Left Abdomen Flashcards

Question

Intestinal ischemia treatment - general

Answer 1

–Initial supportive management: fluid resuscitation, hemodynamic monitoring and support, correction of electrolyte abnormalities, pain and nausea control –Systemic anticoagulation under most circumstances ( may hold if GI bleed present) –initiation of broad-spectrum antibiotics

Answer 2

depends on the specific etiology (arterial occlusion or thrombosis, mesenteric venous thrombosis, and nonocclusivemesenteric ischemia) –Options:arterialembolectomy, bypass, or stenting, arterial or venous thrombolysis, and intra-arterial vasodilator infusion •Surgery required if intestinal infarction or perforationis suspected

Answer 3

**Smoking**—Smoking is a risk factor for Crohn disease but *not* for ulcerative colitis **Physical activity**—Physical activity has been associated with a decrease in risk of Crohn disease, but *not* ulcerative colitis **Dietary factors**— –High intake of dietary fiber, particularly from fruit and cruciferous vegetables, has been associated with a decrease in risk of Crohn’s disease but *not* ulcerative colitis –Fats –Increased dietary intake of total fat, animal fat, and polyunsaturated fatty acids has been correlated with an increased incidence of ulcerative colitis *and* Crohn’s disease

Answer 4

**–Cardinal symptoms** •Crampyabdominal pain (RLQ if terminal ileum involved) •chronic intermittent diarrhea (with or without gross bleeding), fatigue, and weight loss ## Footnote * –May present with signs and sx’s of intestinal obstruction (abdpain, intractable vomiting) if crohn’shas caused intestinal strictures* * –Perianal disease (fistulas, abcessesand fissures) in 1/3 of crohn’spatients*

Answer 5

–Extraintestinalmanifestations, such as iritis, arthritis, skin disorders, may occur in patients with IBD –Intermittent low grade fever, intermittent diarrhea

Answer 6

Laboratory testing does not establish the diagnosis. •Labs: CBC, CMP, UA, pregnancy test, Serum iron, vitamin D, and vitamin B12 levels, C-reactive protein, albumin–anemia, hypoalbuminemia, vitamin B12 deficiency, vitamin D deficiency often occur in patients with Crohn’s disease CRP is elevated in the acute phase of IBD •If diarrhea present then send stool for stool studies; –Enteric pathogens, culture and sensitivity, ova, and parasite fecal leukocytes, or fecal lactoferrin, and Clostridium difficile test

Answer 7

•**Colonoscopy including the terminal ileum with biopsies–Diagnostic test of choice –Definitive** –Endoscopic features include focal ulcerations adjacent to areas of normal appearing mucosa along with nodular mucosal changes that result in a cobblestone appearance –Skip areas of involvement are typical with segments of normal-appearing bowel interrupted by large areas of disease. * Ct of Abd/pelvis with IV and oral contrast or MRI of the Abdomen and pelvis with contrast are comparable in sensitivity and specificity * Capsule Imaging

Answer 8

Acutely ill patients requiring inpatient hospitalization –intravenous fluid and electrolyte replacement, intravenous broad spectrum antibiotics, nutritional assessment, and consultation with a gastrointestinal surgeon. •Medications–5-aminosalicylates (Sulfasalazine) –Corticosteroids (Prednisone, or methylprednisolone) –Immunomodulators(azathioprine, 6-mercaptopurine,methotrexate) –Biologic therapies •Anti TNF Therapies, Anti-Integrins, Anti-IL-12/IL-23 antibodies

Answer 9

* General: signs of distress, abnormal vitals * HEENT: uveititis, iritis, aphthousulcers * Chest: Tacyhpnea * Cardiac: tachycardia * Abd: location and severity of abdpain, signs of peritonitis * Rectal: hematochezia, bloody diarrhea * Extremities: joint pain * Skin: pyoderma gangrenosum, erythema nodosum, pallor

