Large Bowel Disorders Flashcards
Acquired by 20% of patients through fecal-oral transmission in a hospital setting
Antibiotic associated colitis (Clostridium difficile infection)
Signs and symptoms include: Moderate greenish, foul-smelling watery diarrhea. Mild LLQ tenderness. Stool has mucus but seldom blood. Fever up to 40C (104F)
Antibiotic Associated Colitis(C.diff)
Treatment for Antibiotic Associated Colitis(C.diff)
D/C antibiotics. 1st Metronidazole(Flagyl) 500mg TID x 10-14/d. If fails, Vancomycin 125mg PO QID (more expensive). Probiotics
If appendicitis is left untreated, how soon does gangrene and perforation develop?
within 36 hrs
Most common abdominal surgical emergency
appendicitis
Classic h/o of appendicitis
periumbilical pain followed by nausea
point just below the middle of a line connecting the umbilicus and the anterosuperior iliac spine.
McBurney’s point
Pain in the right lower quadrant with palpation of the left lower quadrant
Rovsing sign
evaluated by passively flexing the right hip and knee and internally rotating the hip
obturator sign
evaluated by placing patient in either the supine or the left lateral decubitus position and extending the right leg at the hip
psoas sign
Has become the most important imaging study in patients with ATYPICAL presentations of appendicitis
CT scans
condition of having diverticula of the colon. more common in the sigmoid colon. associated w/low fiber, high intake of fat/red meat, obesity, lack of excercise
diverticulosis
which are outpocketings of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall (Mucosal layer herniates thru muscularis layer)
diverticula
H/O includes: chronic constipation, some pts may c/o cramping, bloating, flatulence, and irregular defecation
diverticular disease
PE may reveal LLQ tenderness and palpable sigmoid/descending colon
diverticular disease
Treatment for diverticular disease
Bulk in diet to get one BM per day at minimum
Swelling and inflammation of diverticulum in the intestinal wall
diverticulitis
erosion of the diverticular wall by increased intraluminal pressure or inspissated stool within a diverticulum; inflammation and focal necrosis ensue, resulting in perforation
diverticulitis
Signs and symptoms include: achy LLQ pain, N/V, low grade fever, palpable mass, distention, stool occult blood, leukocytosis
diverticulitis
CI during initial stages of diverticulitis due to risk of perforation
barium enema or colonoscopy
test of choice in pts suspected of having acute diverticulitis
CT scan
Outpatient treatment for diverticulitis
clear liquid diet, analgesia, Augmentin or Flagyl + Cipro x 7 days
Inpatient treatment for diverticulitis (ie the elderly, immunosuppressed, those with significant comorbidities, and those with high fever or significant leukocytosis)
IV fluids, NG tube, IV abx. Surgery- Drainage of abscess, temp or perm colostomy
Most common form of congenital abnormality of the small intestine, resulting from an incomplete obliteration of the vitelline duct in 5th week of fetal development
Meckel’s Diverticulum
Occurs on the antimesenteric border of the ileum, usually 60cm proximal to the ileocecal valve
Meckel’s Diverticulum
2% of the population, 2 feet from the ileocecal valve, and is about 2 inches long, 2% of patients develop a complication over their lifetime, present by age 2
rule of twos for Meckel’s Diverticulum
3 most common complications for Meckel’s Diverticulum
GI bleeding, inflammation of diverticulum, intestinal obstruction
Part of the intestines has prolapsed into another section of intestine. Usually occurs at the terminal ileum (ileocecal)
intussusception
predominate cause of intestinal obstruction in persons aged 3 months to 6 years
intussusception
Signs and symptoms include: colicky/intermittent pain, loose stools w/vomiting, blood or mucus passed through rectum (currant jelly stools)
intussusception
Absence of bowel sounds in the RLQ
Dance’s sign. Associated w/intussusception
method of choice to detect intussusception
ultrasound- a bull’s eye or coiled spring lesion often observed
Treatment for intussusception
barium enema
Twisting of the bowel on itself. Sigmoid if most common form. Occurs frequently in middle-aged men and elderly men
volvulus
Patients experience abdominal pain, distension, and absolute constipation
volvulus
Clinical syndromes caused by impaired intestinal motility and are characterized by symptoms and signs of intestinal obstruction in the absence of a lesion-causing mechanical obstruction
Ileus and intestinal pseudo-obstruction
most frequently implicated cause of delayed discharge following abdominal operations
Ileus and intestinal pseudo-obstruction
Treatment of ileus
Support patient with bowel rest, fluids and electrolytes. Avoid opiates
Neurogenic or muscular impairment of peristalsis. Common after bowel surgery
paralytic ileus
Signs and symptoms include: severe colicky pain, absolute constipation, distention, high pitched bowel sounds
mechanical intestinal obstruction
Signs and symptoms include: pain, absolute constipation, distention, SILENT abdomen
paralytic intestinal obstruction
A cyst at the bottom of thetailbone (coccyx) that can become infected and filled with pus
Pilonidal Cyst
Caused by ingrown hairs
Pilonidal Cyst
Signs and symptoms include: pain, swelling, redness at bottom of spine, draining pus, fever, leukocytosis
pilonidal cyst
Involves incision and draining, removal of pus and hair, and sewing of the edges of the fibrous tract to the wound edges to make a pouch
marsupialization
A tear in the anoderm distal to the dentate line, resulting in linear or rocket shaped ulcer. Results from high anal pressure :trauma to the anal canal during defection
anal fissure
Symptoms include: Severe, tearing pain during defecation. Throbbing discomfort. Mild hematochezia
anal fissure
Subepithelial vascular cushions with connective tissue, smooth muscle fibers, AV communications with the superior rectal artery and rectal veins located proximal to the dentate line
internal hemorrhoids
Arise from the inferior hemorrhoidal veins located below the dentate line.
external hemorrhoids
Conservative treatment of hemorrhoids
fiber, increased fluids, anusol, tucks pads, sitz baths
