Lower GI

Question 1

what is appendicitis?

Answer 1

inflammation of the appendix

Question 2

what is the etiology of appendicitis?

Answer 2

appendix is obstructed and it leads to inflammation

Question 3

what are the complications of appendicitis?

Answer 3

gangrene, abscess formation, peritonitis

Question 4

what are the clinical manifestations of appendicitis?

Answer 4

RLQ in periumbilical area
rebound pain
* sudden pain relief may indicate rupture and can lead to peritonitis
low grade fever
nausea
anorexia

Question 5

what are common diagnostic tools / assessments to determine if a patient has appendicitis?

Answer 5

signs / symptoms
increased WBC
sonogram (will see enlarged appendix)
exploratory lap

Question 6

what is peritonitis?

Answer 6

inflammation of the peritoneum

Question 7

explain the concern with peritonitis, what happens?

Answer 7

Inflammation leads to a fluid-shift (third-spacing). This can cause hypovolemia shock. This also causes decreased peristalsis which can lead to a paralytic ileus and intestinal obstruction.

Question 8

what are clinical manifestations of peritonitis?

Answer 8

sudden and severe onset
abdominal pain
tenderness
rigid, board like abdomen
nausea
vomiting
fever
elevated WBC
increased HR
decreased BP

Question 9

what is IBS?

Answer 9

irritable bowel syndrome - this is a chronic condition characterized by alteration in bowel pattern due to changes in intestinal motility . This can present as chronic and frequent constipation or diarrhea.

Question 10

what are some of the signs and symptoms associated with IBS?

Answer 10

abdominal distension, fullness, flatus, and bloating
intermittent abdominal pain exacerbated by stress and relived by pooping
bowel urgency
intolerance to certain foods (sorbitol, lactose, gluten)
non-bloody stools with excessive mucus

Question 11

what is the relationship between stress and IBS?

Answer 11

stress can exacerbate IBS but it does not CAUSE it.

Question 12

what is IBD?

Answer 12

inflammatory bowel disease - which includes Crohns and ulcerative colitis

Question 13

what is the patho behind crohn’s?

Answer 13

Crohn’s affects the lymph structures in the GI tract by blocking them, this causes the tissue to become inflamed and engorged. This causes deep fissures and ulcers to form in the tissue (because it is so inflamed) that it appears to have a cobblestone like appearance in the bowels (also called skip lesions).

Question 14

what are the common complications from Crohn’s?

Answer 14

malnutrition
anemia
scar tissue formation - which can lead to obstruction
fistulas
cancer

Question 15

what are the clinical manifestations of Crohn’s?

Answer 15

cramp like abdominal pain RLQ
watery diarrhea
can have systemic manifestations - weight loss, fatigue, anorexia, fever, malabsorption
palpable RLQ mass
mouth ulcers
fistula formation
granulomas (these are masses of immune cells that have tried to encapsulate a problem)

Question 16

what is ulcerative colitis?

Answer 16

inflammation of the mucosa of the rectum and colon

Question 17

what is the patho behind ulcerative colitis?

Answer 17

inflammation begins in the rectum and extends in a CONTINUOUS segment that may involve the entire colon. This can lead to several ulcerations or necrosis of the epithelial tissue, which can cause abscesses. The tissue tries to repair itself by layering with new granulation tissue but this is prone to damage and bleeding since it is fragile.

Question 18

what are the clinical manifestations of ulcerative colitis?

Answer 18

abdominal pain
bloody diarrhea
systemic : fatigue, weight loss, anorexia, fever

Question 19

what are the complications of ulcerative colitis?

Answer 19

hemorrhage
perforation
cancer
malnutrition
anemia
strictures
anal, rectal, and colon fissures and abscesses
toxic megacolon
colorectal carcinoma
F&E imbalances

Question 20

what is toxic megacolon?

Answer 20

rapid dilation of the large intestines that can be life threatening - this happens due to the major increase in inflammation, it can actually stop the colon from working, which causes food and gas to build up causing the rapid dilation

Question 21

what is diverticulosis?

Answer 21

characterized by the development of diverticula - which are small pouches in the lining of the colon that bulge outward through weak spots

Question 22

where is diverticulosis usually found?

Answer 22

in the descending colon

Question 23

what are the clinical manifestations of diverticulosis?

Answer 23

usually asymptomatic

Question 24

what is diverticulitis?

Answer 24

inflammation of one or more of the diverticula, usually from retained fecal matter in the pouch

Question 25

what are the clinical manifestations of diverticulitis?

Answer 25

abdominal pain LLQ (this is where your descending colon is)
fever, increased WBC
constipation / diarrhea
may have passage of frank blood