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SI/Colon Flashcards

1
Q

A young female presents with generalized LLQ pain that is worsened with food and relieved with defecation, what diagnosis are you thinking?

A

IBS

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2
Q

How do you diagnose IBS?

A

Diagnosis of exclusion

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3
Q

What kind of lab work are you doing to lead you to IBS?

A

CBC, ESR, stool for blood, thyroid, and colonoscopy

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4
Q

What type of treatment can you offer your patient with IBS?

A

Avoid triggers, emotional support, dietary therapy, tricyclic antidepressants, and probiotics

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5
Q

Your patient presents with severe cramping and abdominal pain, they state that they have not been able to pass gas or stool over the past 2 days, what diagnosis are you thinking?

A

Bowel obstruction

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6
Q

How would you describe the decrease or absence of intestinal peristalsis? (like after surgery)

A

Paralytic ileus

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7
Q

How would you describe twisting of the intestine?

A

Volvulus

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8
Q

How would you describe telescoping of the intestine?

A

Intussusception

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9
Q

What would you look for on PE with bowel obstruction?

A

Change in bowel sounds. Or sounds above & none below. Percussion - dense

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10
Q

How would you diagnose a bowel obstruction?

A

Abdominal x-ray (start) – upright to see air fluid levels or dilated loops of bowel

Could do an abdominal CT

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11
Q

How would you treat someone with a bowel obstruction?

A

Relieve the pressure (suction with nasal cannula), relieve obstruction, surgery is possible

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12
Q

What are some consequences of missing a bowel obstruction?

A

Tissue death, perforation, sepsis, and death

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13
Q

A patient presents with sudden severe abdominal pain they describe as a 10/10 with diarrhea, vomiting, and fever. What diagnosis are you thinking?

A

Mesenteric Ischemia

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14
Q

What typically causes mesenteric ischemia?

A

Narrowing of the mesenteric arteries (chronic) or a sudden blockage of artery by embolus. It’s in the SMALL INTESTINE, resulting in decreased oxygenated blood flow.

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15
Q

What is happening in Ischemic colitis?

A

Inflammation or injury to the LARGE INTESTINE that results in decreased blood flow.

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16
Q

How would you diagnose mesenteric ischemia?

A

CT of abdomen with contrast is GOLD STANDARD; mesenteric angiogram followed by x-ray to determine the blockage. A duplex US of the mesenteric arteries may be helpful initially as well.

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17
Q

Wait, how would you know the bowel isn’t perforated?

A

Think about higher fever & peritonitis (sxs)

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18
Q

How do you treat mesenteric ischemia?

A

Surgical – stent/removal of emboli

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19
Q

What happens if we fail to detect mesenteric ischemia?

A

Necrosis of bowel, perforation, sepsis, and death (quickly)

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20
Q

What does diverticulum mean?

A

Sac-like protrusion in the colonic wall

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21
Q

What does diverticulosis mean?

A

The condition of having diverticula

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22
Q

What does diverticulitis mean?

A

Inflammation/infection of the diverticula.

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23
Q

How does diverticula present?

A

Often asymptomatic but may have BRB in stool

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24
Q

If a patient has a diverticula, what do we need to educate them about?

A

Avoid seeds, strawberries, popcorn (anything that can “catch”)

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25
Q

What type of patient is at risk for diverticulitis?

A

Connective tissue disorders with out-pouchings, low fiber diet, and too little exercise

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26
Q

If a patient has severe abdominal pain in the LLQ, with a fever, what diagnosis might it be?

A

Diverticulitis

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27
Q

What labs would help confirm diverticulitis?

A

Occult blood in stool – otherwise diagnosis of exclusion (UA, preg test, LFT’s, pelvic exam)

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28
Q

What PE exam must you do on a female with abdominal pain?

A

pelvic exam!

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29
Q

What would you see on PE with diverticulitis?

A

Normal

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30
Q

Is there any imaging that can be done to diagnose diverticulitis?

A

CT scan is best

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31
Q

Should you ever use barium if you suspect perforation?

A

Heck no!!

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32
Q

How would you treat a patient with diverticulitis?

A

Fluids, bed rest, ABx, may need surgical

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33
Q

How can we prevent diverticulitis?

A

High fiber diet!

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34
Q

A young female patient presents with 3 day history of diarrhea and RLQ pain. She states it has been a large volume of diarrhea that has blood in it and also appears to have mucous, what diagnosis are you thinking?

A

Crohn’s

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35
Q

Another young female patient presents with loose, bloody stools, and urgency for BM. She has some pain in the LLQ. What diagnosis might you be thinking?

A

Ulcerative colitis

36
Q

When does the pain increase in Crohn’s?

A

After eating

37
Q

What is occurring in Crohn’s disease?

A

Skip lesions – anywhere from mouth to anus.

38
Q

What is occurring in Ulcerative Colitis?

A

There is a CONTINUOUS lesion(s) only in the colon

39
Q

How can you confirm diagnosis of Crohn’s or UC?

A

Colonoscopy!

40
Q

If a colonoscopy shows a thin colon wall with continuous inflammation, mucous lining intact, and no granulomas, what diagnosis are you thinking?

A

UC

41
Q

If a colonoscopy shows cobblestones & granulomas, what diagnosis do you think?

A

Crohn’s

42
Q

What can develop in Crohn’s patients?

A

Fistulas! That can spread to other organs – even the skin!

43
Q

What labs might you need to check with Crohn’s & UC?

