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140 Cards in this Set
- Front
- Back
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what is the term used to refer to idiopathic chronic inflammatory disease ?
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IBD
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a bimodal inflammatory disease of the colon mucosa
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UC
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how is the diagnosis made for UC?
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by observing a constellation of symptoms with proctosigmoidoscopic exam
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what is the definitive treatment for UC?
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surgery.
the risk of CA of the colon is increased 5-10X's |
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typically UC is found where?
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colon, LLQ
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which layer of the GI does UC effect?
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mucosa only
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what is the cure for UC?
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surgery
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what are some symptoms of UC?
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diarrhea-small, can be bloody
hematochezia weight loss fatigue fever proctitis symptoms pain in LLQ |
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what are some signs of UC?
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abdominal tenderness
hemoccult + abdominal distention severe disease rectal bleeding |
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what are some diagnostic tests for UC?
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sigmoidoscopy
exam stool mucosal biopsy xrays (no BE if p is toxic) Colonoscopy |
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what is the MC agent used to treat UC?
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azulfadine: a sulfa drug
progressive dosing |
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what are some options for treatment of UC?
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azulfadine
corticsteroids immunosuppressants anti-diarrheal agents surgery |
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acute inflammatory infliltrate, bloody diarrhea and goblet cell depletion are all indicitive of which IBD?
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UC
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what do you treat C.Diff with ?
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flagyl
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focal inflammation, submucosal involvement granulomas, goblet cell preservation are indicitive of which IBD?
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Chron's
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this disease most commonly affects the terminal ileum?
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Chron's
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inflammatory process of this disease progressively thickens the intestinal wall, which becomes stenotic...fistual formation and obstruction are common?
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Chron's
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RLQ abdominal pain, diarrhea, fatigue, weight loss, N/V are manifestations of what disease?
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chron's
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what are some signs of Chron's?
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affects mostly young people
abdominal tenderness/mass/distention hyperactive bowel fever mouth ulcers |
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what are some extraintestinal findings of Chron's disease?
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episcleritis
erythema nodosum joints: swelling & tenderness hepatomegaly anema |
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what are some other complications of chron's disease since it also affects the small bowel?
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vitamin deficiency
poor absorption of ADEK low protein causes low calcium diarrhea do to bile acid malabsorb. kidney stones gallstones |
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what are the disease treatment options for chron's?
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steroids
azulfidine metronidazole immunosuppresants surgery |
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in this disease, nerve sensation is lost at the distal colon, which causes distention of the rest of the colon?
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hirschsprung's disease:
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a life-threatening complication that requires immediate treatmen that can result in septicemia, peritonitis or perforation?
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toxic megacolon
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patient presents, toxic, with explosive onset of illness, tachycardia, fever. p reports that he has decreased diarrhea. labs return showing leukocytosis, hypokalemia and hypoalbuminemia. what is your number one diagnosis?
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toxic megacolon
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what is the absence of the colonic nerve plexus?
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Hirschsprung's disease
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how do you treat toxic megacolon?
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acute! hospitalization
electrolyte monitoring blood replacement high dose corticosteroids broad spectrum ABX SX if not reversed within 48 hrss. |
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this disease is caused by a vascular compromise leading to insufficient blood supply?
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ischemic colitis
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what is the hallmark of UC?
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bloody diarrhea.
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diffuse dilation of the colon > 6 cm is indicitive of what disease?
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toxic megacolon
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which disease is a definitive contraindication for barium enema exam?
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toxic megacolon
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upon XRAY, "thumb printing" is seen around the splenic flexure, and rectal involvement is rare...what dx is suspected?
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ischemic colitis
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p has a history of mucosal necrosis, ballooning of capillaries and red cell congestion, what chronic disease would you most likely suspect?
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ischemic colitis
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also known as "regional enteritis" or "granulomatous colitis" it is a chronic progressive inflammation of the GI tract that "comes and goes"?
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chron's disease
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if a patient has chron's what will their endoscopy look like?
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cobblestone pattern
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what will rads of a small bowel series in a pt. with chron's disease reveal?
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skipped areas of narrowing
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what causes pseudomembranous colitis?
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C.Diff
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what are some common extra-intestinal manifestation of chron's?
