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GI > Small Intestine/Colon Issues > Flashcards

Small Intestine/Colon Issues Flashcards

1
Q

What is acute mesenteric lymphadenitis?

A

a syndrome of acute RLQ abdominal pain associated with mesenteric lymph node enlargement and a normal appendix

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2
Q

PE/Clinical presentation of mesenteric adenitis?

A

Pain in the upper abdomen or RLQ, localized in right side but not precise location.

CT helps with diagnosis

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3
Q

Lab test for mesenteric adenitis?

A

CBC-leukocytosis

Abdominal sonography/CT scan

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4
Q

Diverticula disease is defined as?

A

Colonic diverticula are herniations of mucosa and submucosa through the muscularis

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5
Q

DiverticulOSIS is defined as?

A

asymptomatic presence of multiple colonic diverticula

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6
Q

DiverticulITIS is defined as?

A

inflammatory process or localized perforation of a diverticulum.

LLQ spasm and guarding

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7
Q

Painful diverticular disease can present with?

A

LLQ pain and often relieved by defecation.

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8
Q

Crohns disease best but more expensive diagnostic imaging?

A

Magnetic resonance enterography (MRe) it is able to distinguish active from chronic fibrotic disease but is more expensive.

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9
Q

CT of the abdomen for Crohns disease will show?

A

thickening of the terminal ileum and is helpful in identifying abscesses and other complications

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10
Q

UC extraintestinal manifestations?

A

liver disease

sclerosing cholangitis

Arthritis

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11
Q

UC ocular manifestations?

A

Iritis

Uveitis

Episcleritis

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12
Q

UC derm manifestations?

A

Erythema nodosum (but more common in crohns)

Pyoderma gangrenosum

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13
Q

UC mucosa manifestations?

A

Aphthous stomatitis

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14
Q

IBS Rome III diagnostic criteria?

A

recurrent abdominal pain or discomfort at least 3 days per month in the past 3 mos associated with 2 or more following?

  • pain is relieved or improved with defecation
  • its onset is associated w/ a change in the frequency of bowel movement
  • its onset is associated w/ a change in the form or appearance of the stool
  • 3mo w/ sxs onset for at least 6 mos before diagnosis.
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15
Q

Acute appendicitis sxs?

A

Vomiting

Rectal tenderness

Rebound tenderness w/ fever

Pain found in the back or right flank if the appendix is
retrocecal

Psoas sign

Obturator sign

Rovsing sign

McBurney’s sign

Subcutaneous hyperesthesias

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16
Q

MCC obstruction of appendicitis in adults?

A

Fecaliths

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17
Q

What imaging is done for suspected appendicitis?

A

Multidetector CT scan

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18
Q

What do you NOT administer for suspected acute appendicitis?

A

Nothing by mouth

DO NOT administer analgesics or antibiotics until a diagnosis is made

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19
Q

General Rx for confirmed acute appendicitis?

A

IV antibiotic prophylaxis to cover gram-negative bacilli and anaerobes

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20
Q

Crohn’s disease mucosal findings?

A

Cobblestoning, aphthoid and deep ulcers

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21
Q

How can Crohn’s be distinguished between UC?

A

presence of transmural involvement and the frequent presence of noncaseating granulomas and lymphoid aggregates on bx.
- skips lesions, but UC goes from abnormal to normal (no skipping)

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22
Q

Is rectal involvement present in UC?

A

Yes, if the disease is active

23
Q

Lab test for UC?

A

ANCA

24
Q

Lab test for Crohns disease?

A

ASCA

25
Q

Is there nocturnal diarrhea with IBS?

A

NO!

26
Q

A superior mesenteric artery is susceptible to embolism because?

A

of the vessel caliber and a narrow-angle of departure from the aorta

27
Q

What is ischemic bowel disease?

A

Inadequate flow of oxygenated blood to intestines

Results from blockage or narrowing of arteries: ie clot, tumor, atherosclerosis.

28
Q

S/Sx of ischemic bowel disease?

