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Surgery > Chapter 12, part 3 > Flashcards

Chapter 12, part 3 Flashcards

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1
Q

Pseudomembranous colitis

A

Overgrowth of C. diff (happens after abx use)

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2
Q

Transmission of pseudomembranous colitis

A

Fecal oral route

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3
Q

What are the two endotoxins that C. diff produces?

A

Enterotoxin
Cytotoxin
Cause mucosal damage resulting in exudative pseudomembrane on scope

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4
Q

Dx of pseudomembranous colitis

A

ELISA (and PCR if necessary)

GDH

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5
Q

Tx of pseudomembranous colitis

A

Initial: oral metronidazole or oral vanc (chosen in more severe cases)
In the case of septic shock, subtotal colectomy with end ileostomy

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6
Q

Causes of bloody diarrhea

A 
Shigella
C. jejuni
Enterohemorrhagic E. coli (EHEC)
E. histolytica
Certain salmonella
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7
Q

E. histolytica and bloody diarrhea

A

Causes amebic colitis

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8
Q

Amoebic colitis sx

A

Mimics IBD (crampy abd pain and bloody diarrhea)

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9
Q

Dx of amoebic colitis

A

Stool studies
Antigen testing
Endoscopy (ulcerations and trophozites)

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10
Q

Tx of amoebic colitis

A

Metronidazole + luminal agent (paromomycin)

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11
Q

Shigella and bloody diarrhea

A

Fecal-oral route or through contaminate food and water

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12
Q

Dx of shigella

A

Stool culture

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13
Q

Tx of shigella

A

Self-limiting, but can give FQ to reduce duration

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14
Q

EHEC

A

Fecal contamination of foods

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15
Q

MC sx of EHEC diarrhea

A

Hemorrhagic colitis

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16
Q

Tx of EHEC

A

Supportive

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17
Q

What is a major potential sequela of EHEC infection?

A

HUS (hemolytic uremic syndrome)
5-10 days after diarrhea
Acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia

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18
Q

Salmonella

A

Gastroenteritis caused by nontyphoidal strains= MC

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19
Q

Sx of salmonella bloody diarrhea

A

Abdominal pain
Fever
Vomiting 1-3 days after exposure

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20
Q

Tx of salmonella bloody diarrhea

A

Self-limiting, supportive

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21
Q

C. jejuni

A

Same sx and tx as salmonella

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22
Q

Cytomegaloviral colitis

A

Presents similar to appendicitis (tx with ganciclovir)

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23
Q

Neutropathic enterocolitis

A

MC affects cecum
Immunosuppressed pts undergoing chemo
Presents like appendicitis
Tx: bowel rest and IV abx

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24
Q

What is the MC site of bowel ischemia and why?

