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70 Cards in this Set

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Chronic inflammation of the mucosa (UC or Crohn's)
Ulcerative Colitis
Which disease is also known as "Regional Enteritis" or "Granulomatous Colitis"?
Crohn's disease
Which disease exhibits "skip lesions," UC or Crohn's?
Crohn's disease
Which disease is more likely to develop toxic megacolon, UC or Crohn's?
Ulcerative Colitis
Which disesase affects all of the layers of intestine, UC or Crohn's?
Crohn's disease
Which disease, on endoscopy, reveals a "cobblestone pattern," UC or Crohn's?
Crohn's disease
In which disease is surgery curative, UC or Crohn's?
Ulcerative Colitis
Which disease has a greater risk of developing cancer, UC or Crohn's?
Ulcerative Colitis
Which disease recurs after surgery, UC or Crohn's?
Crohn's disease
Which disease is more likely to have rectal bleeding, UC or Crohn's?
Ulcerative Colitis
Which disease is more likely to have strictures, fistulas, and abscesses?
Crohn's disease
Which disease is worsened by smoking, UC or Crohn's?
Crohn's disease (Ulcerative Colitis is improved by smoking)
What are intestinal complications of Ulcerative Colitis?
• Abscess • Carcinoma • Fistula • Fissures • Hemorrhage • Perforation • Polyposis • Stricture
What are systemic complications of Ulcerative Colitis?
• Anemia • Ankylosing spondylitis • Arthritis • Iritis • Liver damage • Sclerosing cholangitis • Skin lesions • Stomatitis
What is the treatment of Ulcerative Colitis?
• Azulasalzine (Azulfadine): most commonly used agent • Corticosteroids • Immunosuppressant (Imuran • Antidiarrheals • Surgery (is curative)
When is surgery performed for treatment of Ulcerative Colitis?
• Colonic perforation • Dysplasia • Intractable disease • Toxic Megacolon
What is "lead-pipe"?
a barium enema in patients with ulcerative colitis, caused by loss of haustration
What is the most common area affected by Crohn's disease?
• terminal ileum, but can affect other areas of the bowel • can affect from "mouth to anus"
What are extraintestinal findings of Crohn's diseas?
• Eye (episcleritis) • Hepatomegaly • Joints (swelling, tenderness) • Skin (erythema nodosum)
What are complications of Crohn's disease?
• Diarrhea (due to bile acid malabsorption) • Gallstones • Kidney stones • Vitamin deficiency (poor absorption of fat-soluble vitamins)
What is the treatment of Crohn's disease?
• Azulfadine • Metronidozole • Corticosteroids • Immunosuppressants • Surgery (only for obstruction lesions, draining abscess, and resection of fistulas) • Low residue diet & B12 injections
What is Toxic Megacolon?
• extreme inflammation and distention of the colon
What are causes of toxic megacolon?
• ambieasis • Ulcerative Colitis • Crohn's disease • Hirchprung's disease
What is Hirschsprung disease?
the absence of colonic nerve plexus
What diagnostic tests are contraindicated with Toxic Megacolon?
• Barium enema • Colonoscopy
What are signs & symptoms of ischemic colitis?
• severe post-prandial epigastric pain • pain out of proportion to the exam
What area is most often affected in Ischemic Colitis?
left colon at the splenic flexure or sigmoid colon
What can be seen on barium xray on a patient with ischemic colitis?
thumb print sign
What is the most common digestive disorder seen in family practice?
Irritable Bowel Syndrome (IBS)
What are symptoms of IBS?
• Alternating diarrhea & constipation • Abdominal bloating • Pain relieved by defecation • Passage of mucous
What is the name of the criteria for defining IBS?
Rome criteria
What is the definition of diverticulosis?
• Herniation of the colon mucosa through the muscularis usually at the perforation nutrient artery to form small little pouches • can be caused by low fiber diets which cause an increase in luminal pressure
What is the most common location of diverticulosis?
sigmoid and distal colon
What are symptoms of diverticulitis?
• Abdominal pain, most commonly, in left lower quadrant • Altered bowel habits • Constipation & obstructive symptoms • Fever • Hematochezia • Malaise • Nausea & Vomiting • Tender rectal exam
What diagnostic studies should and should not be done to confirm diverticulitis?
• CT scan should be done • No sigmoidoscopy or Barium enema • Plain abdomen film may show pneumoperitoneum • Ultrasonography can identify inflammatory mass or abscess
What is the most common congenital anomaly of the GI tract?
Meckel Diverticulum
What is the Rule of 2's with Meckel Diverticulum?
• 2% of the population • 2:1 male-to-female ratio • (within) 2 feet from ileocecal valve • 2 inches long • 2 things confused with (ulcer & appendicitis) • 2 types of ectopic tissue (gastric & pancreatic) • 2 complications (hemorrhage & perforation)
What are some complications of Meckel diverticulum?
• hemorrhage (due to eroision of mucosa by acid produced by ectopic gastric mucosa) • volvulus • intussusception
What is the most common surgical emergency?
appendicitis
What is the principal cause of appendicitis?
luminal obstruction (fecolith)
What are symptoms of appendicitis?
