Western Path 1St Quiz Ii

Front 1

LBO cause
large bowel obstruction

Back 1

either mechanical interruption of the flow of intestinal contents
or the dilation of the colon in the absence of an anatomic lesion

Front 2

mechanical LBO

Back 2

60% malignancies, 20% diverticular disease. 5% colonic volvulus
Tumor cause-graduate onset, narrow colonic lumen
Diverticulitis- inflammation of colonic wall become fibrotic and thickened, leading to luminal narrowing
Colonic Vovulus-twist colons. (older)

Front 3

Acute pseudo obstruction ( anatomic lesion) - ogilvie syndrome

Back 3

s/s=LBO, but without evidence of distal colonic obstruction(b/c lack of peristalsis)
reason not clear. m/b decreased parasympathetic tone or excessive sympathetic output
colon maybe dilated

Front 4

LBO hX

Back 4

hx of obstipation, nausea, vomiting and crampy abdominal pain.
abrupt onset makes an acute obstructive event ( volvulus)
constipation, change in the caliber of stools- carcinoma, w/ weight loss

Front 5

LBO HX 2

Back 5

Right sided colonic lesion can grow quite large before obstruction occurs
sigmoid colon and rectal tumors cause colonic obstruction
pneumaturia, mucinuria may occur when fistulization of sigmoid colon to the BL.

Front 6

LBO pe

Back 6

abdominal distention
sound normal -quiet, hyperresonant ( sound hollow)
tenderness in abdomen
guaiac postitive stool may be seen
rectal ow lower sigmoidal mass maybe palpated

Front 7

LBO DDx

Back 7

diverticular
colorectal carcinoma
cecal volvulus
intussusception
ogilvie symdrome
sigmoid volvulus

Front 8

diverticulitis pathology`

Back 8

=inflammation of one or more diverticula
reson not clear,, fecal material or undigested food particles may collect in a diverticulum causing obstruction
obstruction may result in distension of the diverticula secondary to mucous secretion and overgrowth of normal colonic bacteria

Front 9

Diverticulitis Hx

Back 9

depends on location
left lower quadrant pain is the most common presenting complaint 70%
Crampy pain and may be associated with a change in bowel habits
nausea, vomiting .constipation ,diarrhea, falstulence, bloating

Front 10

Diverticulitis Hx

Back 10

At right colon may be mistaken for acute appendicitis
Diverticulitis in transverse colon may mimic PUD, pancreatitis
retroperitoneal involvement may present similar to renal disease
wome, lower quadrant pain may be difficult to distinguish from gynecological precess
sever is accompanied by anorexia, nause, and comiting
constipation r oftern reported

Front 11

diverticulitis Pe

Back 11

simple one, tender ab
LLQ tenderness is most common

Front 12

diverticulitis PE

Back 12

tender palpable mass
peritonitis d/t free perforation- rebound tenderness
bowel sound can be diminished and absent

Front 13

diverticulitis TX

Back 13

lifelong high-fiver diet
colonoscopy should be done after resolution of an initial episode to exclude other diagnoses

Front 14

infectious enterocolitis pathophysiology

Back 14

Diarrhea may be classified as
osmotic-d/t diminished absorption
inflammatory- mucosal lining of the intestine is inflamed
secretory-increased secretory activity
motile-caused by intestinal motility disorders

Front 15

Gastroenteritis Hx1

Back 15

diarrhea that lasts longer than a month requires consideration of different spectrum of etiologic factor than diarreha that lasts less than 1-2 weeks
fever-invasive organism \
vomiting-implies bowel involvement, without diarrhea-noninfectious caused
pain-cramps may be caused by an electrolyte balance

Front 16

hydration and nutritional stutus

Back 16

hydarton: diminished skin turgor, acute weight loss, resting hypotension, dry mucus membranes, decreased frequency of urination. change in mental status.
children, absence of tears, poor capillary refill, sunken eyes
Nutritional: muscle wasting, and signs of neural dysfunction d/t nutritional depletion, observed in patients

Front 17

gastroenteritis therapy

Back 17

rehydrate orally or intravenously
treat symptoms (fevers, pain...)
treat certain specitfic cased with empiric antibiotic therapy(food-supportive treatment)

Front 18

malabsorption syndromes

Back 18

absorption of single nutrient componenet maybe impaired as in lactose intolerance
diffuse disorder( celiac disease or crohn's disease) , all nutrients is impaired

Front 19

Malabsorption Hx

Back 19

Diarrhea, watery, reflecting the osmotic load received by the intestine
Steatorrhea, stool float on top of the water
weight loss and fatigue
flatulence and abdominal distention( bacterial fermaentation of unabsorbed food release gas)
Edema( protein malabsorption cause peripheral edema)
anemia-microcytic (iron def) or macrocytic(Vb12)
Bleeding disorder (Vk)
metabolic disorders (Vd)
edema

Front 20

Malabsorption PE

Back 20

General : prthostatic hypotention, fatigue, weight loss, subcutaneous fat
Abdominal- distended bowel sound hyperactive
cheilosis, glossitis, ulcer of mouth
peripheral edema

Front 21

malabsorption work up

Back 21

CBC ( Vb12 or iron def)
Coags- prothrombin time may be prolonged

Front 22

celiac disease (wheat sensation)

Back 22

Celiac sprue ( gluten sensitive enteropathy), digestive tract interferes with the digestion and absorption of food nutrients
people cant tolerate gliadin, alcohol soluble fraction of gluten( wheat, rye ...)

