Reviewer #4 Flashcards
A common, chronic functional disorder meaning that no organic cause is currently know
IRRITABLE BOWEL SYNDROME
Symptoms of IBS that are intermittent and may occur for years
Abdominal pain or discomfort and alterations in bowel patterns
Associated with development and exacerbation of IBS
Depression, anxiety, sexual abuse, posttraumatic stress disorders
IBS is more frequently diagnosed in
Women
The key to accurate diagnosis is a thorough
History and physical examination
Diagnostic tests are selectively used to rule out other disorders such as
Colorectal cancer
The go-to resource for identifying poop that may be indicative of a health problem
Bristol Stool Chart
A synthetic opioid that slows intestinal transit, may be used to treat diarrhea when it occurs
Loperamide
A serotonergic antagonist is used for IBS patients with severe symptoms of pain and diarrhea
Alosetron (Lotronex)
Alosetron is available only in a restricted access program for women who have
Not responded to other IBS therapies
Approved for the treatment of IBS with constipation in women
Lubiprostone (Amitiza)
Approved for the treatment of IBS with constipation in men and women
Linaclotide (Linzess)
Low doses of tricyclic antidepressants seem beneficial, possibly because they
Decrease peripheral nerve sensitivity
Inflammation of the appendix, a narrow blind tube that extends from the inferior part of the cecum
APPENDICITIS
A common cause of appendicitis is
Obstruction of the lumen by a fecalith (accumulated feces)
Appendicitis begins with
Periumbilical pain, followed by anorexia, nausea, and vomiting
The pain of appendicitis is
Persistent and continuous, eventually shifting to the right lower quadrant and localizing at McBurney’s point
Halfway between the umbilicus and the right iliac crest
McBurney’s point
Magnifies the pain in Appendicitis
Coughing, sneezing, and deep inhalation
Rebound tenderness
Blumberg’s Sign
Pain in the right lower quadrant with palpation of left lower quadrant
Rovsing’s Sign
Pain on internal rotation of right thigh (pelvic appendix)
Obturator’s Sign
Pain on extension of right thigh (retroperitoneal retrocecal appendix)
Psoas Sign
Increased pain with coughing
Dunphy’s Sign
Mildly to moderately elevated in most cases of appendicitis
WBC count
Done to rule out genitourinary conditions that mimic the manifestations of appendicitis
Urinalysis
The preferred diagnostic procedure, but ultrasound is also used
CT Scan
If diagnosis and treatment are delayed, the appendix can
Rupture, and the resulting peritonitis can be fatal
The treatment of appendicitis is
Immediate surgical removal (APPENDECTOMY) if the inflammation is localized
Are administered before surgery
Antibiotics and fluid resuscitation
If the appendix has ruptured and there is evidence of peritonitis or an abscess
Parenteral fluids and antibiotic therapy are given for 6 to 8 hours before the appendectomy to prevent dehydration and sepsis
Especially dangerous because the resulting increased peristalsis may cause perforation of the appendix
Laxatives and Enemas
Begins the day of surge or the first postoperative day. The diet is advanced as tolerated
Ambulation
Results from a localized or generalized inflammatory process of the peritoneum
Peritonitis
Occurs when blood-borne organisms enter the peritoneal cavity
Primary Peritonitis
Much more common. It occurs when abdominal organs perforate or rupture and release their contents (bile, enzymes, and bacteria) into the peritoneal cavity
Secondary peritonitis
The most common symptom of peritonitis
Abdominal pain
A universal sign of peritonitis is
Tenderness over the involved area
Other signs of irritation of the peritoneum
Rebound tenderness, muscular rigidity, and spasm
Patients may lie still and take only shallow breaths because
Movement causes pain
Complications of peritonitis
Hypovolemic shock, sepsis, intraabdominal abscess formation, paralytic ileus, and acute respiratory distress syndrome
A chronic inflammation of the GI tract
Inflammatory Bowel Disease (IBD)
IBD is characterized by
Periods of remission interspersed with periods of exacerbation
There is no cure for IBD and its cause is
Unknown
IBD is classified as either
Crohn’s Disease or Ulcerative Colitis
The inflammation involves all layers of the bowel wall
Crohn’s disease
Chrons can occur anywhere in the GI tract from the mouth to the anus but occurs most commonly in the