• Periumbilical pain which localized to RLQ • Anorexia • Dysuria • Fever • Nausea & Vomiting
What are signs of appendicitis?
• Low grade fever • Mass in RLQ • Psoas/Obturator signs • Rectal pain • RLQ tenderness & rebound tenderness • Rovsing sign: pain in RLQ with palpation in LLQ
What is a MANTRELS score?
Pneumonic to evaluate for appendicitis • M (migration of pain to the RLQ = 1 pt) • A (anorexia = 1 pt) • N (nausea = 1 pt) • T (tenderness in RLQ = 2 pts) • R (rebound pain = 1 pt) • E (elevated temperature = 1) • L (leukocytosis = 2 pts) • S (shift of WBC to the left = 1 pt)
What are key tests to do when evaluating for appendicitis?
• CBC • Urine & pregnancy test • CT scan
What is the treatment for appendicitis?
• Surgery • IV Antibiotics (Flagyl c Gent, Cefotetan) • NPO • Analgesics
What is Angiodysplasia?
• a condition of dilated & fragile blood vessels in the colon that results in intermittent los of blood from the GI tract • related to the aging and degeneration of blood vessels
What are other names of angiodysplasia?
• Colonic arteriovenous malformation • Colonic angiomas • Vascular ectasia of the colon
What diagnostic studies are used to diagnose angiodysplasia?
colonoscopy or angiography
What are different types of colon polyps?
• Adenomatous (can cause rectal bleeding & are potentially malignant) • Hamartomatous (an outgrowth of normal cells of that organ into a tumor mass) • Hyperplastic (usually never malignant, common in rectum) • Inflammatory (caused by defective mucosal healing & seen in chronic inflammatory bowel disease)
What are characteristics of Familial Polyposis Syndrome?
• multiple polyps throughout GI tract • rare, autosomal dominant-inherited • asymptomatic, bleeding, or colorectal ca symptoms • can develop colorectal cancer 10-15 yrs post-onset
What are characteristics of Gardner's Syndrome?
• varient of familial polyposis of the colon • characterized by GI polyps, multiple osteomas, and skin & soft tissue tumors • cutaneous findings include epidermoid cysts, desmoid tumors • polyps have a 100% risk of undergoing malignant transformation
What are characteristics of Peutz-Jeghers syndrome?
• Hamartomas • mucocutaneous pigmentation of the perioral, perinasal areas • can cause intussusception & rectal prolapse • 50% will die from cancer by age 57
What are the different cell types with colon cancer?
• Adenocarcinoma (most common ~ 95%) • Lymphomas (1-4% and 33% of small bowel) • Leiomyosarcoma (1-2%) • Carcinoid tumors • Metastatic tumors
What are symptoms of colon cancer?
• Painless rectal bleeding or change of bowel habits (most common) • Anemia • Anorexia • Abdominal mass • Weight loss
What percentage of colon cancers are near the sigmoid area?
80%
What patients are at high risk for colon cancer?
• patients w/ a personal history of colorectal ca or adenomatous polyps • strong family history of colorectal ca or polyps • personal history of chronic inflammatory bowel disease • family history of a hereditary colorectal cancer syndrome
What elevated lab levels indicate that colon cancer has metastasized?
elevated 5-nucleotidase or alk phos levels
Describe the Dukes Classification for colon cancer
• A: mucous membrane of the bowel only (5 yr survival > 80%) • B: Muscle (5 yr survival 60-80%) • C1: few nodes ( 5 yr survival ~ 50%) • C2: many nodes • D: distant metastasis (5 yr survival ~ 25%)
What is the definition of hemorrhoids?
• dilated veins within the anal canal & distal rectum • caused by straining, heavy lifting, & occasionally by intra-abdominal pressure
What line separates external hemorrhoids from internal hemorrhoids?
dentate line
What are symptoms of hemorrhoids?
• anal pruritis • perianal soiling • rectal bleeding
What is the treatment of anal fissures?
• topical NTG ointment • Botox
What is a hernia?
an abnormal protrusion of the viscous with its sac through the wall of the cavity that it normal occupies
True/False: Hernias are the most common cause of small bowel obstruction
Hernias are the 2nd most common cause of SBO. Adhesions are #1. The correct answer is: False
What are the 2 types of inguinal hernias?
• Indirect (congenital) • Direct (acquired)
Which type of inguinal hernia is more common, indirect or direct?
indirect are the most common hernias in both men and women
Femoral hernias follow the tract below the inguinal ligament through the femoral canal. Where does the femoral canal lie?
medial to the femoral vein and lateral to the lacunar (Gimbernat) ligament
What is a reducible hernia?
refers to the ability to return the contents of the hernia in the abdominal cavity (either spontaneously or manually)
What is an incarcerated hernia?
• no longer reducible • vascular supply of the bowel is not compromised • bowel obstruction is common
What is a strangulated hernia?
ocurs when the vascular supply of the bowel is compromised secondary to incarceration of hernia contents