Front 23

celiac pathology

Back 23

when ingest gliadin, the mucosa of intestines is damaged by immunologically mediated inflammatory response
absence of intestinal villi and lengthening of intestinal crypts characterize mucosal lesions
destruction of the absorptive suface of the intestine leads to a maldigestive and malabsorption syndrome

Front 24

celiac epidemiology

Back 24

first 8-12 months, and second in the third to fourth decades
untreated in childhood diminished in adolescence, symptoms oftern reappear in early adulthood.

Front 25

celiac Hx

Back 25

diarrhea-
steatorrhea (delivery of excessive dietray fat to large bowel)

Front 26

celiac GI sx

Back 26

Flatulence, borborygmus ( bacteria)
severe abdominal pain- uncomplicated celiac sprue

Front 27

Celiac Hx

Back 27

Weight loss
weakness and fatigue
anemia
osteopenia and osteoporosis ( Ca Vd)

Front 28

Extraintestinal celiac Hx

Back 28

Neurologic sx: motor weakness, sensory loss
Skin disorders -skin lesions

Front 29

Celia PE

Back 29

protuberant and tympanic ab d/t fluid and gas
ascites detected in patients with severe hypoproteinemia
weight loss, muscle wasting or loose skin folds
orthostatic hypotension
peripheral edema
ecchymoses
dermatitis herpetiformis
cheiosis and glossitis
evidence of peripheral neuropathy
chvostek signcelia

Front 30

celiac work up

Back 30

serologysensitive and specifi antibodies

Front 31

celiac therapy

Back 31

remove gluten from diet
indoctrination

Front 32

Ulcerative colitis

Back 32

inflammatory disorder to the colon
life long illness
rectum is involved
it extends proximally form anal verge in an uninterrupted pattern

Front 33

Uc pathology

Back 33

serum and mucosal autoantibodies against intestinal epithelial cells
loss of tolerance against indigenous enteric flora
genetic
smoking and appendectomies
enviroment
diet ( too much milk)
uniform inflammatory reaction limited to the colon

Front 34

Uc Hx

Back 34

rectal bleeding
urgency
ab cramp
weight loss
inflammation of synovila membran line joints
tender red nodule under skin

Front 35

UC PE

Back 35

tenderness in the lower left quadrant, fever, tachycardia, weight loss, signicficnat ab tenderness

Front 36

Uc work up

Back 36

CBC-anemia
eleated sedimentation rate
hypo albuminemia
hypokalemia
hypomagnesemia

Front 37

Uc therapy

Back 37

anti inflammatory
TNF inhibitor

Front 38

Crohn Disease (CD) patho

Back 38

presentation: ab pain, diarrhea, intestinal fistulization
unknown
unpredictable flares and remission characterize long term course of disease

Front 39

CD Hx

Back 39

chronic inflammatory process-low grade fever and prolonged diarrhea,w/ ab pain, weight loss
RLQ, periumbilical pain, intermittne diarrhea.
suggestive of intestinal obstruction

Front 40

CD PE

Back 40

temperature, weight, nutritional status, ab tenderness, mass.
Tachycardia pal mucosa(acute anemia)
bowel sounds
skin and oral mucosa
eye-uveitis
perpheral arthritis

Front 41

CD therapy

Back 41

diarrhea-loperamide
Ab cramps-bentyl
colon SB inflammtion-sulfasalazine( antibotic)
Mesalamine
short cause- steroid therapy
Immunosuppressant

Front 42

Surgical therapy for Cd

Back 42

surgical correction
for perinal fistuale

Front 43

TPN

Back 43

supply nutritional needs by dripping nutrients into a vein
short term- active inflammation an severe manutrition
long term -extensive intest9nal resection

Front 44

Acute appendicites

Back 44

obstruction leads to distension of appendix, accumulated intraluminal fluid. ineffective lymphatic and venous drainage allows bacteral invasion of the appendiceal wall
most common cause luminal obstruction are fecaliths and lymphoid follicle hyperplasia

Front 45

Acute appendicitis Epidemiology

Back 45

7% in Us

Front 46

Appy Hx

Back 46

hx of anorexia and periumbilical pain followed by nausea, rlq pian
Duration of symptoms is less than 48 hrs

Front 47

Appy Pe

Back 47

RLQ tenderness
rebound tenderness, pain on percussion , rigidity and guarding

Front 48

mantrels Criteria

Back 48

Migration of pain to the RLQ=1A
anorexia=1
nausea an vomiting =1
tenderness in RLQ=2
rebound pain =1
elevated temperature=1
leukocytosis=2
shift of WBC to the left=1
total=10

Front 49

appy work up

Back 49

ectopic pregnancy in women,
obtain a qualitative beta (beta hCG) measurement in all cases