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Medicine Clerkship > ABD Pain and Colon Dz > Flashcards

ABD Pain and Colon Dz Flashcards

1
Q

What to think with RUQ pain

A
  • liver (hepatitis)
  • common bile duct (cholecystitis, cholangitis)
  • lungs (PE, pneumonia)
  • duodenum (ulcer)
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2
Q

What to think with RLQ pain

A
  • bowels (appendicitis, perforated ulcer, IBD,
  • inguinal hernia)
  • male GU (testicular torsion)
  • female GU (ectopic, PID, ovarian cyst)
  • ureters (ureterolithiasis)
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3
Q

WHat to think with LUQ pain

A
  • pancreas (pancreatitis)
  • spleen (splenic dz)
  • lungs (PE, pneumonia, subphrenic abscess)
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4
Q

What to think with LLQ pain

A
  • bowels (diverticulitis, IBD, inguinal hernia)
  • male GU (testicular torsion)
  • female GU (ectopic, PID, ovarian cyst)
  • ureters (ureterolithiasis)
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5
Q

presentation od proximal vs distal vs rectal vs metastatic colon cancer

A

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

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6
Q

Imaging used to diagnose colon cancer

A

barium enema showing apple core + CEA marker

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7
Q

Duke staging of colon cancer + treatment

A
  • 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
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8
Q

FAP: mutation, presnetation Tx?, prognosis?

A

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

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9
Q

gardner vs turcot syndrome

A

Gardner syndrome: FAP +
osteomas, soft tissue tumors

Turcot syndrome: FAP + CNS
tumors

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10
Q

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

A

Peutz-Jeghers syndrome

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11
Q

HNPCC/Lynch: mutation, presnetation, prognosis

A

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

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12
Q

MC type of polyms + management

A

hyperplastic, no malignant potential so leave alone

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13
Q

type of polyps found in kids + management

A

juveline, remove due to vascularity

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14
Q

polyps with high risk of malignant potential

A

adenomatous polyps

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15
Q

presentation of diverticulitis vs diverticulosis

A

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

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

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16
Q

complications of diverticulitis vs osis

A

itis = abcess, bowel obst, colovesicualr fistuals, perforation

osis - hypovolemic shock, diverticulitis

17
Q

MCC LGI bleed

A

Angiodysplasia (vascular

ectasia, AVM)

18
Q

Heyde syndrome: angiodysplasia

+ aortic stenosis

A

Heyde syndrome

19
Q

Tx for angiodysplasia

A

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

20
Q

etiologies of acute mesenteric ishemia and how to distingiuish between them

A

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

21
Q

postprandial dull abd pain, think?

Dx? Tx?

A

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

  • Dx mesenteric angiography
  • Tx surgical revascularization
22
Q

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

Dx? Tx? etiology

A

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)

23
Q

how to dx and tx pseudomembranous colitis

A

C diff toxins

flagyl > po vanc

24
Q

complications of pseudomembranous colitis

A

toxic megacolon and perforation

25
Q

acute-onset colicky pain,
obstipation, nausea/vomiting

Dx KUB shows Omega loop sign (dilated sigmoid colon) or coffee bean sign (cecum

A

volvulus

26
Q

Tx for volvulus

A
  • sigmoid volvulus → Tx sigmoidoscopy w/ decompression ± elective surgery
  • cecal volvulus → Tx emergent surgery

**MC site is sigmoid

27
Q

What imaging is used to Dx appendicitis

A

CT

28
Q

What are the diff physical exam tests/signs for appendicitis

A

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

29
Q

MC tumor of appendix

How to Dx? Tx?

A

Carcinoid (makes 5-HT)

get CT scan

Tx appendectomy (2 cm)

30
Q

What is carcinoid syndrome? How is ti diagnosed?

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

Dx with urinary 5-HIAA

31
Q

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

Tx? Etiologies? Complications?

A

SBO

Tx NPO/IVF/NG tube, observation

Etiology: adhesions from prior
abd surgery (MCC), hernias (#2)

Complications: septic shock,
gangrene, peritonitis, bowel
perforation

32
Q

Meds that cause paralytic ileus

A

narcotics, anti-cholinergics

33
Q

electrolyte imbalance that can cause paralytic ileus

A

hypoK

34
Q

how to Dx celiac sprue?

A

Dx anti-gliadin or anti-endomysial ab

35
Q

presentations of chrons vs US

A

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

36
Q

KUB and tissue bx chrons vs UC

A

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

37
Q

Tx for chrons vs UC

A

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

38
Q

Complications seen with chrons vs UC

A

Chrons: erythema
nodosum, SBO, fissures/fistulae

UC: CRC, pyoderma
gangrenosum, sclerosing
cholangitis, cholangiocarcinoma,pouchitis, toxic megacolon

39
Q

What is pouchitis and how is it treated?

A

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

tx with metronidazole

Medicine Clerkship (20 decks)

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