A

severe post-prandial pain

weight loss “fear of eating”

acute mesenteric ischemia: severe pain but minimal PE findings.

29
Q

Define chronic mesenteric ischemia?

A

Intermittent severe ischemia results in abdominal colic beginning 15-30 min postprandially, lasting 1-2 hrs and severe atherosclerosis of 2 or all 3 (superior, inferior and celiac)

30
Q

PE findings of chronic mesenteric ischemia?

A

abdominal bruit

weight loss

negative CA workup

31
Q

Diagnositic imaging of chronic mesenteric ischemia?

A

Angiogram (gold standard)

Doppler US or MRA

32
Q

Usual age and medical hx of a pt with superior mesenteric artery embolism?

A

> 60 yrs old with a. fib

33
Q

Triad of sudden onset of sxs with superior mesenteric artery embolism?

A

History of coronary artery disease

Acute abdominal pain

Acute gastrointestinal emptying: N/V/D

34
Q

What is superior mesenteric artery syndrome?

A

vomiting believed to be secondary to compression of the duodenum by the superior mesenteric artery

35
Q

Non-occlusive mesenteric ischemia usually presents in what age population with what medical hx?

A

Elderly pts with recent UTI and possible sepsis.

36
Q

Gold standard imaging for Non-occlusive mesenteric ischemia?

A

Colonoscopy

However, CT scan and MRI may show ischemia and angiogram may show narrowing

37
Q

What is mesenteric venous thrombosis (MVT)?

A

thrombotic occlusion of the mesenteric venous system involving major trucks or smaller branches and leading to intestinal infarction in its acute form

38
Q

Common presentation of a pt with mesenteric venous thrombosis (MVT)?

A

Female, smoker, OCPs, recent trauma: ie MVA.

Usually caused by superior mesenteric vein

39
Q

S/Sx of mesenteric venous thrombosis (MVT)?

A

Mid abdominal colicky pain

positive heme stool test

N/V/D

Anorexia

40
Q

Most helpful imaging for MVT?

A

CT scan: will show bowl wal thickening, venous dilation, and venous thrombus

41
Q

What will an XR show for MVT?

A

ileus, ascites, bowel dilation, bowel wall thickening loop separation, thumb printing.

42
Q

Where do neoplasms arise in regard to colorectal cancer?

A

The luminal surface of large bowel

40%-42% in descending colon

43
Q

Cause of colorectal cancer?

A

3rd MC cancer

2nd leading cause of cancer deaths

90% occur after age of 50

50% are within reach of the flexible sigmoidoscope

44
Q

Family hx of what syndrome increase risk for colorectal cancer?

A

Peutz-Jeghers syndrome

45
Q

Right-sided colon cancer clinical presentation?

A

Anemia

Dull, vague, uncharacteristic abdominal pain

Rectal bleeding

Liquid stool

May have no symptoms at all

46
Q

Left-sided colon cancer clinical presentation?

A

Change in bowel habits (constipation, tenesmus, pencil-thin stools)

Rectal bleeding (bright red on the surface)

Intestinal obstruction (d/t small lumen)

47
Q

Diagnostic test for colon cancer?

A

Digital rectal exams

FOBT

CBC-test for anemia

Increased CEA

LFT-indicated metastasis

48
Q

What age do you start getting a colonoscopy?

A

Age 50, repeat every 10 yrs if average risk pt

49
Q

What age do African Americans start getting a colonoscopy?

A

Age 45

50
Q

When do you get a colonoscopy if pt has 1-2 relatives with hx of CRC?

A

Every 5 yrs beginning at age 40 or 10 yr younger than the earliest diagnosis.

51
Q

Get colonoscopy every 1-2 yrs if pt has?

A

hereditary nonpolyposis CRC

personal hx of CRC

IDB

52
Q

Is cancer of the small intestine rare or not rare?

A

Rare- mostly seen with Crohns disease

53
Q

What is the MC type of cancer found in the small intestines?

A

Adenocarcinoma- 46%

Maybe lymphoma, carcinoid.

GI (16 decks)

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