Lecture 21 - Clinical Aspects of Colon and Rectum Diseases

Question 1

Pregnant women may present with pain localized to the ______ region, rather than RLQ, with appendicitis.

Answer 1

Pelvic region

Question 2

Rovising’s sign is positive, indicating appendicitis, when percussion or palpation of the ______ elicits pain in the ______.

Answer 2

LLQ

RLQ

Question 3

Psoas sign for appendicitis involves felxion of the right ______.

Answer 3

Hip

Question 4

Obturator sign for appendicitis involves internally and externally rotating the FLEXED right ____.

Answer 4

Hip

Question 5

Both elderly and Immunocompromised patients will likely NOT show ________ with appendicitis. Keep in mind HIV patients are ____ times more likely of developing appendicitis.

Answer 5

Leukocytosis

4 times

Question 6

High ____ is pathognomonic for appendicitis in patients with RLQ pain.

Answer 6

CRP

Question 7

_____ imaging should be ordered when a patient presents with symptoms of appendicitis. Remember the appendix should not normally be visible –> if it is, think inflammation.

Answer 7

CT

Question 8

Treatment for appendicitis should always include _____ and IV fluids.

Answer 8

Antibiotics

Question 9

For patients from Asian countries, where does diverticulitis typically present? How does this compare to patients from western countries?

Answer 9

Asian –> typically RLQ

Western countries –> LLQ

Question 10

Like with patients presenting with symptoms of appendicitis, what serum measurement is valuable for diagnosis of Diverticulitis?

Answer 10

High CRP

Question 11

Treatment for diverticulitis should include oral _____. For patients with recurrent diverticulitis, ______ is the recommended treatment, as there are relatively few adverse effects.

Answer 11

Antibiotics

Sigmoidectomy

Question 12

Patients with diverticulitis symptoms should be sent for colonoscopy for CRC screening, but when?

Answer 12

4-6 weeks after symptoms resolve to reduce risk of perforation on exam.

Question 13

Treatment for diverticular bleeding should immediately include _____ and transfusion. If the patient is stable –> send them for ______. If the patient is unstable –> send for interventional radiology surg. In all cases, try to minimize exacerbating factors such as anticoag meds and _____.

Answer 13

IV fluid

Colonoscopy

NSAIDs

Question 14

Patients with ischemic colitis will present with _____ (mild or severe?) abdominal pain and sporadic, urgent desires to defecate. Within ____hrs, these patients will likely exhibit hematochezia.

Answer 14

Mild

24hrs

Question 15

Vovlulus treatment when it occurs in the _____ should be resection. When it occurs in the _____ colon, it should first be colonoscopy, which can unwind it, and then resection bc of high chance for recurrence.

Answer 15

Cecum

Sigmoid colon

Question 16

For IBS diagnosis, symptoms should be present over the last ____ months, and they should have started at least ____ months ago.

Answer 16

3 months

6 months

Question 17

The most impactful treatment for patients with IBS is meditation and exercise, basically aimed at lowering ______. TCA is also a viable option.

Answer 17

Stress

Question 18

Crohn’s is more common in _____ (young or old) _____ (gender?) while UC is more common in _____ (young or old?) _____ (gender?)

Answer 18

Younger

Women

Old

Men

Question 19

How is smoking as a risk factor different between Crohn’s and UC?

Answer 19

Increases risk for Crohn’s but Decreases risk for UC

Question 20

Patients presenting with bleeding from IBD should be placed on prophylactic _______ after resuscitation, despite seeming counterintuitive.

Answer 20

Anticoag

Question 21

The treatment of choice for both Crohn’s and UC is ______ (e.g. anti-TNF, IL-inhibitors, and TKIs).

Answer 21

Biologics

Question 22

Rectoanal Inhibitory Reflex (RAIR), how is this measured with manometry and what does a positive result indicate about Hirschprung’s disease?

Answer 22

RAIR involves inflation of a balloon in the rectum to increase the rectal pressure –> this should lead to a Decrease in anal pressure. Positive result means no Hirschprung.