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87 Cards in this Set
- Front
- Back
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LARGE INTESTINE FUNCTIONS
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ABSORPTION OF WATER, ELECTROLYTES AND COMPACTION OF INTESTINAL CONTENTS TO FORM FECES; ABSORPTION OF VITAMINS PRODUCED BY BACTERIA; STORAGE OF FECES PRIOR TO EXCRETION BY DEFECATION
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BLIND POUCH INFERIOR TO ILEOCECAL SPHINCTER
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CECUM
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WHAT IS THE APPENDIX ATTACHED TO?
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MEDIAL-POSTERIOR PORTION OF THE CECUM
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LOCATION OF RECTUM
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ANTERIOR TO THE SACRUM AND COCCYX
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WHY DOES THE RECTUM EXPAND?
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EXPANDABLE TO ACCOMODATE FECES
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TERMINAL PORTION OF THE RECTUM
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ANAL CANAL
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LAYERS OF THE LARGE INTESTINE
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MUCOSA, SUBMUCOSA, MUSCULARIS, AND SEROSA
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DRAWBACK TO FLEX SIG
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DOESN'T GO TO TRANSVERSE OR ASCENDING COLON SO WE USE COLONOSCOPY
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THE SYMPTOMS IN THIS INTESTINAL DISORDER ARE NOT EXPLAINED BY STRUCTURAL OR BIOCHEMICAL ABNORMALITIES
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IRRITABLE BOWEL SYNDROME
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EXTREMELY COMMON CHRONIC FUNCTIONAL DISORDER CHARACTERIZED BY A VARIABLE COMBINATION OF RECURRENT ABDOMINAL PAIN AND ALTERATIONS IN BOWEL HABITS
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IRRITABLE BOWEL SYNDROME
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DEPRESSION IS A CONCERN WITH WHAT ILLNESS
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IRRITABLE BOWEL SYNDROME
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TREATMENT FOR IRRITABLE BOWEL SYNDROME
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ALLEVIATION OF SYMPTOMS BUT THERE IS NOT A CURE
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PATHOPHYSIOLOGY OF THIS CONDITION: ABNORMAL MOTILITY, VISCERAL HYPERSENSIVITY, ENTERIC INFECTION, PSYCHOSOCIAL ABNORMALITIES
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IRRITABLE BOWEL SYNDROME
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DESCRIBE ABNORMAL MOTILITY IN IRRITABLE BOWEL SYNDROME
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MYOELECTRICAL AND MOTOR ABNORMALITIES IN COLON AND SMALL BOWEL; MAY CORRELATE WITH ABDOMINAL PAIN AND EMOTIONAL STRESS
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DESCRIBE VISCERAL HYPERSENSITIVITY IN IRRITABLE BOWEL SYNDROME
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LOW VISCERAL PAIN THRESHOLD, BLOATING AND DISTENTION COMPLAINTS EVEN IF THEY HAVE NORMAL GAS VOLUMES; RECTAL URGENCY DESPITE SMALL RECTAL STOOL VOLUMES
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DESCRIBE ENTERIC INFECTION IN IRRITABLE BOWEL SYNDROME
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DUE TO CHRONIC INFLAMMATORY CHANGES IN BOWEL, BACTERIAL OVERGROWTH LEADS TO ALTERATION IN IMMUNE ALTERATIONS AFFECTING MOTILITY OR VISCERAL SENSITIVITY
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PSYCHOSOCIAL ABNORMALITIES IN IRRITABLE BOWEL SYNDROME
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OVER 50% OF PATIENTS HAVE UNDERLYING DEPRESSION, ANXIETY, OR SOMATIZATION; CHRONIC STRESS
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WHEN DO IBS SYMPTOMS USUALLY BEGIN?
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LATE TEENS TO TWENTIES
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HOW LONG MUST IBS PATIENTS PRESENT BEFORE DIAGNOSIS IS MADE?
