ABD Pain and Colon Dz

Question 1

What to think with RUQ pain

Answer 1

• liver (hepatitis)
• common bile duct (cholecystitis, cholangitis)
• lungs (PE, pneumonia)
• duodenum (ulcer)

Question 2

What to think with RLQ pain

Answer 2

• bowels (appendicitis, perforated ulcer, IBD,
• inguinal hernia)
• male GU (testicular torsion)
• female GU (ectopic, PID, ovarian cyst)
• ureters (ureterolithiasis)

Question 3

WHat to think with LUQ pain

Answer 3

• pancreas (pancreatitis)
• spleen (splenic dz)
• lungs (PE, pneumonia, subphrenic abscess)

Question 4

What to think with LLQ pain

Answer 4

• bowels (diverticulitis, IBD, inguinal hernia)
• male GU (testicular torsion)
• female GU (ectopic, PID, ovarian cyst)
• ureters (ureterolithiasis)

Question 5

presentation od proximal vs distal vs rectal vs metastatic colon cancer

Answer 5

Proximal colon: bleeding →
melena, iron-deficiency anemia,
fatigue, dull pain

Distal colon: obstruction →
constipation, colicky pain,
hematochezia

Rectal cancer: hematochezia,
rectal mass, tenesmus

Metastatic: portal drainage to
liver → jaundice, ↑LFTs

Question 6

Imaging used to diagnose colon cancer

Answer 6

barium enema showing apple core + CEA marker

Question 7

Duke staging of colon cancer + treatment

Answer 7

• Duke stage A (local) → Tx surgery
• Duke stage B (invasive) → Tx surgery
• Duke stage C (LN) → Tx surgery + chemo (5-FU, leucovorin) + Radiation if Rectal
• Duke stage D (mets) → Tx surgery + chemo
• (5-FU, leucovorin) + Radiation if Rectal

Question 8

FAP: mutation, presnetation Tx?, prognosis?

Answer 8

AD ∆APC → thousands of
polyps → 100% progression to
CRC; Tx ppx colectomy

Question 9

gardner vs turcot syndrome

Answer 9

Gardner syndrome: FAP +
osteomas, soft tissue tumors

Turcot syndrome: FAP + CNS
tumors

Question 10

multiple nonmalignant
hamartomas throughout GI tract
w/ pigmented spots around
mucus surfaces

Answer 10

Peutz-Jeghers syndrome

Question 11

HNPCC/Lynch: mutation, presnetation, prognosis

Answer 11

AD ∆DNA repair genes → hundreds of polyps → 80% progression to
CRC

Question 12

MC type of polyms + management

Answer 12

hyperplastic, no malignant potential so leave alone

Question 13

type of polyps found in kids + management

Answer 13

juveline, remove due to vascularity

Question 14

polyps with high risk of malignant potential

Answer 14

adenomatous polyps

Question 15

presentation of diverticulitis vs diverticulosis

Answer 15

litits = elevated WBC, no bleeding, Dx with CT scan, need IV abx

osis = painless rectal bleeding, Dx with barium enema, need stool softeners

Question 16

complications of diverticulitis vs osis

Answer 16

itis = abcess, bowel obst, colovesicualr fistuals, perforation

osis - hypovolemic shock, diverticulitis

Question 17

MCC LGI bleed

Answer 17

Angiodysplasia (vascular

ectasia, AVM)

Question 18

Heyde syndrome: angiodysplasia

+ aortic stenosis

Answer 18

Heyde syndrome

Question 19

Tx for angiodysplasia

Answer 19

observation (90% stop spontaneously), colonoscopy w/ coagulation (2nd line)

Question 20

etiologies of acute mesenteric ishemia and how to distingiuish between them

Answer 20

Arterial embolism: MCC, most
sudden and severe

Arterial thrombosis: gradual
onset and less severe

Nonocclusive ischemia: due to
↓CO, seen in critically ill pts

Venous thrombosis: rare,
slowest onset and least severe

Question 21

postprandial dull abd pain, think?

Dx? Tx?

