81. Large intestine Flashcards

Question

How does neostigmine work for LBO?

Answer 1

incr ach for colonic motility but risk of ?toxic megacolon?

Answer 2

loop of bowel twisting around itself and mesentery --> obstruction, also maybe ischemia if tight enough

Answer 3

sigmoid, cecum > transverse colon > splenic flexure

Answer 4

ischemia gangrene perf death

Answer 5

residents LT care neurologic/psych disease due to alt in colonic motility chr constipation also possible issue

Answer 6

congenital incomplet fusion of cecal mesentary in posterior abdo wall RF: chr constip, high fiber diet, laxative use, hx lap, pregnancy, pelvic surg, colonoscopy, Long distance running

Answer 7

coffee bean sign - bowel bent inner tube appearnace

Answer 8

contrast enema "whirl sign" on ct

Answer 9

IVF Lytes, coagulopathy addressed abx if gangene or perf endo decompression - or if gangrene, doesn't work, surg

Answer 10

IVF coagulopathy addressed, lytes addressed surgery - cannot do endoscopy here

Answer 11

lead point changes motility allowing proximal aspect of intestine to telescope into another

Answer 12

4-10y rarer - concern for neoplasm/malignancy (mean age 50)

Answer 13

acute onset, intermittent abdo pain, crying, pulling up knees and emesis u/s

Answer 14

acute onset abdo pain, vomit, rectal bleed ct

Answer 15

kid - reduction - hydrostatic or pneumatic adult: surg

Answer 16

ileum through ileoceccal valve into cecum idiopathic cause or related to Peyer's patch in infection

Answer 17

In pediatric intussusception, the treatment of choice for the stable child is a trial of pneumatic reduction with x-ray guidance, or hydro- static reduction with ultrasound guidance when appropriate radiologic facilities are available.12 The choice of hydrostatic or pneumatic reduc- tion is largely dependent on institutional preference. Both have higher reduction rates when compared to barium. The reduction procedure is typically performed by a radiologist and may prevent the need for surgery. Reduction of pediatric intussusception is sufficient treatment in 80% of patient

Answer 18

ischemic bowel necrosis pathologic lead point

Answer 19

C: transmural inflam, skip lesion in GI tract UC: Superifical, cont colon or rectum

Answer 20

C: athritis, apthous stomatitis, uveitis, erythema nodosum, ank spond UC: inflamm athropathies, PSC, skin/eye/bone issues possible

Answer 21

endoscopy, elevated fecal calprotectin, stool lacterferrin crohn: ASCA vs UC: p-anca

Answer 22

C: uleal release budesonide, systemic steroids, immunomod, biologics, mult surg UC: rectal/oral aminosalicyyclate, steroids, immunomod, biologics, surg (colectomy) can be curative

Answer 23

dysreg of host immune system so no longer tolerates normal gut flora/bacteria

Answer 24

abdo pain/tenesmus bloody diarrhea w loss

Answer 25

diarrhea, growth or pubertal delay, weight loss, rectal bleeding, anemia, pallor, fatigue, perianal skin tags, fistulae or abscesses, erythema nodusum or pyoderma gangrenosum, seronegative rheumatic joint pain, or family history of IB

Answer 26

pathologic dilation of colon from inflamm of sm layers in intestine --> m paralysis, dilation, perfoation if untx

Answer 27

anticholinergics antimotility agents narcotics antidep

Answer 28

erythema nodosum pyoderma gangrenosum

Answer 29

episcleritis scleritis uveitis

Answer 30

arhtritis sacroilitis

Answer 31

osteoporosis

Answer 32

primary sclerosing cholangitis

Answer 33

endoscopy with bx

Answer 34

* Fewer than four stools/day * Stools may contain some blood * No systemic signs of toxicity (e.g., fever, tachycardia, anemia, elevated erythrocyte sedimentation rate)

Answer 35

* More than four stools/day * Minimal signs of toxicity

Answer 36

* More than six bloody stools/day * Signs of systemic toxicity

Answer 37

* Patient ambulatory and able to eat * Nodehydration * Notoxicity * No significant abdominal pain or mass * Weight loss of 10%

Answer 38

* Mild disease that has failed to respond to treatment * Patient may have some systemic toxicity, significant weight loss, anemia * Fever, some abdominal pain or tenderness, intermittent nausea or vomiting

Answer 39

* Persistence of symptoms during corticosteroid or biologic (e.g., infliximab) therapy * High fever, persistent vomiting * Intestinalobstruction * Reboundtenderness * Cachexia * Abscess

Answer 40

In general, mild disease can be treated by budesonide or oral steroids, whereas more severe disease often requires systemic IV corticosteroids, immunomodulators, or an anti- tumor necrosis factor (TNF) biologic strategy. -bud 9mg PO daily x8 weeks (ileal release in particular) -mild-mod GI: PPI -extensive includes anti TNF, systemic corticosteroids induction 0.5-0.75mg/kg/day PO pred - higher if severe 40-60

Answer 41

systemic steroids, early introduction to an immunomodulator, such as thiopurines or methotrexate, can be considered to reduce the risk of flare when steroids are withdrawn. Immunomodulators have a relatively slow onset, so are used adjunctively, and have limited use as monotherapy. Azathioprine 1.5 to 2.5 mg/kg/day PO or mercaptopurine 0.75 to 1.5 mg/kg/day PO may be used as an adjunctive therapy or steroid sparing agent. Methotrexate 25 mg/week subcutaneously or intramuscularly is the standard induction dose, with measurement of CBC and liver function tests prior to the initiation of therapy.

