Large Bowel Disorders Flashcards
Most common cause of appendicitis
Fecalith obstructing the appendix
Untreated appendicitis leads to?
Gangrene and perforation within 36 hrs.
Appendicitis epidemiology
10% of pop
Most common surgical emergency
ages 10-30
More common in men
Appendicitis S/S
Anorexia
Periumbicular pain
N/V
RLQ pain follows (McBurneys point)
Most important feature in S/S to dx appendicitis?
Migration of pain from periumbicular to RLQ
Rovsing sign
Rebound tenderness over McBurneys Pt.
Most important factor leading to diverticulosis
Low intake of fiber
DIverticulosis
Describes the presence of diverticula, which are herniations of the large colon through weak spots.
Prevelance increases w/ age.
Most common in sigmoid colon
Diverticulosis S/S
Chronic constipation
Cramping, bloating
LLQ tenderness
Most patients remain asymptomatic
Diverticulitis
Swelling and inflammation of diverticulum in the intestinal wall.
Diverticulitis S/S
Aching abd pain, LLQ Constipation N/V, fever Palpable mass Abd distention Blood in stool
Imaging of choice for diverticulitis
CT w/ contrast
Diverticulitis outpatient Tx
Clear liquid diet
Analgesia
Augmentin and Flagyl (7-10 days)
Diverticulitis inpatient tx
Admit elderly, immunosuppressed, comorbidities.
IV fluids, abx, NG tube, surgery
Meckel’s Diverticulum
Most common congenital abnormality of the small intestine.
Incomplete obliteration of the vitelline dict in 5th week.
Meckels rule of 2’s
2% of pop 2 feet from iliocecal valve 2 inches long 2% of patients develop complications Usually present by age 2 Males to females 2:1
Meckels complications
Bowel obstruction
GI bleed
Diverticulitis
Meckels S/S
Periumbicular abd pain radiating to RLQ
GI bleeding
Inflammation
Obstruction, N/V
Intussusception
Part of the intestine prolapsing into another like a telescope.
Usually occurs at terminal ileum (iliocecal)
Generally ideopathic
Intussusception is the main cause of?
Intestinal obstruction in (mostly males) age 3 months to 6 years.
Intussusception S/S
Sudden, loud, intermittent pained crying from abd pain.
N/V/D
Blood, mucous passed rectally
Currant jelly stools
Intussusception imaging
US reveals bulls eye or coiled spring
Intussusception Tx
Barium enema works 80% of the time.
Volvulus
Twisting of the bowel on itself.
Older men
Usually sigmoid
Volvulus S/S
Abd pain, distention, constipation
N/V
Volvulus imaging and tx
X-ray, CT
Barium enema
Surgery
Ileus
Pseudo-obstruction
Impaired clearing of stool in the absence of obstruction
Usually caused by abdominal surgery.
Ileus Tx
Temporary problem
Supportive tx
Pilonidal Cyst
Cyst at bottom of tailbone that can become infected.
More common in young men
Caused by ingrown hairs
Pilonidal Cyst S/S
Pain, redness and swelling at bottom of spine.
Fever, pus, leukocytosis
Anal. Fissure.
A tear in the anoderm distal to dentate line.
Rocket shaped ulcer, less than 5mm in length.
Results from high anal pressure
Most common abdonimal wall hernia?
Inguinal (75%)
Femoral hernia
Intestines into the femoral canal.
Rare, occur mostly in women
Cause bulge in thigh
Ventral hernia
Occurs in the abdominal wall at some site other than the groin.
Umbillical and incisional most common
Umbilical Hernia
Common hernias occuring in children and older adults.
Spigelian Hernia
Occurs below the umbilicus along the lateral rectus muscle