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AT LEAST 3 MONTHS
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THREE CATEGORIES OF IBS
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PREDOMINANTLY CONSTIPATION, PREDOMINATELY DIARRHEA, OR ALTERNATING (ONLY IN 10%)
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ALARM SYMPTOMS IN SUSPECTED IBS ***
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ACUTE ONSET, 4O YEARS OR OLDER (NORMALLY IT APPEARS IN TEENS OR TWENTIES), SEVERE CONSTIPATION/DIARRHEA, NOCTURNAL DIARRHEA, HEMATOCHEZIA***, WEIGHT LOSS***, FEVER, FAMILY HISTORY OF CANCER, IBD, OR CELIAC DISEASE***
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PE ON IRRITABLE BOWEL SYNDROME
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USUALLY NO SIGNIFICANT FINDINGS, MAY HAVE MILD LOWER ABDOMINAL TENDERNESS, REASSURE PATIENTS
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IF DIAGNOSIS CRITERIA FOR IBS IS FULFILLED AND IN THE ABSENCE OF ALARM SYMPTOMS, WHAT DO YOU LIMIT THE LABS TO?
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CBC, CHEM PANEL, SERUM ALBUMIN; NOT WARRANTED--- ESR, STOOL TESTS, ENDOSCOPY, BARIUM ENEMA
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IF DIARRHEA IS PRESENT WITH IBS, WHAT TEST CAN YOU DO?
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SEROLOGIC TEST FOR CELIAC DISEASE
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DIFFERENTIAL DIAGNOSIS FOR IBS
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COLONIC CANCERS, THYROID DISORDERS, MALABSORPTION, PSYCHIATRIC DISORDERS (DEPRESSION, ANXIETY, PANIC)
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COMMON DIETARY INTOLERANCES
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BROWN BEANS, BRUSSEL SPROUTS, CABBAGE AND CAULIFLOWER, RAW ONIONS, GRAPES AND PLUMS, COFFEE, RED WINE, CAFFEINE, FATTY FOODS
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LACTOSE FREE DIET FOR PATIENTS WITH IBS IF PATIENT HAS WHAT SYMPTOM
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DIARRHEA
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FOR THOSE IBS PATIENTS WITH CONSTIPATION, WHAT DIET THERAPY IS RECOMMENDED?
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HIGH FIBER DIET (BRAN POWDER)
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RESERVE DRUGS FOR IBS PATIENTS WHEN?
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THEY HAVE SEVERE SYMPTOMS THAT DO NOT RESPOND TO MORE CONSERVATIVE MEASURES
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WHAT ANTISPASMODIC AGENT IS USED FOR IBS?
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BENTYL (ANTICHOLINERGIC AGENT-- LESSEN BLOATING AND ABDOMINAL PAIN AFTER EATING)
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ANTIDIARRHEAL DRUG FOR IBS
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LOPERAMIDE--CAN BE USED PROPHYLACTICALLY WHEN DIARRHEA IS EXPECTED (STRESSFUL TIMES) OR WHEN SOCIAL ENGAGEMENT IS COMING
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ANTICONSTIPATION AGENTS USED FOR IBS
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LAXATIVES AND FIBER SUPPLEMENTS
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PSYCHOTROPIC AGENTS THAT USED FOR IBS
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TRICYCLIC ANTIDEPRESSANTS- USEFUL F/ DIARRHEA DOMINANT; NORTRIPTYLINE, DESIPRAMINE, IMIPRAMINE; SSRI; MAY HELP OVERALL SENSE OF WELL BEING
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NEW PSYCHOTROPIC AGENTS FOR IBS
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TEGASROD AND ALOSETRON
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BEHAVIORAL THERAPY; RELAXATION TECHNIQUES; HYPNOTHERAPY; PSYCH EVAL; PAIN TREATMENT CENTER---ALTERNATIVE THERAPY FOR WHAT?
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IBS
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DESCRIBE ANTIBIOTIC ASSOCIATED DIARRHEA (DON'Y CONFUSE WITH ANTIBIOTIC ASSOCIATED COLITIS)
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COMMON CLINICAL OCCURRENCE THAT IS MILD DIARRHEA AND DOES NOT REQUIRE LABS OR TX; WILL SPONTANEOUSLY RESOLVE AFTER STOPPING ANTIBIOTIC
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ANTIBIOTIC ASSOCIATED COLITIS USUALLY CAUSED BY WHAT
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C DIFFICILE
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MOST SUSCEPTIBLE TO ANTIBIOTIC ASSOCIATED COLITIS
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HOSPITALIZED PATIENTS
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LOPERAMIDE IS WHAT DRUG? DOSE?