Terminal ileum and colon
Segments of normal bowel can occur
between diseased portions, the so-called
Skip Lesions
a disease of the colon and rectum
ULCERATIVE COLITIS
a characteristic feature of damage
to the colonic mucosa epithelium
Diarrhea with large fluid and electrolyte
losses
In ulcerative colitis and Crohn’s disease,
manifestations are often the same
diarrhea,
bloody stools, weight loss, abdominal pain,
fever, and fatigue)
Depending on the severity of the disease,
patients are treated with either a
“stepdown” or “step-up” approach
uses less toxic
therapies (e.g., aminosalicylates and
antimicrobials) first, and more toxic
medications (e.g., biologic and targeted
therapy) are started when initial
therapies do not work
The step-up approach
contains
sulfapyridine and 5-aminosalicylic acid (5-
ASA) accounts for its therapeutic benefits for
IBD. It’s exact mechanism of action is
unknown, but topical application to the
intestinal mucosa suppresses
proinflammatory cytokines and other
inflammatory mediators
Sulfasalazine
are used to achieve remission in
IBD. It is given for the shortest possible time
because of side effects associated with longterm use
Corticosteroids such as Prednisolone and
Budesonide
Immunosuppressants
are given to maintain
remission after corticosteroid induction
therapy
has also been found to be
effective for treatment of Crohn’s disease,
but patients may suffer flu-like symptoms,
bone marrow depression, and liver
dysfunction
Methotrexate
Since ulcerative colitis affects only the colon
a total proctocolectomy is curative
occurs when
intestinal contents cannot pass through
the GI tract. The obstruction may occur in
the small intestine or colon and can be
partial or complete, simple or strangulated
INTESTINAL OBSTRUCTION
usually resolves with
conservative treatment, whereas a
complete obstruction usually requires
surgery
partial obstruction
loop
Herniation
connected tissue
Adhesions
part of intestine slides
into an adjacent part of the intestine
Intussusception
loop of intestine
Volvulus
a detectable
occlusion of the intestinal lumen. Most
intestinal obstructions occur in the small
intestine
Mechanical obstruction
the most common
cause of small bowel obstructions and can
occur within days of surgery or several
years later
Surgical adhesion
The most common cause of colon
obstruction is
cancer, followed by
diverticular disease
may result
from a neuromuscular or vascular disorder
Nonmechanical obstruction
is the most common form of nonmechanical
obstruction
Paralytic (adynamic) ileus (lack of
intestinal peristalsis and bowel sounds)
One clue is that
bowel sounds usually
return before postoperative adhesions
develop
a mechanical
obstruction of the intestine without
demonstration of obstruction by
radiologic methods
Pseudo-obstruction
are rare and are the
result of an interference with the blood
supply to a portion of the intestines
Vascular obstruction
The most important early manifestations
of a small bowel obstruction are
colicky
abdominal pain, nausea, vomiting, and
abdominal distention
Patients with obstructions in the proximal
small intestine rapidly develop
nausea and
vomiting, which is sometimes projectile
and contains bile
that looks like stool
indicates a long-standing obstruction
requiring immediate surgery
Foul-smelling vomitus
usually relieves abdominal pain
in higher intestinal obstructions
Vomiting
is seen
in patients with lower intestinal
obstruction
Persistent, colicky abdominal pain
Strangulation causes
severe, constant pain
that is rapid in onset
Is usually absent or
minimally noticeable in proximal small
intestine obstructions and markedly
increased in lower intestinal obstructions
Abdominal distention
usually absent unless strangulation or
peritonitis has occurred
Abdominal tenderness and rigidity
Auscultation of bowel sounds reveals
highpitched sounds above the area of
obstruction. Bowel sounds may also be
absent
The patient often notes
borborygmi
(audible abdominal sounds produced by
hyperactive intestinal motility)
borborygmi
may
provide direct visualization of an
obstruction in the colon
Sigmoidoscopy or colonoscopy
Elevated hematocrit values may reflect
hemoconcentration
is performed if the
bowel is strangulated, but many bowel
obstructions resolve with conservative
treatment
Emergency surgery
Initial medical treatment of bowel
obstruction caused by adhesions includes