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arthritis
sacroiliitis sclerosing cholangitis iritis, conjunctivitis erythema nodosum |
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what actually causes the painful yet rare finding of erythema nodosum?
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inflamm of the fatty tissue under the skin. often caused by a variety of common infections: viral/bact/fungal
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what are some predisposing diseases that usually cause patients to develop ischemic colitis?
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CVD
CAD CHF arrhythmias all which decrease flow |
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what is "sitophobia"
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fear of food
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which area of the bowel is most commonly affected in ischemic colitis?
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the left large colon, at the splenic flexure or sigmoid
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p presents after several acute onsets of abdominal pain after eating. complains of crampy lower abdominal pain and blood diarrhea. labs return with increased leukocytes. upon PE abdomen is distended and you cannot ellicit any pain. what do you suspect?
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ischemic colitis
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what is the treatment for ischemic colitis?
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IV fluids, ABX.
resection of irreversible ischemic portion may be necessary |
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what is the most common of all digestive disorders seen in family practice?
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IBS
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one of your patient's has ASHD: arteriosclerotic heart disease, and now comes to you with complaints of severe pain in his stomach for hours after eating. what do yoususpect and what do you do?
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suspect abdominal angina due to ischemic bowel.
arterial bypass SX to treat |
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Fe patient presents with complaints of mucous in her stool and pain in stomach. however upon defication her pain goes away. you run a series of labs including CBC, and some XRAYS. she seems anxious but otherwise in perfect health. labs return normal. what is your number 1 suspicion?
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IBS
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what criteria can be used for defining irritable bowel syndrome?
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the rome criteria
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what is some recommended pharmocologic therapy for IBS?
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anticholinergics to be taken 3 x's daily prior to meals.
Lomotil: for diarrhea Mylicon (simethicone) |
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herniation of the colon mucosa through the muscularis usually at the perforation nutient artery to form small little pouches
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diverticulosis
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where do diverticulum most commonly occur?
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in the sigmoid and distal colon
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what problem do diverticula cause in the esophagus?
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dysphagia
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what problems do diverticula cause in the small bowel?
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bacterial infections with malabsorption
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what is a common dietary problem that causes most cases of herniation of the colon?
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low fiber diets are responsible for the increase in intraluminal pressure which leads to herniation of the mucosa through the colonic muscle
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a very symptomatic inflammation of the diverticulum pouches ?
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diverticulitis
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abdominal pain in LLQ, fever, altered bowel habits, N/V, malaise, hematachezia are S/S of ?
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diverticulitis
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upon exam of your P, you discover mod tenderness in the LLQ, fever, + abnormal bowel sounds. labs return with a guiac + stool, leukocytosis. you suspect?
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diverticulitis
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sausage-like mass in LLQ or tender loop of sigmoid bowel + plain film of abdomen that reveals free air under the diaphragm is indicitive of?
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diverticulitis
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sausage like mass palpated in RUQ is indicitive of?
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intusseption
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what test should be performed to diagnose diverticulosis?
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scope and barium enema
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what test should be performed to dx dverticulitis?
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CT scan. no BE
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what is the MC congenital anomaly of the GI tract?
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meckel diverticulum
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what is meant by the "rule of 2"s:
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they are indicitive of Meckel Diverticulum
2% of the population 2:1 male:fe 2 feet from ileocecal valve 2 inches long 2 things confused with : ulcer/appy 2 complications hem/perf |
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a true diverticulum of the ileum containing all 3 layers of the bowel wall
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Meckel's Diverticulum
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this congenital abnormality, can be present in an indirect hernia, where it is known as "Hernia of Littre." Furthermore, it can be attached to the umbilicus, with the possibility of local cysts, torsions of intestine around the intestinal stalk, leading to obstruction, ischemia, and necrosis.
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Meckel's Diverticulum
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small bulge in the small intestine present at birth. It is a vestigial remnant of the omphalomesenteric duct, and is the most frequent malformation of the gastrointestinal tract
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meckel's diverticulum
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how do meckel diverticulum cause obstruction?
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most often due to volvulus about the meckel divertic or intussusception with the diverticulum as the lead point
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how are most meckel diverticulum diagnosed?