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IMMODIUM AS NEEDED 2 MG PO; CAN ALSO USE LIMOTOL---CONTROLLED SUBSTANCE (2.5 OR 5 MG)
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ANTIBIOTIC ASSOCIATED COLITIS MOST COMMONLY DEVELOPS AFTER USE OF WHAT ANTIBIOTICS
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AMPICILLIN, CLINDAMYCIN, AND CEPHALOSPORINS
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SIGNS AND SYMPTOMS OF ANTIBIOTIC ASSOCIATED COLITIS
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MILD TO MODERATE WATERY DIARRHEA WITH LOWER ABDOMINAL CRAMPS (GREENISH AND FOUL SMELLING); STOOLS HAVE MUCOUS BUT SELDOM CAUSE GROSS BLOOD; EXAM NORMAL OR LLQ TENDERNESS
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MORE SERIOUS SYMPTOMS OF ANTIBIOTIC ASSOCIATED COLITIS
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ABDOMINAL PAIN AND PROFUSE WATERY DIARRHEA, FEVER UP TO 104, ABDOMINAL TENDERNESS, LEUKOCYTES
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WHAT WILL THE WBC COUNT BE IN ANTIBIOTIC ASSOCIATED COLITIS?
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UP TO 50000 (HIGH)
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SPECIAL EXAMS/TESTS FOR ANTIBIOTIC ASSOCIATED COLITIS
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STOOL STUDIES FOR C DIFICILE; EIA FOR TOXIN A AND B; FECAL LEUKOCYTES IN ONLY 50% OF PATIENTS
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DIAGNOSIS IN MILD TO MODERATE CASES OF ANTIBIOTIC ASSOCIATED COLITIS BY WHAT?
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STOOL TOXIN ASSAY
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SEVERE CASES OF ANTIBIOTIC ASSOCIATED COLITIS MAY HAVE TO BE DIAGNOSED BY?
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FLEXIBLE SIGMOIDOSCOPY PROVIDES MOST RAPID DIAGNOSIS (NORMALLY LEFT SIDED THAT IS WHY WE CAN DO FLEX SIG INSTEAD OF COLONOSCOPY)---WILL SEE MARKED PSEUDOMEMBRANOUS FORMATION IN SEVERE CASES
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DIFFERENTIAL DIAGNOSES IN ANTIBIOTIC ASSOCIATED COLITIS
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IBD, ISCHEMIC COLITIS, OTHER INFECTIOUS PATHOGENS
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TREATMENT OF ACUTE ANTIBIOTIC ASSOCIATED COLITIS
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DISCONTINUE ABX THERAPY IF POSSIBLE; SPECIFIC THERAPY FOR BAD DIARRHEA; DRUG OF CHOICE IS FLAGYL 500 MG PO TID FOR 2 WEEKS
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DIVERTICULAR DISEASES OCCUR SECONDARY TO WHAT?
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LOW FIBER, HIGHER INTRALUMINAL PRESSURES
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WHAT PERCENTAGE OF LOWER GI BLEEDS ARE FROM DIVERTICULOSIS?
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50%
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VERY COMMON DISEASE OF THE COLON THAT IS NORMALLY ASYMPTOMATIC THAT INCLUDES COMPLICATION OF LOWER GI BLEEDS AND DIVERTICULITIS
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DIVERTICULAR DISEASE
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PHYSICAL FINDINGS IN DIVERTICULITIS
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LOW GRADE FEVER, LLQ TENDERNESS WITH PALPABLE MASS, STOOL OCCULT BLOOD COMMON, HEMATOCHEZIA RARE, LEUKOCYTOSIS IS MILD TO MODERATE
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SIGNS AND SYMPTOMS IN DIVERTICULITIS
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RANGE FROM MILD TO SEVERE, ACHING ABDOMINAL PAIN IN LLQ, CONSTIPATION OR LOOSE STOOLS, NAUSEA AND VOMITING
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WHAT TYPE OF IMAGING IN DIVERTICULITIS?