Answer 42

aggressive therapy, gastroenterology consultation, and often hospitalization. For patients with symptoms suggestive of obstruction, mass, or abscess, surgical consultation is prudent. Evaluation includes CBC, complete metabolic panel, blood cultures, stool culture, C difficile toxin antigen, urinalysis, and abdominal CT or MRI.

Answer 43

-fail medical therapy -serious complications including abscess (perc drain if 5cm or greater) -strictureplasy if resection <10cm

Answer 44

5-asa including mesalazine and sulfasalazine proctitis PR of above not responding to above: budesonide if fail: sys predn: 0.5-1mg/kg PO pregn

Answer 45

Cyclosporine, but given complications including (myelosupp, electrolyte disturbances, hepatic tox, nephro toxic, risk PCP) more likely inflximab avoid antichol, antidiarrheas, or procedures like colonsocpy barium enema as may risk toxic megacolon surg if refractory to above

Answer 46

-avoid cipro and metronidazole first trimester -steriods incr risk DB -5-ASA, immunomod and anti TNF safe in pregnancy

Answer 47

IVF IV corticosteroids abx tx lyte abn assess for intestinal infection

Answer 48

nonoccusive: hypoperfusion and reperfusion injury - see bowel wall edema nad subepithelium hemorrhage so mucosa ulcerates

Answer 49

-Cardiac: arrh, HF, shock - vascular: AS, embolic, thrombotic, vasculitis -infection: ecolo 0157:h7, hep b, cmv -iatrogenic: surg on aorta -physiologic : LD running -coke/meth

Answer 50

copd, ibd, collagen vascular disease, heme disorders, ld running meds: anti htn, vascon, antipsychotic, OCP, antidiarrheal, pseudophed, immunosuppressive agent

Answer 51

lowest flow state of all splancnhic organs, limited collaterals usually L sided correlating with IMA

Answer 52

mild crampy abdo pain n/v may have rectal bleed

Answer 53

none sp but check wbc, lactate, decr hb, bicarb, incr LDH

Answer 54

mes fat stranding abn colon wall enh thumbprinting wall thickening luminal narrowing inner wall hypoperfusion sev: pneumatosis linearis, bowel dilation, pericolonic free fluid

Answer 55

colonoscopy for bx

Answer 56

bowel rest hydration pain management sign fx - abx

Answer 57

rare complication of chronic constipation and fectal impaction leading to inc intraluminal pressure wall necrosis, ischemic olitis, stercoral ulcer formation and concern for perf

Answer 58

anterior rectum rectosigmoid junction apex of sigmoid colon

Answer 59

ct - fecal impaction with hard calcified fecal mass, colon dilation, colon wall thickening, mucosal discontinuity, pericolonic fat stranding, extraluminal free air

Answer 60

bowel regimen enemas manua dismpaction as long as no perf or peritonitis - if so - endoscpic guided disimpaction, consider abx or surg if perf

Answer 61

acute begins within 12 weeks vs chronic 8-12mo: damages rapidly growing intestinal cells, mucosa injury = loss N barrier function - inflamm = further damage can lead to stricture, fibrosis, ischemia

Answer 62

colon cecum rectum

Answer 63

acute - hx chronic - dx exclusion - endoscopy

Answer 64

supportive care: take to rad onc, nutrition imporvement, steroid enema?

Answer 65

supportive - stool softner, analgesia, antiinflamm like sulfasalazine, mesalalzine ?hyperbaric therapy shows improvement?

Answer 66

"typhlitis" - rare but important in all immunosupp with ac abdo pain - intestinal mucosal injury typically at cecum and terminal ileum -damage from chemo?

Answer 67

u/s in peds particularly: bowel wall thickening >0.5cm ct - bowell wall thciekning, cecum dilation, pericolonic inflamm, pericecal fluid, pneumatosis intestinalsis, perf

Answer 68

iperacillin-tazobactam (3.375 g IV, every 6 hours for adult patients, or 100 mg piperacillin/12.5 mg tazobactam per kilogram every 8 hours in pediatric patients), imipenem-cilastatin (500 mg IV every 6 hours or 1 g IV every 6 to 8 hours for adults, or 15–25 mg/kg every 6 hours in pediatric patients). Dual therapy can be used with cefepime (1g IV every 8 hours in adults, or 50 mg/kg every 8 hours) with metronidazole (1 g IV every 6 hours in adults or 30 mg/kg/day divided every 6 hours in pediatric patients). Antifungal treatment targeting candida albicans should be used in severe cases or in patients not showing any improvement after 72 hours of antibiotic treatment (fluconazole)