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Gastrointestinal > Large Bowel Disorders > Flashcards

Large Bowel Disorders Flashcards

1
Q

What is the definition of a Diverticula?

A

small mucosal herniations protruding through intestinal and smooth muscle layer along natural openings of the vasa recta of the colon

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2
Q

What is the most common area for a diverticula and why?

A

Sigmoid colon = highest intraluminal pressure

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3
Q

What is the definition of Diverticulosis?

A

uninflamed diverticula associated with low fiber diet, constipation, and obesity

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4
Q

What is the most common cause of acute lower GI bleeding?

A

Diverticulosis!

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5
Q

What is the definition of Diverticulitis?

A

inflamed diverticula 2ry to obstruction/infection (fecaliths) leading to distention

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6
Q

What are the clinical manifestations of diverticulitis?

A
  1. fever
  2. LLQ pain
  3. N/V
  4. diarrhea/constipation
  5. flatulence
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7
Q

What is the diagnostic test of choice for diverticulitis?

A

CT scan

Ba enema not done in acute phase!!

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8
Q

What is the management of diverticulitis?

A

clear liquid diet

broad spectrum abx = cipro (or Bactrim) + Metronidazole

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9
Q

What is the management of diverticulosis?

A

high fiber diet, fiber supplements

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10
Q

What is the definition of a volvulus?

A

twisting of any part of bowel in itself

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11
Q

Where does a volvulus most commonly happen?

A

sigmoid colon or cecum

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12
Q

What are the clinical manifestations of a volvulus?

A

obstructive s/sxs —> abd. pain, distention, N/V, fever, tachycardia

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13
Q

What is the management of a volvulus?

A

Endoscopic decompression initially!

Surgical correction is 2nd line

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14
Q

What is the most common cause of obstruction of the appendix?

A

Fecalith (hardening of feces)

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15
Q

What is the one clinical feature that can rule out appendicitis?

A

if the patient is hungry!!

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16
Q

What is Rovsing sign?

A

RLQ pain with LLQ palpation

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17
Q

What is obturator sign?

A

RLQ pain with internal and external hip rotation with bent knee

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18
Q

What is Psoas sign?

A

RLQ pain with right hip flexion/extension (SLR)

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19
Q

How is appendicitis diagnosed?

A

CT scan
US
leukocytosis

20
Q

What is the hallmark of irritable bowel syndrome?

A

Abdominal pain associated with altered defecation/bowel habits (diarrhea, constipation, or alteration between the 2)

21
Q

What is the clinical definition of IBS?

A

chronic, functional idiopathic disorder with NO organic cause

22
Q

Name some “alarming symptoms” of IBS?

A

Evidence of GI bleeding
Anorexia or weight loss
Nocturnal symptoms
Onset > 45 years
Persistent diarrhea causing dehydration OR
Severe constipation causing fecal impaction

23
Q

What are the possible pathophysiology of IBS?

A
  1. Abnormal motility –> chemical imbalance in intestine causing abnormal movements and spasm
  2. Visceral hypersensitivity –> lower pain thresholds to intestinal distention
  3. Psychosocial interactions
24
Q

What specific chemicals can be imbalanced in the intestine to cause IBS?

A

Serotonin and Acetylcholine

25
Q

What is the Rome II Diagnostic Criteria for IBS?

A

Abdominal pain or discomfort with 2 of 3 features for at least 12 weeks during preceding 12 months

  1. relief with defecation**
  2. onset associated with change in stool frequency
  3. onset associated with change in stool formation
26
Q

What are the management options for IBS?

A

Lifestyle changes –> smoking cessation, eat low fat/unprocessed foods, sleep, exercise

Anticholinergics (Dicyclomine) 
Antidiarrheal (Loperamide)
Prokinetics
Bulk-forming laxatives
Saline or osmotic laxatives
27
Q

What is acute mesenteric ischemia?

A

sudden decrease of mesenterial blood supply to the bowel

GI EMERGENCY!!!

28
Q

Where is inadequate perfusion most common in acute mesenteric ischemia and why?

A

at the splenic flexure b/c less collateral blood perfusion

29
Q

What are the most common etiologies for acute mesenteric ischemia?

A
  1. embolus (ex. pts with Afib)
  2. thrombus (esp in pt with prior known atherosclerosis)
  3. Non-occlusive causes (less common) –> shock, cocaine
30
Q

What are the clinical manifestations of acute mesenteric ischemia?

A

SEVERE abdominal pain out of proportion to physical findings

31
Q

What is the diagnostic test of choice for acute mesenteric ischemia?

A

Angiogram!

32
Q

What is the management for acute mesenteric ischemia?

A

Revascularization! (angioplasty with stenting or bypass)

Surgical resection if bowel not salvageable

33
Q

What is chronic mesenteric ischemia?

A

mesenteric atherosclerosis of the GI tract leading to inadequate perfusion in post-prandial states (esp. at splenic flexure)

34
Q

What are the clinical manifestations of chronic mesenteric ischemia?

A 
chronic dull abdominal pain worse after meals "intestinal angina" 
Weight loss (anorexia)
35
Q

What is the diagnostic test of choice for chronic mesenteric ischemia and what will it show?

A

Colonoscopy –> mucosal atrophy with loss of villi

36
Q

What is the management for chronic mesenteric ischemia?

A

bowel rest

revascularization (angioplasty with stenting or bypass)

37
Q

What is toxic megacolon?

A

non-obstructive, severe colon dilation > 6cm + signs of systemic toxicity

38
Q

What are the most common etiologies of toxic megacolon?

A 
UC, Crohn's 
pseudomembranous colitis
infectious
XRT
ischemic 
Hirschsprung
39
Q

What are the clinical manifestations of toxic megacolon?

A 
Abdominal pain
diarrhea
N/V
rectal bleeding or tenesmus
fever, tachycardia, hypotension
40
Q

What is Hirschsprung?

A

a congenital aganglionic colon (neurogenic bowel obstruction)

41
Q

What is the diagnostic test of choice for toxic megacolon and what will it show?

A

Abdominal X-ray —> large dilated colon > 6cm

42
Q

What is the management of toxic megacolon?

A

bowel decompression (NG tube)
bowel rest
broad spectrum abxs

Colostomy if refractory

43
Q

What is the medical definition of tenesmus?

A

continual or recurrent inclination to evacuate the bowels

44
Q

What are the clinical manifestations of ischemic colitis?

A

LLQ pain with tenderness and bloody diarrhea

Due to sloughing off of the colon

45
Q

What is the diagnostic test of choice for ischemic colitis and what will it show?

A

Colonoscopy —> segmental ischemic changes in areas of low perfusion (ex. splenic flexure)

Gastrointestinal (8 decks)

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