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PLAIN ABDOMINAL FILMS ARE OBTAINED ASAP ON ALL; LOOK FOR EVIDENCE OF FREE ABDOMINAL AIR, ILEUS, OR A SMALL OR LARGE BOWEL OBSTRUCTION
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IF PATIENTS WITH DIVERTICULOSIS ARE SEVERE, WHAT HAPPENS?
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THEY ARE HOSPITALIZED; IF NO IMPROVEMENT AFTER 2-4 DAYS A CT OF THE ABDOMEN IS OBTAINED
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WHAT IMAGING IS CONTRAINDICATED IN DIVERTICULITIS?
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COLONOSCOPY, ENDOSCOPY, AND BARIUM ENEMA
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WHEN DO YOU DO COLONOSCOPY OR BARIUM ENEMA IN DIVERTICULITIS?
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AFTER 7 TO 10 DAYS AFTER ACUTE ATTACK (TO CORROBORATE THE DX AND R/O CANCER)
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DIFFERENTIAL DIAGNOSIS FOR DIVERTICULITIS
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PERFORATED COLONIC CARCINOMA; CROHN'S DISEASE, APPENDICITIS, C DIFICILE COLITIS, ISCHEMIA COLITIS, GYNECOLOGIC DISORDERS
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FISTUAL FORMATIONS OF DIVERTICULITIS MAY INVOLVE WHAT ORGANS?
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BLADDER, URETER, VAGINA, UTERUS, BOWEL, OR ABDOMINAL WALL
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STRICTURE FORMATION OF THE COLON IN DIVERTICULITIS MAY CAUSE WHAT?
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PARTIAL OR COMPLETE OBSTRUCTION
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WHAT IS DRUG THERAPY FOR DIVERTICULITIS?
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MILD SYMPTOMS AND NO SIGNS OF PERITONITIS- FLAGYL PLUS CIPROFLOXACIN, SEPTRA, OR LEVAQUIN; ALT- AUGMENTIN; SURGERY IF NO IMPROVEMENT FOR 2-3 DAYS OR ABSCESS LARGER THAN 4 CM
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WHEN DO YOU HOSPITALIZE DIVERTICULITIS PATIENTS?
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HIGH FEVERS, PERITONEAL SIGNS, OR INCREASING SYMPTOMS----WILL NEED NPO, NG DRAINAGE, IV FLUID SUPPORT, IV ANTIBIOTICS CEFOXITIN OR PIPERACILLIN
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YOU CAN HAVE ELECTIVE SURGERY FOR DIVERTICULITIS WHEN WHAT IS THERE?
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FISTULAS AND COLONIC OBSTRUCTION
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WHAT DO RECURRENT ATTACKS OF DIVERTICULITIS WARRANT?
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ELECTIVE SURGICAL RESECTION
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DESCRIBE DIVERTICULAR BLEEDING
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PAINLESS ACUTE ONSET OF HEMATOCHEZIA W/O PRECEDING SYMPTOMS; USUALLY LARGE COLUMN OF BRIGHT RED BLOOD OR MAROON BLOOD
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WHAT PERCENT OF DIVERTICULITIS PATIENTS DEVELOP LOWER GI BLEED?
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5%
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DIVERTICULA BLEED MORE OFTEN WHEN THEY ARE ON WHAT SIDE?
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RIGHT
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SIGNS AND SYMPTOMS OF DIVERTICULAR BLEEDING
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ACUTE ONSET OF ABDOMINAL CRAMPING FOLLOWED BY PASSAGE OF LARGE AMOUNT OF BLOOD; MAY HAVE SIGNS OF HYPOVOLEMIA; DO TILTS; ABDOMINAL EXAM WILL BE NORMAL
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WHEN DO YOU DO COLONOSCOPY ON DIVERTICULAR BLEEDING?
