer 30

Ascariasis albendazole/mebendazole

Question 31

Ascariasis complications include (2)

Answer 31

``` SBO hepatobiliary obstruction (cholangitis, pancreatitis).  ```

Question 32

[Procedure] can be used to treat reducible prolapsed internal hemorrhoids that fail to respond to conservative treatment (hydrocortisone cream). 

Answer 32

Rubber band ligation Hemorrhoids usually appear as blue or purple bulges rather than an erythematous mass with concentric rings (rectal prolapse).

Question 33

Pt post bowel surgery presents with watery diarrhea abdominal pain, and bloating. Bowel sounds are normal and pt has flatus. Dx and treatment (2)?

Answer 33

Small intestinal bacterial overgrowth (SIBO) | Neomycin + Rifaximin

Question 34

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.

Answer 34

severe pain

Question 35

Infrared coagulation, rubber band ligation, and sclerotherapy are all used to treat symptomatic ___ hemorrhoids that fail conservative management

Answer 35

nonthrombosed internal

Question 36

Which diagnostic imaging is now typically performed when appendicitis is suspected on clinical presentation?

Answer 36

CT Abd/Pelvis | w/contrast

Question 37

____ is recommended for treatment of complicated diverticulitis with abscess formation with a fluid collection ≥3 cm.

Answer 37

CT-guided percutaneous drainage | & give antibiotics

Question 38

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.

Answer 38

oral antibiotics IV antibiotics

Question 39

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: ____

Answer 39

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)

Question 40

[Treatment] is generally reserved for patients with Diverticulitis cx by fistulas, perforation with peritonitis, obstruction, or recurrent attacks of diverticulitis

Answer 40

Sigmoid resection

Question 41

MBO typically causes ___ bowel sounds.  illeus typically causes ___ bowel sounds. KUB in MBO shows ___ KUB in illeus shows ___

Answer 41

hyperactive hypoactive dilated loops of bowel with air-fluid levels and a clear transition point dilated loops of bowel only

Question 42

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. 

Answer 42

left (sigmoid)

Question 43

Chronic constipation and colonic dysmotility are risk factors for this closed-loop obstruction

Answer 43

Sigmoid volvulus | segment of sigmoid colon twists on its mesentery

Question 44

Adenocarcinoma in the __ side of the colon, obstructive symptoms are uncommon. It commonly present with occult bleeding and iron-deficiency anemia.

Answer 44

right (cecal)