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during surgery or autopsy.
nonspecific otherwise. |
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intermittent dull abdominal pain, + mild iron deficiency anemia that can be considered as a a cause of lower GI bleed in kids, that commonly develops volvulus/or obstruction can be indicitive of ?
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meckel diverticulum
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what is the principle cause of appendicitis?
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luminal obstruction= fecolith
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what is the most common surgical emergency?
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appy
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what is the most common age group that appy affects?
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10-30
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in what quadrant is pain most commonly felt in diverticulitis?
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LLQ
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what is the recommended tx for all patients with diverticulitis?
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admitted to hosp, IV fluids, NPO, IV antibiotics, NG tube
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upon deep palpation of the LLQ your patient has pain in the RLQ. what is this called?
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Rovsing sign
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what is a CRP?
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C-Reactive Protein:
an acute-phase reactant synthesized in the liver in response to bacterial infection. serum levels rise within 6-12 hours |
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what labs do you need to check when you suspect appy?
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cbc: wbc>10k, neutrophil >75%
CRP: serum levels rise within 6-12 hrs of acute tissue inflamm |
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what are the key tests for appy?
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cbc
urine & preg CT scan |
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what is the treatement for appy?
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surgery.
give IV abx: flagyl c GENT., cefotetan NPO analgesics |
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a condition of dilated and fragile blood vessels in the colon that results in intermittent loss of blood from the GI tract?
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angiodysplasia
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if your (elderly) patient has a GI bleed what is something you should keep in mind as part of your differential?
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Angiodysplasia
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where is angiodysplasia typically found?
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throughout the GI tract but most common in the cecum and right colon
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how is the diagnosis made for angiodysplasia?
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by colonoscopy or angiography
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what are the 3 main types of colon polyps?
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adenomatous
Hamartomatous hyperplastic |
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these colon polyps cause rectal bleeding and are potentially malignant
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adenomatous: tubular, villous, tubulouvillous
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these colon polyps are an outgrowth of normal cells of that organ into a tumor mass?
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hamartomatous
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these colon polyps are usually never malignant, are common in the rectum and are usually multiple in number
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hyperplastic
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what is the diagnostic test of choice to dx colon polyps?
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colonoscopy
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what is the only way to determine what type of colon polyp is present?
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mucosal biopsy
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what is the definitive treatment for colon polyps?
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endoscopic polypectomy
surgical resection |
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a rare, inherited disease that progress by the patient's 20's. there are thousands of adenomatous polyps. asymptomatic. bleeding.
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familial polyposis syndrome
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a varient of familial polyposis of the colon with extracolonic manifestations. characterized by GI polyps, multiple osteomas, and skin and soft tissue tumors
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gardner's syndrome
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what is the definitive tx for Gardner's syndrome and familial polyposis?
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complete colectomy
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an autosomal dominant condition characterized by hamartomatous polyps throughout the GI tract + mucocutaneous pigmented macules on the lips, buccal mucosa and skin?
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peutz-jeghers syndrome
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colon polyps + cutaneous pigmentation?
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peutz-jeghers syndrome
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what is the main difference between Gardener's syndrome and familial polyposis syndrome?
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gardner's has extracolonic manifestations: multiple osteomas, skin and soft tissue tumors; epidermoid cysts, desmoid tumors and other benign tumors
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cutaneous pigmentation of the perioral region crossing the vermilion border, perinasal and perioral areas is indicitive of?
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peutz-jeghers syndrome
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what does the ACS recommend for colorectal cancer screening?
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best combo is FOBT or FIT every year plus flex sig every 5 years
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what should happen next if the FOBT or FIT shows blood in the stool?
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colonoscopy.
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what should be done next if the sigmoidsocopy results show a polyp or if double-contrast BE studies find anything normal?
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conlonoscopy. and removal of polyps during procedure.
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why would a patient undergo colorectal cancer screening earlier and/or more often?
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if they have risk factors:
personal h/o CA or adenomatous polyps fam h/o colorectal CA or polyps personal h/o chronic IBD fam h/o hereditary colorectal CA synd |
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what are the top 3 cancer killers for men?
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prostate
lung colorectal |
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what are the top 3 cancer killers for women?
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breast
lung colorectal |
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what is the most common symptom of colon carcinoma?
