Jeef First Aid Gi Part 7

Front 1

166. Appendicitis?

Back 1

a. All age groups.
b. Most common indication for emergent abdominal surgery in children.

Front 2

167. Appendicitis sx?

Back 2

a. Initial diffuse periumbilical pain -> localized pain at McBurner’s point (1/3 distance from ASIS to umbilicus).
b. Nausea, fever, may perforate-> Peritonitis.

Front 3

168. Appendicitis cause in Kids?

Back 3

a. Lymphoid hyperplasia after viral infection.

Front 4

169. Appendicitis cause in Adults?

Back 4

a. Obstruction, fecalith.

Front 5

170. Differential for appendicitis?

Back 5

a. Elderly- diverticulitis.
b. Ectopic pregnancy – use β-hCG to rule out.

Front 6

171. Diverticulum?

Back 6

a. Blind pouch protruding from the alimentary tract that communicates w/the lumen of the gut.
b. Most diverticula (esophagus, stomach, duodenum, colon) are acquired and are termed “false” in that they lack or have an attenuated muscularis externa.
c. Most often in sigmoid colon.

Front 7

172. “True diverticulum”?

Back 7

a. All 3 gut wall layers outpouch eg, Meckel’s.

Front 8

173. “False diverticulum” or pseudodiverticulum?

Back 8

a. Only mucosa and submucosa outpouch.
b. Occur especially where vasa recta perforate muscularis externa.

Front 9

174. Diverticulosis pathogenesis?

Back 9

a. Many diverticula.
b. Common (in ~50% of people >60).
c. Caused by ↑ intraluminal pressure and focal weakness in colonic wall.
d. Associated w/low-fibre diets.
e. Most often in sigmoid colon.

Front 10

175. Diverticulosis sx?

Back 10

a. Often asymptomatic or associated with vague discomfort and/or painless rectal bleeding.

Front 11

176. Diverticulitis path?

Back 11

a. Inflammation of diverticula classically causing LLQ pain, fever, leukocytosis.
b. May perforate -> Peritonitis, abscess formation, or bowel stenosis.
c. Give Abx.

Front 12

177. Diverticulitis sx?

Back 12

a. LLQ pain, fever, leukocytosis.
b. May cause bright red rectal bleeding.
c. May also cause colovesical fistula (fistula w/bladder)-> pneumaturia.
d. Sometimes called “left-sided appendicitis” due to clinical presentation.

Front 13

178. Zenker diverticulum?

Back 13

a. False diverticulum.
b. Herniation of mucosal tissue at junction of Pharynx and oesophagus.
c. Presenting symptoms:
1. Halitosis (due to trapped food particles)
2. Dysphagia
3. Obstruction.

Front 14

179. Meckel’s diverticulum?

Back 14

a. True diverticulum.
b. Persistence of Vitelline duct or yolk stalk.
c. May contain ectopic acid-secreting gastric mucosa and/or pancreatic tissue.
d. Most Common congenital anomaly of the GI tract!!!
e. Contrast w/omphalomesenteric cyst =cystic dilation of vitelline duct.

Front 15

180. Meckel’s diverticulum complication?

Back 15

a. Bleeding
b. Intussusception
c. Volvulus
d. Obstruction near terminal ileum.

Front 16

181. Intussusception?

Back 16

a. Telescoping of 1 bowel segment into distal segment.
b. Can compromise blood supply.
c. Unusual in adults (associated w/intraluminal mass or tumour).
d. Majority of cases in children (usually idiopathic; May be viral ADENOVIRUS).
e. Abdominal surgery in early childhood.

Front 17

182. Volvulus?

Back 17

a. Twisting of a portion of bowel around its mesentery.
b. Can lead to obstruction and infarction.
c. May occur at cecum and sigmoid colon, where there is redundant mesentery.
d. Usually in elderly!

Front 18

183. Hirschsprung’s disease cause?

Back 18

a. Congenital megacolon characterized by lack of ganglion cells/enteric nervous (Myenteric and Meissner’s) on biopsy.
b. Due to failure of neural crest cell migration.

Front 19

184. Presentation of Hirschsprung’s?

Back 19

a. Chronic constipation early in life.
b. Dilated portion of colon proximal to the aganglionic segment, resulting in a “transition zone”.
c. Involves rectum.
d. Usually failure to pass meconium.

Front 20

185. What condition has an increased risk of Hirschsprung’s?

Back 20

a. Down syndrome.

Front 21

186. Duodenal atresia?

Back 21

a. Causes early bilious vomiting w/proximal stomach distension?
b. “Double Bubble”! Due to failure of recanalization of small bowel.

Front 22

187. With what condition is Duodenal atresia Associated w/?

Back 22

a. Down syndrome.

Front 23

188. Meconium ileus?

Back 23

a. In Cystic Fibrosis, meconium plug obstructs intestine, preventing stool passage at birth.

Front 24

189. Necrotizing enterocolitis?

Back 24

a. Necrosis of intestinal mucosa and possible perforation.
b. Colon is usually involved, but can involve entire GI tract.
c. In neonates, more common in preemies (↓ immunity).

Front 25

190. Ischaemic colitis path and sx?

Back 25

a. Reduction in intestinal blood flow causes ischaemia.
b. Pain after eating-> weight loss.
c. Commonly occurs at splenic flexure and distal colon.
d. Typically affects elderly.

Front 26

191. Adhesion?

Back 26

a. Acute bowel obstruction, commonly from a recent surgery.
b. Can have well-demarcated necrotic zones.

Front 27

192. Angiodysplasia?

Back 27

a. Tortuous dilation of vessels-> bleeding.
b. Most often found in cecum, terminal ileum, and ascending colon.
c. More common in older pts.
d. Confirmed by angiography.

Front 28

193. Colonic polyps?

Back 28

a. Masses protruding into gut lumen -> sawtooth appearance.
b. 90% non-neoplastic.
c. Often rectosigmoid.

Front 29

194. What types of colonic polyps are precancerous?

Back 29

a. Adenomatous polyps.