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19 Cards in this Set
- Front
- Back
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transmural inflammation
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Crohn's disease
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granulomas
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Crohn's disease
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submucosal thickening and inflammation
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Crohn's disease
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small bowel involvement
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Crohn's disease
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contiguous involvement
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ulcerative colitis
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rectal sparing
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Crohn's disease
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gross blood per rectum
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ulcerative colitis
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perianal disease
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Crohn's disease
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fistulization
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Crohn's disease
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cobblestoning
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Crohn's disease
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A 24 year old man spends the night cruising bars and drinking heavily. In the wee hours of the morning he is quite drunk and he starts vomiting repeatedly. He initially brings up gastric contents only, but eventually he vomits bright red blood.
Dx? Diagnostic test? |
Dx: Mallory Weiss tear
Diagnostic test: Endoscopy (Photocoagulation may be used if needed) |
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A 55 year old patient w/ known PUD presents w/ sudden onset of severe epigastric pain. Physical exam reveals guarding and rebound tenderness.
Dx? Diagnostic test? |
Dx: Anterior Perforated ulcer
Diagnostic test: Chest or Abdominal x-ray to show free air under diaphragm |
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A 4 year old boy passes a large bloody bowel movement.
Dx? Diagnostic test? Tx? |
Dx: Meckel’s diverticulum
Diagnostic test: Radioisotope scan looking for gastric mucosa in the lower abdomen Tx: Surgical excision |
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A 59 year old is referred for evaluation because he has been fainting at his job where he operates heavy machinery. He is pale and gaunt, but otherwise his physical exam is remarkable only 4+ occult blood in the stool. Lab studies show a hemogoblin of 5.
Dx? Diagnostic test? Tx? |
Dx: Cancer of the right colon
Diagnostic test: Colonoscopy and biopsies Treatment: Blood transfusions and eventually Right Hemicolectomy |
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A 56 year old man has bloody bowel movements. The blood coats the outside of the stool, and has been constipated, and his stools have become of narrow caliber.
Dx? Diagnostic test? |
Dx: Cancer of the distal, left side of the colon
Diagnostic test: Endoscopy and biopsies (If given choices start with Flexible Sigmoidoscopy) |
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A 60 year old man known to have hemorrhoids reports bright red blood in the toilet paper after evacuation.
Dx? Management? |
Dx: Internal hemorrhoids
Management: Proctosigmoidoscopic Examination (It is not reassurance and hemorrhoid remedies prescribed by telephone. In all these cases, cancer of the rectum has to be ruled out) |
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A 60 year old man known to have hemorrhoids complains of anal itching and discomfort, particularly towards the end of the day. He has perianal pain when sitting down and finds himself sitting sideways to avoid the discomfort. He is afebrile.
Dx? |
Management? Dx: External hemorrhoids
Management: Proctosigmoidoscopic Examination (It is not reassurance and hemorrhoid remedies prescribed by telephone. In all these cases, cancer of the rectum has to be ruled out) |
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A 23 year old lady describes exquisite pain with defecation and blood streaks on the outside of the stools. Because of the pain she avoids having bowel movements and when she finally does, the stools are hard and even more painful. Physical examination can not be done, as she refuses to allow anyone to even “spread her cheeks” to look at the anus for fear of precipitating the pain.
Dx? Management? Surgical Tx? |
Dx: Anal Fissure
Management: Exam under Anesthesia (Even though the clinical picture is classical, cancer still has to be ruled out) Tx: Lateral Internal Sphincterotomy |
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A 28 year old male is brought to the office by his mother. Beginning four months ago he has had three operations, done elsewhere, for a perianal fistula, but after each one the area has not healed, but actually the surgical wounds have become bigger. He now has multiple unhealing ulcers, fissures all around the anus, with purulent discharge. There are no palpable masses.
Dx? Diagnostic test? Top 3 medical Tx? |
Dx: Crohn's Disease
(The perianal area has fantastic blood supply and heals beautifully even though feces bathe the wounds. When it does not, you immediately think of Crohn’s disease) Diagnostic test: Flexible sigmoidoscopy with Biopsy (You still have to rule out malignancy) Top 3 medical Tx: 1. Sulfasalazine 2. Metronidazole 3. Prednisone |