A

CBC (check anemia), ASCA,LFT’s, Vit B12 & D, stool studies for occult blood, leukocytosis, and culture to R/O infection.

44
Q

How do we treat UC?

A

Removal of colon = curative

45
Q

Between UC & Crohn’s which one typically has obstruction and weight loss as well?

A

Crohn’s

46
Q

What’s a protective factor for UC?

A

Smoking…

47
Q

Between UC & Crohn’s which one can lead to toxic megacolon & higher risk for colon cancer?

A

UC

48
Q

If your patient with UC presents now with severe cramping and distention, with rebound tenderness, what diagnosis might you be thinking?

A

Toxic megacolon

49
Q

What is occurring in toxic megacolon?

A

Acute toxic colitis with dilation and immobility of the colon.

50
Q

What causes toxic megacolon?

A

Occurs with inflammation, obstruction, infection (like c diff)

51
Q

How do you confirm diagnosis of toxic megacolon?

A 
X-ray = transverse colon 
>6cm + (3 of 4) 
Temp >101.5; 
HR>120bpm; 
leukocytosis >10.5; 
and anemia.
\+ (1 of these) dehydration, altered mental status, hypotension, and electrolyte abnormality.
52
Q

How do we treat toxic megacolon?

A

Reduce distention (NG tube), correct fluid/electrolytes, and treat toxemia (abx or steroids)

May need surgery due to risk of perforation & sepsis (colectomy)

53
Q

What type of patient can we see toxic megacolon in?

A

Narcotic addicts

54
Q

A patient presents with sudden onset of RLQ pain, with a loss of appetite for the past 24 hours, what do you immediately think of?

A

Appendicitis

55
Q

What is the most common cause of appendicitis?

A

Fecalith – leakacge of cecum contents or blockage

56
Q

What is the most common abdominal surgery?

A

Appendicitis

57
Q

What PE findings do you have with appendicitis?

A

McBurney’s point, Rovsings sign, rebound tenderness, Psoas sign, and obturator

58
Q

What do we need to remember about how appendicitis may present initially vs 12 hours later?

A

Initial umbilicus, then McBurney’s, the rebound tenderness

59
Q

What imaging can we do for appendicitis?

A

CT (you don’t have to)

60
Q

How do we treat appendicitis?

A

Surgical intervention; when you suspect surgical consult if suspected!!

61
Q

A patient presents with bowel pattern changes, diarrhea, excessive gas/bloating with fatigue & weakness, what diagnosis are you thinking?

A

Celiac

62
Q

What is celiac disease?

A

Autoimmune disorder of small intestine – intolerance to gluten

63
Q

What other symptoms may a person with celiac have?

A

Dermatitis Herpetiformis (on buttocks & extensor surfaces that itches)

64
Q

How do we diagnose a patient with celiac disease?

A

Lab – anti-tTG antibodies or anti-endomysium antibodies (IgA)

65
Q

How do we treat celiac disease?

A

Gluten free diet (may need to stop dairy until inflammation resolves)

Abx for dermatitis herpetiformis

66
Q

What is considered “normal” for bowel movements?

A

2/day – 3/week

67
Q

So what then is constipation?

A

Decrease in stool volume and an increase in stool firmness accompanied by straining x 3 months with no obstructive or peristalsis disorder

68
Q

How do we confirm diagnosis of constipation?

A

R/O obstruction, rectal exam R/O impaction, x-ray for bowel gas pattern, complete ROS, abdominal exam

69
Q

How do we treat constipation?

A

No evidence of serious disease = diet (increase fiber), fluid intake, activity, and medication evaluation

70
Q

Where in the GI tract is it least likely to have a cancer occur?

A

small intestine (only 2%)

71
Q

When do we often diagnose small intestine cancer?

A

Once it has metastasized = deadly

72
Q

How would we diagnose small intestine cancer?

A

CBC, electrolytes, LFT’s, CT, and endoscopy

73
Q

If a patient has jaundice and you have R/O liver, GB, and pancreas. What body part should you think of?

A

Small intestine - cancer

74
Q

Where in the GI tract is it most common for cancer to occur?

A

Colorectal

75
Q

If a patient presents with colic type abdominal pain, with bleeding, a change in bowel habits, and a thin appearance, what diagnosis are you thinking?

A

Colorectal cancer

76
Q

What are some risk factors to developing colorectal cancer?

A

Genetic predisposition, polyps, diet (high in fat & refined carbs)

77
Q

What might someone with colorectal cancer also have?

A

iron-deficiency anemia, hypoalbuminemia, occult blood in stool, elevated alk phosphatase

78
Q

If alkaline phosphatase is elevated, what do you need to think of?

A

Can indicate colonic cancer, liver, or bone

79
Q

How would you confirm diagnosis of colorectal cancer?

A

X-ray = “apple core” appearance!

80
Q

What are the screening guidelines for colorectal cancer?

A

Colonoscopy every 10 years age 50 – 75

FOBT = every year

Flex sig = every 5 years

81
Q

If a patient presents with maroon colored stool, melena, and fatigue, what diagnosis are you thinking?

A

Angiodysplasia

82
Q

What is angiodysplasia?

A

Swollen, fragile blood vessels of the colon due to age and degeneration of blood vessels

83
Q

How do you diagnose angiodysplasia?

A

Colonoscopy or CT

84
Q

How do you treat angiodysplasia?

A

Most stop bleeding, if not – cautery via colonoscopy

85
Q

If a patient presents with diarrhea, bloating, gas, and pain after consuming dairy product, what diagnosis?

A

Lactose Intolerance

GI (6 decks)

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