Lower GI Disorders

Question 1

what are the two ways C diff colitis can present?

Answer 1

diarrhea or toxic megacolon (worse)

Question 2

what is first line treatment for C diff colitis?

Answer 2

metronidazole or vancomycin

Question 3

what is grossly present on c diff colitis ressection?

Answer 3

green yellow exudate

Question 4

how does c diff colitis appear on histo slide?

Answer 4

volcano lesion…crypts look like they are spewing into nasty mucosal area

Question 5

what is the light and dark pink in the mucosa of c diff colitis on histo?

Answer 5

light is mucin

dark is fibrosis/necrosis

Question 6

if c diff colitis is treated quickly, what cells make the crypts normal again?

Answer 6

regenerative cells

Question 7

name seven things that are on a differential for LLQ pain

Answer 7

ectopic pregnancy
kidney or ureter stone
appendicitis
colon cancer
IBD
diverticulitis
aortic aneurysm

Question 8

when do diverticulae usually develop?

Answer 8

in older age as walls get weaker

Question 9

what diet is susceptible to diverticulae?

Answer 9

low fiber western diet

Question 10

diverticulae do not include what type of tissue from the colon?

Answer 10

the muscularis propria

Question 11

what is the difference between diverticular colitis and diverticulitis?

Answer 11

diverticular colitis in inflammation around the orifice of the diverticulum
diverticulitis is inflammation within the diverticulum from blocking of the orifice

Question 12

name five complications of diverticulosis

Answer 12

hemorrhage
stricture
diverticular colitis
diverticulitis
perforation

Question 13

what is it called when fecal matter gets stuck in an orifice?

Answer 13

fecalith

Question 14

a macroperforation from diverticulum can lead to what two complications?

Answer 14

abscess

fistula

Question 15

how does diverticulitis present?

Answer 15

abdominal pain
fever/leukocytosis
constipation
peritoneal signs

Question 16

what should you not do with diverticulitis?

Answer 16

colonoscopy or barium enema

Question 17

what are the two complications of diverticulitis?

Answer 17

microperforation

macroperforation

Question 18

what are the two complications that can arise from microperforation from diverticulitis

Answer 18

stricture or obstruction

Question 19

what are the three complications that can arise from macroperforation from diverticulitis

Answer 19

abscess
fistula
peritonitis

Question 20

what are the four fistulas that can occur with macroperforation from diverticulitis?

Answer 20

colovesical
colocutaneous
colovaginal
coloenteric

Question 21

how does diverticulitis develop?

Answer 21

block orifice…increase pressure in diverticulum and then block blood flow…necrosis of tissue and bacteria able to invade

Question 22

how do you manage diverticulitis?

Answer 22

give antibiotics and clear liquid diet

Question 23

what is the most common location for diverticulum?

Answer 23

sigmoid colon

Question 24

how does appendicitis develop?

Answer 24

fecalith blocks the appendix orifice and leads to inflammation in the appendix due to necrosis and bacterial invasion

Question 25

name three complications of appendicitis

Answer 25

perforation
peritonitis
sepsis

Question 26

what is the initial pain experienced in appendicitis?

Answer 26

periumbilical pain…visceral

Question 27

what point develops pain that is over the appendix in appendicitis?

Answer 27

McBurneys point

Question 28

what are symptoms of appendicitis?

Answer 28

abdominal pain
vomiting
mild fever
anorexia

Question 29

what will RLQ have on physical exam with appendicitis?

Answer 29

rebound tenderness

Question 30

what is the rovsing sign with appendicitis?

Answer 30

palpate RLQ but pain in LLQ

Question 31

what is the psoas sign with appendicitis?

Answer 31

move R thigh and have pain there

Question 32

what is the obturator sign with appendicitis?

Answer 32

flex and laterally rotate R leg and have severe pain

Question 33

what are histo changes with appendicitis?

Answer 33

hypercellularity with inflammatory cells in the inner layers of tissue
mural hemorrhages
neutrophils in the muscularis propria

Question 34

what can a patient not have to be diagnosed with constipation?

Answer 34

pain in abdomen

Question 35

how long must patient have constipation symptoms to be diagnosed?q

Answer 35

3 months

Question 36

name the three categories of constipation

Answer 36

slow transit
normal transit
defecatory disorders

Question 37

what is the primary cause of slow transit constipation

Answer 37

decreased number of cells of cajal leading to colonic inertia

Question 38

what are the three secondary slow transit constipation causes?

Answer 38

metabolic (diabetes)
neurologic (stroke)
medications (opiates)

Question 39

what are two drug classes that cause secondary slow transit constipation?

Answer 39

opiates and diuretics

Question 40

what are the three defecatory disorders that can cause constipation?

Answer 40

anatomic disorders
hirschprung disease
functional outlet obstruction

Question 41

what is a rectocele? how does it happen?

Answer 41

outpouching of rectum from straining with constipation

Question 42

what causes functional outlet obstruction?

Answer 42

paradoxical contraction of the puborectalis muscle and closure of the anal canal

Question 43

what are two signs that point toward functional outlet obstruction as cause of constipation?

Answer 43

really hard straining

digital removal of feces