Lower GI Disorders (Quiz 2)

Question 1

how can C. diff colitis present

Answer 1

• present with diarrhea all the way to toxic megacolin

Question 2

how do you diagnose C. diff colitis

Answer 2

• finding toxin (toxin A)

Question 3

treatment of C. diff colitis

Answer 3

• oral vancomycin first

- metronidazole otherwise

Question 4

when does C. diff colitis occur

Answer 4

• following antibiotic usage

Question 5

what do you see on gross pathology with C. diff colitis

Answer 5

• pseudomembranes: yellow-green exudates

Question 6

what do you see on histopath with C. diff colitis

Answer 6

• volcano lesions

- mucosal necrosis

Question 7

which populations predominantly have diverticulosis

Answer 7

• older age

- predominantly westerners

Question 8

which side of the body presents with diverticulosis

is rectal involved?

Answer 8

• lower left quadrant

- rectal not involved

Question 9

pathogenesis of diverticulosis

Answer 9

• aging and low fiber diet leads to weakening of the colonic wall and increased intralumenal pressure
• leads to colonic diverticular disease

Question 10

what are sac-like herniation of mucosa and submucosa into the colonic wall

most common location

Answer 10

• diverticula

- sigmoid colon

Question 11

where do diverticula occur

Answer 11

• sites of colonic wall weakness

- where blood vessels penetrate muscularis propria

Question 12

what the majority of symptoms of diverticulosis

Answer 12

• asymptomatic

Question 13

pathogenesis of diverticulitis

Answer 13

• fecalith impacted within diverticulum
• abrades mucosa and causes inflammation
• can lead to perforation

Question 14

how to diagnose diverticulitis

Answer 14

• CT scan

Question 15

do you do a colonoscopy or barium enema on those suspected of having diverticulitis

why?

Answer 15

no

• can lead to perforation

Question 16

management of diverticulitis

Answer 16

• clear liquid diet or NP

- broad spectrum antibiotics

Question 17

what is characterized by mucosal necrosis with surrounding inflammation

Answer 17

• diverticulitis

Question 18

which layer of the colon is not present within a typical colonic diverticulum

Answer 18

• muscularis propria

Question 19

pathogenesis of appendicitis

Answer 19

• fecalith leads to ischemia
• leads to mucosal edema or necrosis
• bacterial invasion
• can perforate

Question 20

what condition is Rovsing’s sign, Psoas sign, and Obturator sign associated with

Answer 20

• appendicitis

Question 21

what do you see on CBC with appendicitis

Answer 21

• increased WBC (PMNs)

Question 22

radiographic diagnosis of appendicitis

Answer 22

• ultrasound or CT

Question 23

when does the appendix appear erythematous and edematous during appendicitis

Answer 23

• when inflammation extends deeper into wall

Question 24

management of appendicitis

Answer 24

• broad spectrum antibiotics

- surgery

Question 25

________ can lead to perforation in appendicitis

Answer 25

• transmural necrosis

Question 26

primary slow transit constipation due to

Answer 26

• colonic inertia

Question 27

secondary slow transit constipation due to

Answer 27

• metabolic
• neurologic
• medications

Question 28

what is a functional outlet obstruction

what in the history could give you indication of this

Answer 28

• contractions of puborectalis muscle with closure of anal canal
• excess straining
• digital maneuvers for evacuation