placing the patient on NPO status,
inserting an NG tube for decompression,
providing IV fluid therapy with either
normal saline or lactated Ringer’s solution
The treatment goal for the patient with a
malignant bowel obstruction is to
regain
patency and resolve the obstruction
is the
third most common form of cancer and
responsible for 9% of cancer deaths
COLORECTAL CANCER
CRC is more common in
men
is the most common
type of CRC. Approximately 85% of CRCs
arise from adenomatous polyps
Adenocarcinoma
the gold standard for CRC
screening because the entire colon is
examined (only 50% of CRCs are detected
by sigmoidoscopy), biopsies can be
obtained, and polyps can be immediately
removed and sent to the laboratory for
examination
Colonoscopy
is a
complex glycoprotein sometimes
produced by CRC cells
Carcinoembryonic antigen (CEA)
used
for Stage 1 tumors, especially those in the
left colon
Laparoscopic surgery
Low-risk stage 2 tumors are treated with
wide resection and reanastomosis
Stage 3 tumors are treated with
surgery
and chemotherapy
Once the cancer has spread to distant sites
(Stage 4),
surgery is palliative, and
chemotherapy is directed at controlling
the spread
may be used to provide pain
relief
Radiation
In rectal cancer, the surgeon has three
major options:
Local excision
o Abdominal-perineal resection (APR) with
a permanent colostomy, and
o Low anterior resection (LAR) to preserve
sphincter function
are saccular dilations or
outpouchings of the mucosa that develop
in the colon
Diverticula
is inflammation of the
diverticula, resulting in perforation into
the peritoneum
Diverticulitis
occurs when pockets
referred to as diverticula, form in the wall
of the colon
Diverticulosis
occurs when these pockets
become infected or swollen
Diverticulitis
Diverticula may occur anywhere in the GI
tract but are most found in the left
(descending, sigmoid) colon
Diverticulitis is characterized by
inflamed
diverticula and increased luminal
pressures that cause erosion of the bowel
wall, and thus perforation into the
peritoneum
The most common symptoms of
diverticulitis are
acute pain in the left
lower quadrant (location of sigmoid
colon), a palpable abdominal mass, and
systemic symptoms of infection (fever,
increased C-reactive protein, and
leukocytosis with a shift to the left)
can be asymptomatic
and is typically discovered during routine
sigmoidoscopy or colonoscopy
Diverticular disease
a protrusion of the viscus
(internal organ such as the intestine)
through an abnormal opening or a
weakened area in the wall of the cavity in
which it is normally contained
HERNIA
Most common, occurs at a weakness in the abdominal wall where the spermatic cord (men) or round ligament (women) emerges.
Inguinal Hernia
Occurs through the femoral ring into the femoral canal; more common in women.
Femoral Hernia
Occurs due to weak rectus muscle or failure of umbilical closure after birth
Umbilical Hernia
Develops at the site of a previous incision due to weak abdominal muscles.
Ventral/Incisional Hernia
Surgical repair for hernia
Herniorrhaphy
Reinforcement with mesh for hernia
Hernioplasty
For strangulated hernias.
Emergency Surgery
An autoimmune disorder causing damage to the small intestine due to ingestion of gluten (wheat, barley, rye).
Celiac Disease
Classic Symptoms of CD
Foul-smelling diarrhea, steatorrhea, flatulence, abdominal distention, malnutrition.
Daignostics for CD
Serologic tests (anti-tTG, EMA antibodies).
Small intestine biopsy.
The abnormal dilatation and distortion of the vascular channel, together with destructive changes in the supporting connective tissue within the anal cushion
Hemorrhoids
Inside the rectum, not painful but may cause bleeding.
Internal Hemorrhoids
Outside the anus, painful and may swell.
External Hemorrhoids
No prolapse
Grade I
Prolapse during defecation but reduces spontaneously.
Grade II
Requires manual reduction.
Grade III
Cannot be reduced manually.
Grade IV
Cuts off blood supply to hemorrhoid.
Rubber Band Ligation
Injection to shrink hemorrhoid.
Sclerotherapy
Using heat, infrared, or laser.
Cauterization
Removal of hemorrhoids.
Hemorrhoidectomy
A pruritic, vesicular skin lesion, called
dermatitis herpetiformis
Thrombosis of the subcutaneous external hemorrhoidal veins of the anal canal rather than a true hemorrhoid
THROMBOSED EXTERNAL HEMORRHOIDS
lack of
intestinal peristalsis and bowel sounds
paralytic ileus
