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Q4 Clin Med III (GI) > Obstruction/Rectal Dz > Flashcards

Obstruction/Rectal Dz Flashcards

1
Q

Divisions of small intestines? (3)

A

1) Duodenum (pylorus to ligament of Treitz)
2) Jejenum
3) Ileum

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2
Q

Vascular supply of small intestines?

A

SMA

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3
Q

Primary role of small intest?

A

absorption

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4
Q

Components of large bowel? (8)

A

1) Cecum
2) Ascending colon
3) Hepatic Flexure
4) Transverse colon
5) Splenic flexure
6) Descending colon
7) Sigmoid
8) Rectum

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5
Q

Vascular supply for large bowel?

A

SMA

IMA

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6
Q

Primary role of large bowel?

A

Absorb H2O, e-

Store feces

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7
Q

Causes of small bowel obstruction (SBO)? (5)

A

1) POST-OP ADHESION (primary cause, 80% self-resolve)
2) Malignancy
3) Hernia
4) Strictures (Crohn’s, NSAIDS, radiation, ischemia)
5) Tumors

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8
Q

Intussusception epidemiology?

Sxs?

A

(U) kids, benign, self-limiting
Adults (U) a/w tumors

Currant jelly stool

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9
Q

W/ SBO, intestinal dilation seen where?

Exacerbated by?

A

proximal to obstruction

swallowed air, intest secretion

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10
Q

Dilation from SBO leads to?

A

↑ peristalsis ->

compressed lymphatics ->

swelling in lumen ->

↑pressure drives fluid into peritoneum (3rd spacing)

or

necrosis -> leaks bacteria

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11
Q

SBO signs/sxs? (5)

A

1) Abd pain (intermittent initially, then constant)
2) Distention (more C w/ distal obstr)
3) N/V (more C w/ distal obstr)
4) Constipation (pass gas but not stool)
5) Obstipation (can’t pass gas or stool)

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12
Q

SBO sxs that are “bad signs”? (2)

A

Constant pain

Obstipation

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13
Q

Important SBO hx? (5)

A

1) Prior abd surgery?
2) Hernia?
3) CA?
4) N/V/D/C? If so, how long?
5) Pain ↓ or ↑?

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14
Q

Important SBO physical exams? (3)

A

1) VITAL SIGNS (tachy w/ hypoTN = SHOCK/strangulation/sepsis)
2) Bowel sounds (Early = high-pitched w/ rushes, Late = silent)

3) Abdominal palpation (diffuse tenderness)
(Rebound + very still pt = advanced dz)

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15
Q

SBO lab findings:

Electrolytes?

BUN/Cr?

WBC?

Hct?

LDH?

A

Electrolytes = altered

BUN/Cr = elevated (dehydration)

WBC = (U) elevated (late)

Hct = increased if hemoconcentration (late)

LDH = elevated if tissue breakdown (late)

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16
Q

SBO imaging studies? (3)

A

1) Plain films: supine and upright
2) CT scan w/o contrast
3) UGI w/ small bowel follow through

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17
Q

SBO findings on plain films?

A

Dilated bowels
Air-fluid levels
Free air if perforated
30% false negatives

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18
Q

CT w/o contrast indicated for SBO when?

A

Plain films are negative

Do CT first if high clinical suspicion

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19
Q

If very high suspicion for SBO, first action should be?

A

call surgeon (let him decide imaging)

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20
Q

SBO management? (7)

A

1) Volume resuscitation
2) Decompress w/ nasogastric tube
3) NPO
4) Abx
5) Correct e- imbalance
6) Watch vitals
7) Reassess for next 3 days

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21
Q

Paralytic Ileus is?

A

↓ bowel motility with NO obstruction

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22
Q

Paralytic Ileus caused by? (6)

A

1) intra-abd surgery
2) opiates
3) bedrest
4) trauma
5) e-
6) sepsis

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23
Q

Paralytic Ileus presentation? (5)

A

1) No BS
2) Less severe abd pain
3) (P) massive distention
4) N/V
5) Normal vitals

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24
Q

Paralytic Ileus diagnositcs?

Findings on plain films?

A

Same as SBO (ruling this out)

Dilation of small AND large bowels

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25
Q

Paralytic Ileus management? (6)

A

1) Assess for vol restriction
2) Decompress w/ NG tube if N/V
3) NO abx
4) NPO
5) AMBULATE
6) If > 4 days, (P) feeding tube?

26
Q

Large Bowel Obstruction (LBO) caused by? (4)

A

1) Adenocarcinoma (most C)
2) Stricture from diverticulitis/ischemia
3) Volvulus (malrotation)
4) IBD, FB, fecal impact

27
Q

LBO presentation? (5)

A

1) Cramping pain
2) Distention
3) Constipation/Obstipation
4) N/V
5) High-pitched bowel sounds

28
Q

Important LBO hx? (5)

A

1) Chronic rectal bleeding/black stool/∆ in caliber? (signs of CA)
2) Recent bloody stool w/ diarr? (ischemia)
3) LLQ pain w/ diarr? (diverticulitis)
4) How long? (rapid onset = volvulus)
5) Chronic narcotic use or chronic constipation? (compaction)

29
Q

LBO labs? (3)

A

CBC
CMP
LDH

30
Q

LBO imaging?

