pathology 4 Irritable bowel syndrome-Appendicitis-Diverticula of the GI tract- Zenker diverticulum Meckel diverticulum Malrotation Volvulus Intussusception Flashcards
• Irritable bowel syndrome is diagnosed if at least two of what three criteria are met?
Recurrent abdominal pain that improves after defecation, change in stool frequency, and change in the appearance of stool
• A 40-y/o woman has irregular bowel movements and pain that subsides after defecation. She asks if these symptoms are likely to be chronic.
Yes (the patient likely has irritable bowel syndrome, which has chronic symptoms)
• What is the treatment for irritable bowel syndrome?
Since the symptoms fluctuate, it is important to reassess the patient’s chief complaint and treat the current symptoms
A 13-year-old boy has sharp pain that started at the umbilicus and then migrated toward the right. What test can confirm the diagnosis?
Ultrasound can confirm appendicitis, but cannot not rule it out if clinical suspicion is high (the painful spot is the McBurney point)
A boy has 2 days of fever, vomiting, and severe abdominal pain. On work-up, the RLQ is tender and WBC count elevated. What is the treatment?
Surgery (appendectomy for appendicitis)
A 21-year-old woman presents with diffuse periumbilical pain and nausea. Other than appendicitis, what condition should be ruled out?
Ectopic pregnancy (ruled out by a β-human chorionic gonadotropin test)
A 7-year-old boy is transferred to your ED for suspected appendicitis. What signs would you check for on your physical exam?
Psoas, obturator, and Rovsing signs, & may see pain at the McBurney point, guarding, and rebound tenderness
In children, what causes appendicitis?
Obstruction by lymphoid hyperplasia (as opposed to fecaliths in adults)
What is a diverticulum?
A blind pouch leading off of the alimentary tract that communicates with the lumen of the tract
What is the difference between a true diverticulum and a false diverticulum?
True diverticulum contains three layers (mucosa, submucosa, serosa), whereas false diverticulum contains only two layers (mucosa, submucosa)
A 62-year-old man with known diverticulosis has a screening colonoscopy. Where would you most expect to observe a diverticulum?
The sigmoid colon
What is the etiology of diverticulosis?
Increased intraluminal pressure combined with focal weakness of the colonic wall
A patient is concerned about her likelihood of developing diverticulosis. What dietary change do you suggest?
Increase the amount of dietary fiber
A 57-year-old woman presents with vague abdominal discomfort and painless rectal bleeding. What is the most likely diagnosis?
Diverticulosis
Diverticulitis classically causes pain in what region of the abdomen?
The left lower quadrant (most commonly occurs in the sigmoid colon)
A man with fevers and rectal bleeding is found to have diverticulitis. What are the four most common potential complications?
Perforation, peritonitis, abscess formation, and bowel stenosis
A 73-y/o man admitted for LLQ pain and rectal bleeding develops pneumaturia on day 4 of hospitalization. What complication has occurred?
Colovesical fistula (one of the more common complications of diverticulitis)
After being diagnosed with diverticulitis, your patient asks about the mainstay of treatment. What do you respond?
Antibiotics, although surgery may be required
A patient’s vasa recta perforate the muscularis externa. What is the diagnosis?
Pseudodiverticulum or false diverticulum
An 80-year-old woman has vague GI discomfort and hematochezia, along with many people her age. She will most likely have what diagnosis?
Diverticulosis
A patient has symptoms similar to appendicitis but instead has the pain on the left side. What is highest on your differential?
Diverticulitis (left-sided appendicitis)
What is a Zenker diverticulum?
Herniation of mucosal tissue at Killian triangle, between the thyropharyngeal/cricopharyngeal parts of the inferior pharyngeal constrictor
Is Zenker diverticulum a true or false diverticulum?
False diverticulum (it contains only the mucosa and submucosa—a true diverticulum involves all three layers)
A patient presents with halitosis and decreased oral intake due to discomfort on swallowing. What is the most likely diagnosis?
Zenker diverticulum
In what age and gender group is Zenker diverticulum most common?
Elderly men
What is the most common congenital anomaly of the gastrointestinal tract?
Meckel diverticulum
A 19-month-old boy has a congenital anomaly causing melena and RLQ pain. What are some potential complications?
Intussusception, volvulus, colonic obstruction (this is a Meckel diverticulum
Approximately what size is a typical Meckel diverticulum?
2 inches (the five 2’s: 2 inches long, 2 feet from ileocecal valve, 2% of population, first 2 years of life, 2 epithelial types)
How far are Meckel diverticula typically located from the ileocecal valve?
2 feet (the five 2’s: 2 inches long, 2 feet from ileocecal valve, 2% of population, first 2 years of life, 2 epithelial types)
In approximately what percentage of the population can Meckel diverticula be found?
2% (the five 2s: 2 inches long, 2 feet from ileocecal valve, 2% of population, first 2 years of life, 2 epithelial types)
When in life do Meckel diverticula typically present?
First 2 years (the five 2s: 2 inches long, 2 feet from ileocecal valve, 2% of population, first 2 years of life, 2 epithelial types)
A 16-month-old girl has had melena for the past 7 weeks, and sometimes clutches her RLQ. What test can confirm the most likely diagnosis?
Pertechnetate uptake by ectopic gastric mucosa to confirm Meckel diverticulum (in some cases, appendicitis may need to be ruled out)
A patient with a Meckel diverticulum has significant pain. What is most likely to be causing it?
Gastric acid secretion from ectopic tissue growth (gastric and/or pancreatic)
A newborn has a cystic dilation of the vitelline duct found on exam. Do you need to perform a pertechnetate study?
No, as this finding is more consistent with an omphalomesenteric cyst rather than a Meckel diverticulum
An infant is born with an atypical bowel position and Ladd bands on plain film. What is a potential complication of this condition?
Volvulus, duodenal obstruction (this is malrotation in which Ladd bands are peritoneal bands that can obstruct the colon)
Malrotation of the gut is due to improper rotation of what fetal structure during development?
The midgut
An infant has twisting of a portion of the bowels around its mesentery. Where is this twisting likely to occur?
Midgut (this is volvulus)
A 3-year-old presents with loose stools and severe but intermittent lower abdominal pain. What section of the GI tract is likely affected?
The ileocecal junction (this is intussusception, which often presents with classic “currant jelly” stools)
Is intussusception found more commonly in adults or infants?
Infants
An adult with telescoping bowel on imaging should receive a colonoscopy for what associated condition?
Colon cancer (this is intussusception, which may be a presenting sign of colon cancer in adults)
A young child presents with abdominal pain. Abdominal ultrasound shows a “bull’s eye” appearance to a loop of bowel. Do you call surgery?
Yes, as this finding is classically associated with intussusception, which is an abdominal emergency
