Lecture 21 - Clinical Aspects of Colon and Rectum Diseases Flashcards
Pregnant women may present with pain localized to the ______ region, rather than RLQ, with appendicitis.
Pelvic region
Rovising’s sign is positive, indicating appendicitis, when percussion or palpation of the ______ elicits pain in the ______.
LLQ
RLQ
Psoas sign for appendicitis involves felxion of the right ______.
Hip
Obturator sign for appendicitis involves internally and externally rotating the FLEXED right ____.
Hip
Both elderly and Immunocompromised patients will likely NOT show ________ with appendicitis. Keep in mind HIV patients are ____ times more likely of developing appendicitis.
Leukocytosis
4 times
High ____ is pathognomonic for appendicitis in patients with RLQ pain.
CRP
_____ imaging should be ordered when a patient presents with symptoms of appendicitis. Remember the appendix should not normally be visible –> if it is, think inflammation.
CT
Treatment for appendicitis should always include _____ and IV fluids.
Antibiotics
For patients from Asian countries, where does diverticulitis typically present? How does this compare to patients from western countries?
Asian –> typically RLQ
Western countries –> LLQ
Like with patients presenting with symptoms of appendicitis, what serum measurement is valuable for diagnosis of Diverticulitis?
High CRP
Treatment for diverticulitis should include oral _____. For patients with recurrent diverticulitis, ______ is the recommended treatment, as there are relatively few adverse effects.
Antibiotics
Sigmoidectomy
Patients with diverticulitis symptoms should be sent for colonoscopy for CRC screening, but when?
4-6 weeks after symptoms resolve to reduce risk of perforation on exam.
Treatment for diverticular bleeding should immediately include _____ and transfusion. If the patient is stable –> send them for ______. If the patient is unstable –> send for interventional radiology surg. In all cases, try to minimize exacerbating factors such as anticoag meds and _____.
IV fluid
Colonoscopy
NSAIDs
Patients with ischemic colitis will present with _____ (mild or severe?) abdominal pain and sporadic, urgent desires to defecate. Within ____hrs, these patients will likely exhibit hematochezia.
Mild
24hrs
Vovlulus treatment when it occurs in the _____ should be resection. When it occurs in the _____ colon, it should first be colonoscopy, which can unwind it, and then resection bc of high chance for recurrence.
Cecum
Sigmoid colon
For IBS diagnosis, symptoms should be present over the last ____ months, and they should have started at least ____ months ago.
3 months
6 months
The most impactful treatment for patients with IBS is meditation and exercise, basically aimed at lowering ______. TCA is also a viable option.
Stress
Crohn’s is more common in _____ (young or old) _____ (gender?) while UC is more common in _____ (young or old?) _____ (gender?)
Younger
Women
Old
Men
How is smoking as a risk factor different between Crohn’s and UC?
Increases risk for Crohn’s but Decreases risk for UC
Patients presenting with bleeding from IBD should be placed on prophylactic _______ after resuscitation, despite seeming counterintuitive.
Anticoag
The treatment of choice for both Crohn’s and UC is ______ (e.g. anti-TNF, IL-inhibitors, and TKIs).
Biologics
Rectoanal Inhibitory Reflex (RAIR), how is this measured with manometry and what does a positive result indicate about Hirschprung’s disease?
RAIR involves inflation of a balloon in the rectum to increase the rectal pressure –> this should lead to a Decrease in anal pressure. Positive result means no Hirschprung.
