Large Bowel Disorders

Question 1

Most common cause of appendicitis

Answer 1

Fecalith obstructing the appendix

Question 2

Untreated appendicitis leads to?

Answer 2

Gangrene and perforation within 36 hrs.

Question 3

Appendicitis epidemiology

Answer 3

10% of pop
Most common surgical emergency
ages 10-30
More common in men

Question 4

Appendicitis S/S

Answer 4

Anorexia
Periumbicular pain
N/V
RLQ pain follows (McBurneys point)

Question 5

Most important feature in S/S to dx appendicitis?

Answer 5

Migration of pain from periumbicular to RLQ

Question 6

Rovsing sign

Answer 6

Rebound tenderness over McBurneys Pt.

Question 7

Most important factor leading to diverticulosis

Answer 7

Low intake of fiber

Question 8

DIverticulosis

Answer 8

Describes the presence of diverticula, which are herniations of the large colon through weak spots.
Prevelance increases w/ age.
Most common in sigmoid colon

Question 9

Diverticulosis S/S

Answer 9

Chronic constipation
Cramping, bloating
LLQ tenderness
Most patients remain asymptomatic

Question 10

Diverticulitis

Answer 10

Swelling and inflammation of diverticulum in the intestinal wall.

Question 11

Diverticulitis S/S

Answer 11

Aching abd pain, LLQ
Constipation
N/V, fever
Palpable mass
Abd distention
Blood in stool

Question 12

Imaging of choice for diverticulitis

Answer 12

CT w/ contrast

Question 13

Diverticulitis outpatient Tx

Answer 13

Clear liquid diet
Analgesia
Augmentin and Flagyl (7-10 days)

Question 14

Diverticulitis inpatient tx

Answer 14

Admit elderly, immunosuppressed, comorbidities.

IV fluids, abx, NG tube, surgery

Question 15

Meckel’s Diverticulum

Answer 15

Most common congenital abnormality of the small intestine.

Incomplete obliteration of the vitelline dict in 5th week.

Question 16

Meckels rule of 2’s

Answer 16

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

Question 17

Meckels complications

Answer 17

Bowel obstruction
GI bleed
Diverticulitis

Question 18

Meckels S/S

Answer 18

Periumbicular abd pain radiating to RLQ
GI bleeding
Inflammation
Obstruction, N/V

Question 19

Intussusception

Answer 19

Part of the intestine prolapsing into another like a telescope.
Usually occurs at terminal ileum (iliocecal)
Generally ideopathic

Question 20

Intussusception is the main cause of?

Answer 20

Intestinal obstruction in (mostly males) age 3 months to 6 years.

Question 21

Intussusception S/S

Answer 21

Sudden, loud, intermittent pained crying from abd pain.
N/V/D
Blood, mucous passed rectally
Currant jelly stools

Question 22

Intussusception imaging

Answer 22

US reveals bulls eye or coiled spring

Question 23

Intussusception Tx

Answer 23

Barium enema works 80% of the time.

Question 24

Volvulus

Answer 24

Twisting of the bowel on itself.
Older men
Usually sigmoid

Question 25

Volvulus S/S

Answer 25

Abd pain, distention, constipation

N/V

Question 26

Volvulus imaging and tx

Answer 26

X-ray, CT
Barium enema
Surgery

Question 27

Ileus

Answer 27

Pseudo-obstruction
Impaired clearing of stool in the absence of obstruction
Usually caused by abdominal surgery.

Question 28

Ileus Tx

Answer 28

Temporary problem

Supportive tx

Question 29

Pilonidal Cyst

Answer 29

Cyst at bottom of tailbone that can become infected.
More common in young men
Caused by ingrown hairs

Question 30

Pilonidal Cyst S/S

Answer 30

Pain, redness and swelling at bottom of spine.

Fever, pus, leukocytosis

Question 31

Anal. Fissure.

Answer 31

A tear in the anoderm distal to dentate line.
Rocket shaped ulcer, less than 5mm in length.
Results from high anal pressure

Question 32

Most common abdonimal wall hernia?

Answer 32

Inguinal (75%)

Question 33

Femoral hernia

Answer 33

Intestines into the femoral canal.
Rare, occur mostly in women
Cause bulge in thigh

Question 34

Ventral hernia

Answer 34

Occurs in the abdominal wall at some site other than the groin.
Umbillical and incisional most common

Question 35

Umbilical Hernia

Answer 35

Common hernias occuring in children and older adults.

Question 36

Spigelian Hernia

Answer 36

Occurs below the umbilicus along the lateral rectus muscle