Small Intestine/Colon Issues Flashcards
What is acute mesenteric lymphadenitis?
a syndrome of acute RLQ abdominal pain associated with mesenteric lymph node enlargement and a normal appendix
PE/Clinical presentation of mesenteric adenitis?
Pain in the upper abdomen or RLQ, localized in right side but not precise location.
CT helps with diagnosis
Lab test for mesenteric adenitis?
CBC-leukocytosis
Abdominal sonography/CT scan
Diverticula disease is defined as?
Colonic diverticula are herniations of mucosa and submucosa through the muscularis
DiverticulOSIS is defined as?
asymptomatic presence of multiple colonic diverticula
DiverticulITIS is defined as?
inflammatory process or localized perforation of a diverticulum.
LLQ spasm and guarding
Painful diverticular disease can present with?
LLQ pain and often relieved by defecation.
Crohns disease best but more expensive diagnostic imaging?
Magnetic resonance enterography (MRe) it is able to distinguish active from chronic fibrotic disease but is more expensive.
CT of the abdomen for Crohns disease will show?
thickening of the terminal ileum and is helpful in identifying abscesses and other complications
UC extraintestinal manifestations?
liver disease
sclerosing cholangitis
Arthritis
UC ocular manifestations?
Iritis
Uveitis
Episcleritis
UC derm manifestations?
Erythema nodosum (but more common in crohns)
Pyoderma gangrenosum
UC mucosa manifestations?
Aphthous stomatitis
IBS Rome III diagnostic criteria?
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.
Acute appendicitis sxs?
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
MCC obstruction of appendicitis in adults?
Fecaliths
What imaging is done for suspected appendicitis?
Multidetector CT scan
What do you NOT administer for suspected acute appendicitis?
Nothing by mouth
DO NOT administer analgesics or antibiotics until a diagnosis is made
General Rx for confirmed acute appendicitis?
IV antibiotic prophylaxis to cover gram-negative bacilli and anaerobes
Crohn’s disease mucosal findings?
Cobblestoning, aphthoid and deep ulcers
How can Crohn’s be distinguished between UC?
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)
Is rectal involvement present in UC?
Yes, if the disease is active
Lab test for UC?
ANCA
Lab test for Crohns disease?
ASCA
Is there nocturnal diarrhea with IBS?
NO!
A superior mesenteric artery is susceptible to embolism because?
of the vessel caliber and a narrow-angle of departure from the aorta
What is ischemic bowel disease?
Inadequate flow of oxygenated blood to intestines
Results from blockage or narrowing of arteries: ie clot, tumor, atherosclerosis.
S/Sx of ischemic bowel disease?
severe post-prandial pain
weight loss “fear of eating”
acute mesenteric ischemia: severe pain but minimal PE findings.
Define chronic mesenteric ischemia?
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)
PE findings of chronic mesenteric ischemia?
abdominal bruit
weight loss
negative CA workup
Diagnositic imaging of chronic mesenteric ischemia?
Angiogram (gold standard)
Doppler US or MRA
Usual age and medical hx of a pt with superior mesenteric artery embolism?
> 60 yrs old with a. fib
Triad of sudden onset of sxs with superior mesenteric artery embolism?
History of coronary artery disease
Acute abdominal pain
Acute gastrointestinal emptying: N/V/D
What is superior mesenteric artery syndrome?
vomiting believed to be secondary to compression of the duodenum by the superior mesenteric artery
Non-occlusive mesenteric ischemia usually presents in what age population with what medical hx?
Elderly pts with recent UTI and possible sepsis.
Gold standard imaging for Non-occlusive mesenteric ischemia?
Colonoscopy
However, CT scan and MRI may show ischemia and angiogram may show narrowing
What is mesenteric venous thrombosis (MVT)?
thrombotic occlusion of the mesenteric venous system involving major trucks or smaller branches and leading to intestinal infarction in its acute form
Common presentation of a pt with mesenteric venous thrombosis (MVT)?
Female, smoker, OCPs, recent trauma: ie MVA.
Usually caused by superior mesenteric vein
S/Sx of mesenteric venous thrombosis (MVT)?
Mid abdominal colicky pain
positive heme stool test
N/V/D
Anorexia
Most helpful imaging for MVT?
CT scan: will show bowl wal thickening, venous dilation, and venous thrombus
What will an XR show for MVT?
ileus, ascites, bowel dilation, bowel wall thickening loop separation, thumb printing.
Where do neoplasms arise in regard to colorectal cancer?
The luminal surface of large bowel
40%-42% in descending colon
Cause of colorectal cancer?
3rd MC cancer
2nd leading cause of cancer deaths
90% occur after age of 50
50% are within reach of the flexible sigmoidoscope
Family hx of what syndrome increase risk for colorectal cancer?
Peutz-Jeghers syndrome
Right-sided colon cancer clinical presentation?
Anemia
Dull, vague, uncharacteristic abdominal pain
Rectal bleeding
Liquid stool
May have no symptoms at all
Left-sided colon cancer clinical presentation?
Change in bowel habits (constipation, tenesmus, pencil-thin stools)
Rectal bleeding (bright red on the surface)
Intestinal obstruction (d/t small lumen)
Diagnostic test for colon cancer?
Digital rectal exams
FOBT
CBC-test for anemia
Increased CEA
LFT-indicated metastasis
What age do you start getting a colonoscopy?
Age 50, repeat every 10 yrs if average risk pt
What age do African Americans start getting a colonoscopy?
Age 45
When do you get a colonoscopy if pt has 1-2 relatives with hx of CRC?
Every 5 yrs beginning at age 40 or 10 yr younger than the earliest diagnosis.
Get colonoscopy every 1-2 yrs if pt has?
hereditary nonpolyposis CRC
personal hx of CRC
IDB
Is cancer of the small intestine rare or not rare?
Rare- mostly seen with Crohns disease
What is the MC type of cancer found in the small intestines?
Adenocarcinoma- 46%
Maybe lymphoma, carcinoid.