Answer 21

Chronic mesenteric ischemia (artherlosclerosis of celiac artery, SMA or IMA)

• Dx mesenteric angiography
• Tx surgical revascularization

Question 22

colonic pseudoobstruction w/o
mechanical cause → bloating,
obstipation, nausea/vomiting

Dx? Tx? etiology

Answer 22

Ogilvie syndrome

• Dx of exclusion (r/o other causes)
• Tx underlying cause, decompressive colonoscopy (2nd line), neostigmine (3rd line)
• colon >10 cm → Tx emergent decompression

Etiology surgery, trauma, drugs (opiates)

Question 23

how to dx and tx pseudomembranous colitis

Answer 23

C diff toxins

flagyl > po vanc

Question 24

complications of pseudomembranous colitis

Answer 24

toxic megacolon and perforation

Question 25

acute-onset colicky pain, obstipation, nausea/vomiting Dx KUB shows Omega loop sign (dilated sigmoid colon) or coffee bean sign (cecum

Answer 25

volvulus

Question 26

Tx for volvulus

Answer 26

* sigmoid volvulus → Tx sigmoidoscopy w/ decompression ± elective surgery * cecal volvulus → Tx emergent surgery **MC site is sigmoid

Question 27

What imaging is used to Dx appendicitis

Answer 27

CT

Question 28

What are the diff physical exam tests/signs for appendicitis

Answer 28

Rovsing sign: LLQ pressure causes referred RLQ pain Psoas sign: right psoas flexion causes RLQ pain Obturator sign: right obturator flexion causes RLQ pain McBurney point: 2/3 distance from umbilicus to right ASIS

Question 29

MC tumor of appendix How to Dx? Tx?

Answer 29

Carcinoid (makes 5-HT) get CT scan Tx appendectomy (2 cm)

Question 30

What is carcinoid syndrome? How is ti diagnosed?

Answer 30

``` metastasis of carcinoid tumor to liver → systemic 5-HT effects → flush + diarrhea + wheezing + TIPS (tricuspid insufficiency, pulmonary stenosis) ``` Dx with urinary 5-HIAA

Question 31

colicky abd pain, n/v, obstipation or constipation with KUB showing dilated loops and air fluid levels Tx? Etiologies? Complications?

Answer 31

SBO Tx NPO/IVF/NG tube, observation ``` Etiology: adhesions from prior abd surgery (MCC), hernias (#2) ``` Complications: septic shock, gangrene, peritonitis, bowel perforation

Question 32

Meds that cause paralytic ileus

Answer 32

narcotics, anti-cholinergics

Question 33

electrolyte imbalance that can cause paralytic ileus

Answer 33

hypoK

Question 34

how to Dx celiac sprue?

Answer 34

Dx anti-gliadin or anti-endomysial ab

Question 35

presentations of chrons vs US

Answer 35

Chrons: flare-and-remission pattern of crampy abd pain, bloody diarrhea, recent weight loss -MOUTH to ANUS/skip UC: flare-and-remission pattern of crampy abd pain, bloody diarrhea, recent weight loss -COLORECTAL ONLY/continuous--ALWAYS INVOVLES RECTUMMM

Question 36

KUB and tissue bx chrons vs UC

Answer 36

Chrons: KUB with terminal ileum string sign tissue bx with transmural, noncaseating granulomas, creeping fat, SKIP LESIONS UC: KUB with lead pipe sign and tissue bx with mucosal invovlement only, cryp abcesses, pseudopolyps, CONTINUOUS LESIONS

Question 37

Tx for chrons vs UC

Answer 37

Chrons: • Tx steroids + 5-ASA (sulfsalazine) • perianal Crohn → Tx metronidazole • rectal Crohn → Tx subtotal colectomy UC: • Tx steroids + 5-ASA (sulfsalazine) • severe dysplasia → Tx total proctocolectomy

Question 38

Complications seen with chrons vs UC

Answer 38

Chrons: erythema nodosum, SBO, fissures/fistulae UC: CRC, pyoderma gangrenosum, sclerosing cholangitis, cholangiocarcinoma,pouchitis, toxic megacolon

Question 39

What is pouchitis and how is it treated?

Answer 39

Pouchitis: fever, bloody diarrhea, and dyscgezia s/p ileal puch formation in UC pt tx with metronidazole