Answer 10

Laboratory –CBC, CMP, UA, pregnancy test –Fecal occult blood Imaging–**Colonoscopy with biopsies** is the gold standard for diagnosis of UC. –Ct of Abd/pelvis with IV and oral contrast

Answer 11

* Mild UC –Topical mesalamine(Asacol), an NSAID, given as a suppository * Moderate to severe UC –Immunomodulators(azathioprine, 6-mercaptopurine,methotrexate) –Biologics (Anti-TNF, Anti-Integrins,Anti-IL-12/IL-23 antibodies) * Acute severe UC–Hospitalization–Corticosteroids IV, Anti-TNF or cyclosporine **Total Colectomy is curative**

Answer 12

–**Abdominal pain is the most common symptom** •LLQ (85% of the time) •Abdpain is usually constant and is often present for several days prior to presentation •Approximately 50 percent of patients have had one or more prior episodes of similar pain –Nausea and vomiting •reported in 20 to 62 percent of patients –Low grade fever is often present –constipation reported in approximately 50 percent of patients –diarrhea in 25 to 35 percent of patients. –Hematochezia is rare –Approximately 10 to 15 percent of patients have urinary urgency, frequency, or dysuria

Answer 13

Shx–Advanced age, Smoking, High dietary intake of red meat, low dietary fiber, lack of vigorous physical activity, BMI (≥25 kg/m2) * Fhx–Uncertain if genetic predisposition at this time * Medications–Several medications are associated with an increased risk of diverticulitis and diverticular bleeding including nonsteroidal antiinflamatorydrugs, steroids, and opiates

Answer 14

* Laboratory –Lab tests are not sensitive or specific for diverticulitis –CBC, CMP, UA, pregnancy test * Leukocytosis would support the diagnosis * Imaging–**Ct of Abd/pelvis with IV and oral contrast** has a high sensitivity and specificity for acute diverticulitis and can exclude other causes of abdominal pain.

Answer 15

Outpatient management –Oral antibiotics and close follow up Augmentin or (Flouroquinoloneor Bactrim + metronidazole)

Answer 16

Inpatient management –Supportive care (if indicated) •fluid resuscitation, hemodynamic monitoring and support, correction of electrolyte abnormalities, pain and nausea control –IV antibiotics •Ciprofloxacin (a fluoroquinolone) + flagyl(metronidazole) –Surgery •may be required for severe disease, perforation or abscess

Answer 17

–hematochezia or melena –abdominal pain –otherwise unexplained iron deficiency anemia –a change in bowel habits •constipation –Less common presenting symptoms include •abdominal distention, and/or nausea and vomiting, which may be indicators of obstruction

Answer 18

* Advanced age * male gender * smoking * a family history of colorectal cancer * inflammatory bowel disease (especiallyUlcerative Colitis)

Answer 19

Colorectal cancer, inflammatory bowel disease, diabetes, history of abdominal irradiation, acromegaly, renal transplant

Answer 20

obesity, tobacco use, excess consumption of alcohol, excess consumption of processed meat, and lack of physical activity

Answer 21

**protective effect of aspirin** and other nonsteroidal anti-inflammatory drugs (NSAID) on the development of colonic adenomas and cancer

Answer 22

•Asymptomatic •Abdominal pain or mass •Abdominal distention •Rectal exam –Positive fecal occult blood –Mass •Anemia

Answer 23

•Screening–Fecal Occult Blood –fecal immunochemical testing (FIT) –Colonoscopy •Laboratory –CBC, CMP, UA, pregnancy test –Fecal occult blood •Imaging–Ct of Abd/pelvis with IV and oral contrast –**Colonoscopy : The gold standard** -allows for detection of polyps and malignant lesions as well as biopsy of suspicious lesions.

Answer 24

Treatment and management depends on the stage of the cancer •Surgical resection –the only curative modality for localized colon cancer –Most patients who present with metastatic disease are not surgical candidates * Chemotherapy * Radiation * Combination of the above