A

Colon

Usually d/t prolonged hypoperfusion secondary to hemodynamic instability

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25
What is the MC site of the colon for ischemia
Watershed areas (splenic flexure)
26
S/sx of ischemia of the colon
Worsening abdominal pain (out of proportion to the exam) Bloody diarrhea Abdominal distention
27
Lab findings for ischemia of the colon
Lactic acidosis | Leukocytosis
28
Rads for ischemia of the colon
CT: Bowel wall edema or pneumatosis of intestinal wall Sigmoidoscopy or colonoscopy: Patchy hemorrhagic areas with dusky mucosa
29
Tx of ischemia of the colon
If full thickness necrosis or perforation: urgent segmental resection and creation of stroma Partial thickeness: abx, bowel rest, and correction of hypoperfused state
30
Where can Crohn's be found?
Anywhere in GI tract (mouth to anus) | Terminal ileum is MC
31
What type of involvement occurs in Crohn's?
Patchy involvement
32
What components does Crohn's affect?
Transmural inflammation
33
Gross appearance of Crohn's
Segments look grossly inflammed with thickened mesentery and creeping serosal fat
34
What is seen on colonoscopy in Crohn's?
Long longitudinal ulcers and erosions of the submucosa: cobblestoning
35
Path of Crohn's
Transmural infiltration with deep penetrating fissures through muscularis propria and non-caseating granulomas
36
Presentation of Crohn's
Crampy abdomainl pain Diarrhea +/- bleeding Fever Weight loss
37
Dx of Crohn's
Colonscopy and imaging of the small bowel Granulomas on hx Colonscopy q1-2 yrs beginning 10 years after dx
38
Tx of Crohn's
Sulfasalazine, immunosuppresives and biologics Pts with highly symptomatic focal dz may benefit from early interventions Fulminent colitis (doesn't respond to therapy in 5-6 days): total abdominal colectomy and end ileostomy Total proctocolectomy is contraindicated in Crohn's If obstructive sx present: surgery is recommended
39
What are the hallmark of Crohn's?
Fistulas: 1/3 will develop internal fistula = SB to SB or SB to colon
40
Enterocutaneous fistulas in Crohn's
Low output <500 mL/day High output >500 mL/day Bowel rest, TPN and aggressive tx of the Crohn's Refractory: operation and resection
41
Where can UC be found?
Rectum and progresses proximally (does not involve the small bowel)
42
What type of involvement occurs in UC?
Contiguous
43
What components does UC affect?
Only affects the mucosa
44
Gross appearance of UC
Nl
45
Colonoscopy findings of UC
Extremely friable mucosa
46
Path of UC
Nl muscularis propria
47
Presentation of UC
Frequent bloody diarrhea Crampy abd pain Tenesmus and urgency resulting in fecal incontinence
48
Dx of UC
Stool studies for ova and parasites Stool cultures Colonoscopy and hx
49
Extracolonic fistulas and UC
Pyoderma gangrenosum- destructive inflammatory ulcerative dz of the skin commonly found around ostomy sites Primary sclerosing cholangitis: obliterating inflammatory dz of the small and large bile ducts = MC noninfectious indication for liver transplant
50
Tx of UC
Moderate dz: sulfasalazine Severe cases: azathioprine and 6-mercaptopurine -Steroids during exacerbation Surgery fro those pts refractory to meds= MC indication
51
What is the risk of UC pts having colon CA?
33% lifetime risk | Colonoscopy starting 10 yrs after dx
52
What cures UC?
Surgical therapy at removing all mucosa | Total proctocolectomy with ileal pouch and anastamosis
53
Total proctocolectomy with IPAA
Entire colon and rectum mobilized and removed J. pouch constructed using the terminal ileum Pouch anastamosed to the remnant of the distal rectum and anus Temporary diverting loop ileostomy may be done May do rectal mucosectomy to remove remaining mucosa
54
What is the 3rd MC cancer in the US?
Colorectal
55
Adenocarcinoma
Adenoma leads to dysplasia leads to invasive carcinoma
56
What is the MC neoplastic polyp?
Adenoma | Precursor for all colorectal CA
57
Adenoma
Can be pedunculated or sessile (no stalk, so automatically level 4) Tubular, villous, tubovillous If they are >2 cm, villous, and sessile: higher risk of CA
58
Hagitt criteria level 0
Carcinoma in situ. No invasion
59
Hagitt criteria level 1
Head of polyp
60
Hagitt criteria level 2
Head + neck of polyp at junction of adenoma and stalk
61
Hagitt criteria level 3
Into the stalk
62
Hagitt criteria level 4
Into submucosa of bowel but above muscularis propria
63
Tx of malignancies
Polypectomy if malignancy well differentiated | May need resection if not defined lesions
64
What are the MC neoplasms?
Benign | Classified into hyperplastic, juvenile, and inflammatory
65
Parameters of benign neoplasms
<3 mm | No malignant potential
66
Juvenile polyp
Hamartomas seen throughout the GI tract | Associated with polyposis syndromes, no malignant potential, but often bleed
67
Inflammatory polyp
Result from repetitive mucosal ulceration and regeneration

Surgery (30 decks)

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