UW Flashcards
guy has bubbles in his urine also has diverticulitis and UTI, this is most commonly due to diverticular disease and presents with pneumaturia (air) , fecaluria, or urinary tract infection. Abdominal CT scan with oral or rectal (not intravenous) contrast can confirm the diagnosis by showing contrast material in the bladder with thickened colonic and vesicular walls
**Colovesical fistula **
guy has has watery diarrhea and in past her had his cecum and lower small bowl removed, this can develop after ileocecal resection due to colonic bacteria entering the small intestine. The gold standard for diagnosis is* jejunal aspirate* with a quantitative culture of intestinal fluid; however, this test is invasive. Instead, SIBO can be confirmed with a carbohydrate breath test.
Small intestinal bacterial overgrowth (SIBO)
woman incsidntly found Dense mass in liver on CT with central scaring , asymptomatic, this is a benign liver lesion due to an aberrant congenital artery. It is usually found incidentally in young women and is marked by the presence of a stellate central scar and radiating fibrous bands.
Focal nodular hyperplasia
woman with Women on long-term oral contraceptives, what liver mass
Hepatic adenoma
livre mass with Acute or chronic liver injury (eg, cirrhosis)
Regenerative nodules
liver mass with Systemic symptoms
Chronic hepatitis or cirrhosis
Elevated ɑ fetoprotein
Hepatocellular carcinoma
inliver Single/multiple lesions
Known extrahepatic malignancy
Liver metastasis
this occurs when the cecum and ascending colon twist on their mesentery, forming a closed-loop obstruction. Progressive abdominal pain and distension, along with nausea/vomiting, are typical. Abdominal x-ray may reveal a large, dilated loop of colon.
Cecal volvulus
this (eg, due to malignancy) can cause abdominal distension and pain; however, x-ray typically reveals an enlarged gastric bubble with decompressed bowel distally.
Gastric outlet obstruction
can cause self-resolving episodes of abdominal pain and vomiting. However, because the mechanical obstruction occurs in the distal small bowel (ie, ileum), x-ray typically reveals multiple, dilated small-bowel loops
leocolic intussusception (prolapse of the ileum into the colon)
(intestinal obstruction due to dysfunctional peristalsis) typically causes generalized distension of the large and small bowel on x-ray.
Paralytic ileus
can cause colonic dilation on x-ray. However, x-ray typically reveals diffuse dilation of the colon within its normal anatomic arrangement rather than a single, dilated colonic loop, as in cecal volvulus. In addition, patients typically appear toxic (eg, fever, altered sensorium) and often have bloody diarrhea.
Toxic megacolon
is a life-threatening complication of esophageal instrumentation. Clinical presentation may include severe chest/back pain, fever, and a widened mediastinum on chest x-ray. Water-soluble contrast esophagography can confirm the diagnosis.
Esophageal perforation
Patients with this disease, especially those who have required intestinal surgery in the past, are at high risk for future complications and often need aggressive management with biologic and/or immunomodulator therapy. Smoking is strongly associated with increased severity and progression of this disease
severe Crohn
Rapid onset of periumbilical pain (often severe)
Pain out of proportion to examination findings
Hematochezia, risk factor are Atherosclerosis and Hypercoagulable disorders and Laboratory studies typically show leukocytosis, elevated hemoglobin, elevated amylase, and metabolic acidosis. we need to do Mesenteric angiography if diagnosis is unclear adn CT (ifpreferred)
Acute mesenteric ischemia
Sigmoidoscopy is an effective tool for evaluating lesions in the distal colon but does not visualize the right colon. Patients with left-sided adenomas or adenocarcinomas detected on sigmoidoscopy have increased risk for synchronous neoplasia on the right side and require visualization of the entire colon with
colonoscopy
BMI ≥40 kg/m2 or BMI ≥35 kg/m2 with serious comorbidity (eg, T2DM, hypertension, OSA) with revious attempts at weight loss, diet, exercise habits and with risk for cardiac (eg, CAD) and pulmonary (eg, OSA) disease waht to do
Preparation for bariatric surgery
is common in those from Eastern Asia, Eastern Europe, and South America. It generally presents with progressive epigastric pain and weight loss. Friable tumor vessels can bleed into lumen, leading to iron deficiency anemia. Metastasis to the liver can result in hepatomegaly and elevated transaminases and alkaline phosphatase
Gastric cancer
typically occurs in the setting of severe malnutrition due to alcohol use disorder, substance use disorder, or psychiatric illness. Common manifestations include prominent cutaneous findings (eg, follicular hyperkeratosis, perifollicular hemorrhage, ecchymosis, petechiae), gingivitis (eg, recessed gums that bleed easily, dental caries), and impaired wound healing. Diagnosis is made with plasma or leukocyte
Scurvy (vitamin C deficiency)
is warranted for patients with Clostridioides (formerly Clostridium) difficile infection that progresses despite appropriate medical management, especially when abdominal symptoms worsen or when megacolon or increased serum lactate is present. Peritonitis (Surgical evaluation) is a definitive indication
Surgical evaluation (eg, laparotomy).
This patient with abdominal pain, fever, and peritonitis (eg, abdominal rigidity) has subdiaphragmaticfree air on lateral decubitus x-ray, indicating perforated viscus.** Small-bowel obstruction** can be complicated by bowel perforation. Free air on x-ray and clinical signs of peritonitis should prompt
emergent surgical exploration
Barium enema and upper gastrointestinal series use contrast to outline the lumen of the gastrointestinal tract for diagnosis of functional or structural abnormalities (eg, obstructing mass). However, barium contrast is contraindicated if
perforation is suspected
This patient has risk factors (eg, hyperlipidemia, 50-pack-year smoking history) for chronic mesenteric ischemia (which can be evaluated by what and tpically causes recurrent episodes of postprandial pain
ontrast angiography
this patient developed abdominal pain, nausea, vomiting, abdominal distension and absent bowel sounds following a traumatic injury. Abdominal x-ray demonstrates gastric dilation and gas-filled loops of both the small and large intestines, suggesting
paralytic (adynamic) ileus.
syndrome should be suspected in patients with multiple duodenal ulcers refractory to treatment or ulcers distal to the duodenum or associated with chronic diarrhea. In these patients, inactivation of pancreatic enzymes by increased production of stomach acid may lead to malabsorption.
Zollinger-Ellison
is characterized by acute abdominal pain and lower gastrointestinal bleeding. It typically follows an episode of hypotension and most commonly affects arterial watershed areas at the splenic flexure and rectosigmoid junction. CT scan may show a thickened bowel wall. Colonoscopy can confirm the diagnosis.
schemic colitis
Thrombosed external hemorrhoids usually appear as purple or blue anal bulges below the dentate line and may cause severe pain. Although conservative management (eg, fiber, stool softeners, topical anti-inflammatories and antispasmodics) is usually indicated, patients with severe pain should undergo
hemorrhoidectomy under local anesthesia.
infrared coagulation, rubber band ligation, and sclerotherapy are all used to treat symptomatic nonthrombosed internal hemorrhoids that fail conservative management. These techniques are avoided with external hemorrhoids because their location below the dentate is highly innervated and these procedures would cause
severe pain
n patients with mild and nondebilitating pain, thrombosed external hemorrhoids can resolve with conservative management consisting of stool softeners, sitz baths, and topical anti-inflammatories and antispasmodics (eg, glucocorticoid suppositories, nitroglycerin cream). This patient has excruciating pain. ( Antibiotics are indicated for perirectal abscesses but are not usually required )
do surgery-hemorrhoidectomy