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rectal bleeding or change in bowel habits
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what are some common symptoms of colon carcinoma?
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anemia, anorexia, malaise, abd mass, weight loss
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where are 80% of all colon cancers near?
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the sigmoid area
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what is CEA best used for/?
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carcinoembryonic Antigen: only used as a guide to follow up after primary treatment...
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apple core lesion on BE is indicitive of?
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colon carcinoma
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how can you diagnose colon carcinoma
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hemoccult of stool
cbc: anemia 5 nuleotidase or alk phos elevated indicates metastic ds |
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what is probably the best diagnostic test, most accurate and most practical to diagnose colon carcinoma?
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colonoscopy
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what is the duke's classification?
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a. mucous membrane of bowel. >80%
b.muscle 60-80% c.1 few nodes 50% c.2 many nodes 50% d.distant metastasis <25% |
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what is the only effective treatment of colon carcinoma?
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surgical removal of tumor + adjacent bowel & mesentery
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>40 y/o patient, stool occult blood, iron def anemia, overt rectal bleed, alteration sin bowel habits..what to you automatically perform?``
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DRE
double contrast BE flexSig/ colonoscopy w/ biopsy CEA: to determine recurrence |
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what should a metastic work up include?
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CXR
bone scan liver-spleen scan adb & brain scan |
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what is the treatment for duke's A,B,C lesions?
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all surgical
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dilated veins within the anal canal and distal rectum, a common cause of rectal bleeding?
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hemorrhoids
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what causes hemorrhoids?
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straining, heavy lifting & occasionally by intra-abdominal pressure
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what is the diagnostic test for hemorrhoids?
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sigmoidoscopy
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what area marks the difference between internal and external roids?
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the dentate line
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what are some symptoms of hemorrhoids?
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rectal bleeding
anal pruritis perianal soiling |
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how do you treat hemorrhoids?
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diet high in fiber
stool softners sclerotherapy infrared coagulation banding ligation |
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a tear in the lining of the anus,usually from a difficult passage of stool or from anal sex. bleeding and pruritis are common
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anal fissures
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when a small portion of the mucosa protrudes from the rectum
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mucosal prolapse
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a mucosal prolapse + muscle prolapse ?
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procidentia
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usually a tract from the crypt to the perianal skin
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fistula
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what is the best way to dx a fissure?
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spread the cheeks to visualize the sentinel pile
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how do you treat fissures?
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topical NTG, ointment and botox
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what is the 2nd MC cause of SBO?
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hernias
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an abnormal protrussion of the viscous with its sac through the wall of the cavity that it normally occupies?
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hernias
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what are the two types of inguinal hernias?
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indirect: (congenital)
direct: acquired |
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this type of hernia follows the descent of the gonads and is the most common cause of strangulated hernias?
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indirect or congenital inguinal hernia
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this type of inguinal hernia is usually a weakness of the lateral wall of the fascia, comes on later in life?
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direct or acquired
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what is the most common hernia in both men and women?
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indirect inguinal hernias
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what are the boundaries of hesselbach's triangle?
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inguinal ligament,
laterally by the inferior epigastric arteries, and medially by the conjoined tendon (rectus abdominus) |
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where does a direct hernia usually occur?
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in a weakness of the lateral wall of the fascia
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this type of hernia usually becomes incarcerated or strangulated due to the small space they protrude from ?
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femoral hernia
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what are the main categories of hernias?
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direct
indirect femoral umbilical incisional |
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these types of hernias arecongenital in origin and are repaired if they persist in children older than 2-4 years.
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umbilical hernia
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This iatrogenic hernia occurs in 2-10% of all abdominal operations secondary to breakdown of the fascial closure of prior surgery.
Even after repair, recurrence rates approach 20-45%. |
incisional hernia
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what are the 3 types of hernias
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Reducible hernia
This term refers to the ability to return the contents of the hernia into the abdominal cavity, either spontaneously or manually. Incarcerated hernia An incarcerated hernia is no longer reducible. The vascular supply of the bowel is not compromised. Bowel obstruction is common. Strangulated hernia A strangulated hernia occurs when the vascular supply of the bowel is compromised secondary to incarceration of hernia contents. |
