Small Intestine/Colon Issues

Question 1

What is acute mesenteric lymphadenitis?

Answer 1

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

Question 2

PE/Clinical presentation of mesenteric adenitis?

Answer 2

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

CT helps with diagnosis

Question 3

Lab test for mesenteric adenitis?

Answer 3

CBC-leukocytosis

Abdominal sonography/CT scan

Question 4

Diverticula disease is defined as?

Answer 4

Colonic diverticula are herniations of mucosa and submucosa through the muscularis

Question 5

DiverticulOSIS is defined as?

Answer 5

asymptomatic presence of multiple colonic diverticula

Question 6

DiverticulITIS is defined as?

Answer 6

inflammatory process or localized perforation of a diverticulum.

LLQ spasm and guarding

Question 7

Painful diverticular disease can present with?

Answer 7

LLQ pain and often relieved by defecation.

Question 8

Crohns disease best but more expensive diagnostic imaging?

Answer 8

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

Question 9

CT of the abdomen for Crohns disease will show?

Answer 9

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

Question 10

UC extraintestinal manifestations?

Answer 10

liver disease

sclerosing cholangitis

Arthritis

Question 11

UC ocular manifestations?

Answer 11

Iritis

Uveitis

Episcleritis

Question 12

UC derm manifestations?

Answer 12

Erythema nodosum (but more common in crohns)

Pyoderma gangrenosum

Question 13

UC mucosa manifestations?

Answer 13

Aphthous stomatitis

Question 14

IBS Rome III diagnostic criteria?

Answer 14

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.

Question 15

Acute appendicitis sxs?

Answer 15

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

Question 16

MCC obstruction of appendicitis in adults?

Answer 16

Fecaliths

Question 17

What imaging is done for suspected appendicitis?

Answer 17

Multidetector CT scan

Question 18

What do you NOT administer for suspected acute appendicitis?

Answer 18

Nothing by mouth

DO NOT administer analgesics or antibiotics until a diagnosis is made

Question 19

General Rx for confirmed acute appendicitis?

Answer 19

IV antibiotic prophylaxis to cover gram-negative bacilli and anaerobes

Question 20

Crohn’s disease mucosal findings?

Answer 20

Cobblestoning, aphthoid and deep ulcers

Question 21

How can Crohn’s be distinguished between UC?

Answer 21

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)

Question 22

Is rectal involvement present in UC?

Answer 22

Yes, if the disease is active

Question 23

Lab test for UC?

Answer 23

ANCA

Question 24

Lab test for Crohns disease?

Answer 24

ASCA

Question 25

Is there nocturnal diarrhea with IBS?

Answer 25

NO!

Question 26

A superior mesenteric artery is susceptible to embolism because?

Answer 26

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

Question 27

What is ischemic bowel disease?

Answer 27

Inadequate flow of oxygenated blood to intestines Results from blockage or narrowing of arteries: ie clot, tumor, atherosclerosis.

Question 28

S/Sx of ischemic bowel disease?

Answer 28

severe post-prandial pain weight loss "fear of eating" acute mesenteric ischemia: severe pain but minimal PE findings.

Question 29

Define chronic mesenteric ischemia?

Answer 29

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)

Question 30

PE findings of chronic mesenteric ischemia?

Answer 30

abdominal bruit weight loss negative CA workup

Question 31

Diagnositic imaging of chronic mesenteric ischemia?

Answer 31

Angiogram (gold standard) Doppler US or MRA

Question 32

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

Answer 32

>60 yrs old with a. fib

Question 33

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

Answer 33

History of coronary artery disease Acute abdominal pain Acute gastrointestinal emptying: N/V/D

Question 34

What is superior mesenteric artery syndrome?

Answer 34

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

Question 35

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

Answer 35

Elderly pts with recent UTI and possible sepsis.

Question 36

Gold standard imaging for Non-occlusive mesenteric ischemia?

Answer 36

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

Question 37

What is mesenteric venous thrombosis (MVT)?

Answer 37

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

Question 38

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

Answer 38

Female, smoker, OCPs, recent trauma: ie MVA. Usually caused by superior mesenteric vein

Question 39

S/Sx of mesenteric venous thrombosis (MVT)?

Answer 39

Mid abdominal colicky pain positive heme stool test N/V/D Anorexia

Question 40

Most helpful imaging for MVT?

Answer 40

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

Question 41

What will an XR show for MVT?

Answer 41

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

Question 42

Where do neoplasms arise in regard to colorectal cancer?

Answer 42

The luminal surface of large bowel 40%-42% in descending colon

Question 43

Cause of colorectal cancer?

Answer 43

3rd MC cancer 2nd leading cause of cancer deaths 90% occur after age of 50 50% are within reach of the flexible sigmoidoscope

Question 44

Family hx of what syndrome increase risk for colorectal cancer?

Answer 44

Peutz-Jeghers syndrome

Question 45

Right-sided colon cancer clinical presentation?

Answer 45

Anemia Dull, vague, uncharacteristic abdominal pain Rectal bleeding Liquid stool May have no symptoms at all

Question 46

Left-sided colon cancer clinical presentation?

Answer 46

Change in bowel habits (constipation, tenesmus, pencil-thin stools) Rectal bleeding (bright red on the surface) Intestinal obstruction (d/t small lumen)

Question 47

Diagnostic test for colon cancer?

Answer 47

Digital rectal exams FOBT CBC-test for anemia Increased CEA LFT-indicated metastasis

Question 48

What age do you start getting a colonoscopy?

Answer 48

Age 50, repeat every 10 yrs if average risk pt

Question 49

What age do African Americans start getting a colonoscopy?

Answer 49

Age 45

Question 50

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

Answer 50

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

Question 51

Get colonoscopy every 1-2 yrs if pt has?

Answer 51

hereditary nonpolyposis CRC personal hx of CRC IDB

Question 52

Is cancer of the small intestine rare or not rare?

Answer 52

Rare- mostly seen with Crohns disease

Question 53

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

Answer 53

Adenocarcinoma- 46% Maybe lymphoma, carcinoid.