A

1) Plain films: supine, upright
2) CXR (for perf air)
3) Gastrograffin Enema
4) CT (only if dx still unclear)

31
Q

Possible LBO findings: Plain films? (5)

A

1) Proximal colon distention
2) Rectal air = ileus or PSBO (partial sm bowel)
3) Intraluminal air = ischemia
4) Competent ileocecal valve = higher chance of perf
5) Loss of haustral markings = volvulus

32
Q

Possible LBO findings/uses: Gastrograffin Enema?

A

Uses:
X-Ray unclear,
Identify PSBO vs Obstruction
Localization for surgery

Findings:
“bird beaks” = volvulus

33
Q

Partial LBO management? (5)

If Pseudo-obstruction?

A

1) IV fluids, NPO
2) ABX
3) Decompress if vomiting
4) Slow bowel cleanse
5) No narcotics or anticholinergics

If pseudo-obstr:
neostigmine + decompression

34
Q

Complete LBO management:

Cancer?

Complete Stricture?

Sigmoid Volvulus?

Cecal Volvulus?

Fecal Impaction?

Intussusception?

A

Depends on cause:

Cancer = resection

Complete Stricture = resection

Sigmoid Volvulus = sigmoidoscopy w/ reduction

Cecal Volvulus = resection

Fecal Impaction = H2O/mineral oil enema

Intussusception = barium enema

35
Q

Rectum anatomy?

A

Dentated line at anorectal jxn:
Above = insensate
Below = sensate

Super/Inferior hemorrhoidal veins

36
Q

Hemorrhoids are?

Normal hemorrhoid plexus important for?

A

swollen cluster of vv, aa, CT

protection of vasculature,
sensory (e.g. liquid vs gas)

37
Q

Hemorrhoids (P) cause what? (3)

A

1) allows fecal leakage -> pruritis ani
2) exposes vasculature
3) tissue prolapse

38
Q

Hemorrhoid presentation?

A

bright red blood per rectum,
pain,
itching

39
Q

Important Hemorrhoid hx? (6)

A

R/O other rectal path:

1) qty of blood?
2) color of blood?
3) blood mixed w/ stool? (IBD)
4) recent diar/constip?
5) severe pain w/ BMs? (fissure)
6) d/c or mucus? (IBD, infection)

40
Q

Hemorrhoid diagnostics? (4)

A

1) Rectal (feel for ulcers, fissures, abscess)
2) CBC to eval bleeding
3) Anoscope (visualize)
4) Flexible Sigmoidoscopy (standard of care)

41
Q

Perianal Infections caused by?

A

Obstruction of perianal glands ->
stasis -> infection
(common a/w fistulas)

(U) e coli, anaerobes

42
Q

Perianal infection presentation?

Locations?

A

rectal pain, fullness, fever/chills

Perianal (most C)
Ischiorectal
Intersphincteric
Supralevator

43
Q

Perianal infection diagnostics?

A

Digital rectal

(P) CT/MRI

44
Q

Perianal infection management?

A

I & D w/ anesthesia
(P) drain placement
(P) abx based on culture

45
Q

Fistulas related to rectal dz are?

A

inflammatory tracts connecting abscesses to the skin

46
Q

Fistulas caused by? (3)

A

1) Open/ruptured abscesses
2) Crohn’s
3) Diverticulitis

47
Q

Fistula in Ano is?

A

connection b/w anal canal and skin

48
Q

Fistula presentation?

A

chronic drainage of pus and (P) stool from opening in skin

49
Q

Fistula diagnostics?

A

Exam under anesthesia
MRI if complex/recurrent
Colonoscopy if IBD possible

50
Q

Fistula management?

A

unroofing of fistula tract to allow healing

51
Q

Anal Fissures are?

A

trauma-caused linear tears in lining of anal canal BELOW dentate line

(U) on posterior wall (lowest blood supply here)

52
Q

Anal Fissures are concerns why?

A

Tear causes mm spasm ->
↓ blood flow ->
poor healing

Repeat injury from BMs

53
Q

Anal Fissure presentation?

A

1) Severe rectal pain w/o BM
2) Fear of having BM
3) Rectal bleeding

54
Q

Anal Fissure diagnostics?

A

(U) felt on digital rectal

(P) flex sig/colonoscopy

55
Q

Anal Fissure management?

A 
Stool softener
Sitz baths
Nitroglycerine ointment (↓spam/↑blood flow)
Botox
Surgery if not healed in 3 wks
56
Q

Rectal Prolapse is?

A

protrusion of rectal tissue through anus

57
Q

Rectal Prolapse caused by?

A

Unknown

(P) a/w chronic straining, neuro dz, preggos

58
Q

Rectal Prolapse presentation?

A

mass protruding thru anus,

may start w/ BM and retract

59
Q

Rectal Prolapse exam?

A

Pt strain on toilet to reproduce

60
Q

Rectal Prolapse diagnostics?

A

Defecography (X-ray to see shape/position of emptying rectum)

Anal Manometry if unclear (measure of strength of anal mm)

61
Q

Rectal Prolapse management?

A

all need surgery

62
Q

Rectocele is?

A

rectum bulges into/against vagina

Q4 Clin Med III (GI) (32 decks)

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