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4 TO 12 HOURS AFTER BLEEDING HAS STOPPED; THE COLON MUST BE PURGED WITH LAVAGE SOLUTION OR BOWEL PREP SO YOU CAN SEE
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FORMATION OF VARICOSITIES IN THE VENOUS HEMORRHOID PLEXUS
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HEMORRHOIDS
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HEMORRHOIDS
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FORMATION OF VARICOSITIES IN THE VENOUS HEMORRHOID PLEXUS
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WHAT ARE INTERNAL HEMORRHOIDS?
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VARICES OF THE PORTION OF THE VENOUS HEMORRHOID PLEXUS THAT LIES SUBMUCOSAL JUST PROXIMAL TO THE DENTATE MARGINS
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EXTERNAL HEMORRHOIDS
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ARISE FROM THE SAME PLEXUS BUT ARE LOCATED SUBCUTANEOUSLY IMMEDIATELY DISTAL TO THE DENTATE MARGIN
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FACTORS THAT CONTRIBUTE TO HEMORRHOIDS
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STRAINING AT STOOL, CONSTIPATION, PROLONGED SITTING, PREGNANCY, OBESITY, LOWER FIBER DIETS
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SIGNS AND SYMPTOMS OF HEMORRHOIDS
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PRURITIS, INCONTINENCE, PROLAPSE, BLEEDING, RECURRENT PROTRUSION, FISSURE, INFECTION, AND STRANGULATION
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TREATMENT FOR HEMORRHOIDS
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HIGH FIBER DIET, INCREASE FLUIDS, ANUSOL, WITCH HAZEL PADS, SITZ BATHS
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SEVERE SYMPTOMS OR COMPLICATIONS OF HEMORRHOIDS MAY REQUIRE WHAT?
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HEMORRHOIDECTOMY- MUST HAVE ACUTE STAGE IV THROMBOSED HEMORRHOID
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WHAT CAUSES THROMBOSED EXTERNAL HEMORRHOID?
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RUPTURE OF A VEIN AT THE ANAL MARGIN, FORMING A CLOT IN THE SUBCUTANEOUS TISSUE
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WHAT DOES A THROMBOSED HEMORRHOID PRESENT AS?
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PATIENT COMPLAINS OF A PAINFUL LUMP, AND EXAMINATION SHOWS A TENSE, TENDER, BLUISH MASS COVERED WITH SKIN
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HOW DO YOU EVACUATE A THROMBOSED HEMORRHOID?
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1% LIDOCAINE, ELLIPSE OF SKIN IS EXCISED AND THE CLOT IS EVACUATED; DRY GUAZE DRESSING HELD IN PLACE FOR 12-24 HOURS BY TAPING THE BUTTOCKS TOGETHER; THEN DAILY SITZ BATHS
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WHAT IS THE NORMAL CAUSE OF ANORECTAL INFECTIONS?
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MAINLY SEXUALLY TRANSMITTED BY ANAL RECEPTIVE INTERCOURSE
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2 TYPES OF ANORECTAL INFECTIONS
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PROCTITIS AND PROCTOCOLITIS
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ANORECTAL INFECTION CHAR. BY ANORECTAL PAIN, MUCOPURULENT OR BLOODY DISCHARGE, CONSTIPATION, INFLAMED OFTEN MUCOPURULENT RECTAL MUCOSA
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PROCTITIS
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MOST COMMON PATHOGENS OF PROCTITIS
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GONORRHEA, CHLAMYDIA, SYPHILIS, HERPES, HPV
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DIAGNOSIS OF PROCTITIS
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SPECIMENS ARE OBTAINED FOR GRAM STAIN AND CULTURE AS WELL AS BY BIOPSY; VISUALLY INSPECT FOR EXTERNAL AND PROCTOSCOPY INTERNAL LESIONS
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PROCTOCOLITIS INVOLVES WHAT PART OF GI TRACT
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RECTUM AND SIGMOID COLON
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SHIGELLA, CAMPYLOBACTER, AND AMEBESIAS CAUSE WHAT INFECTION
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PROCTOCOLITIS
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