Colon, Rectum, Anus Flashcards
(45 cards)
How does appendiciits happen?
Fecalith obstructs (adults)/lymphoid aggregates post diarrhea (kids)–> obstruction distention–>edema and inflammation–>irritation of parietal peritoneum–> ischema,infarct–>perforation
Periumbilical abdominal pain moves to RLQ
Appendicits
Why is it that if there distention in the colon due to irritation/infection, then why doesnt it extend to the intestines?
Ileocecal valve prevents reflux of air
Most common causes of a large bowel obstruction?
In US: Colorectal cancer
Global: sigmoid volvulus
How do you work up a large bowel obstruction?
xray to look for distention and air
then CT w/IV contrast
Whorl sign
Swirling appearence of mesentary suggestive of a volvulus
Coffee bean on xray
sigmoid volvulus
Internal or External Hemerroids: Bleed but do not hurt
Internal! No somatic innervation above the pectinate line
Internal or External Hemerroids: Bleed and hurt
External!
Problem for hairy ass’d people
pilonidal disease
Infection of sinus tracts on butt
pilonidal disease
HPVs that are associated w/anal sex
16, 18, and other
What are some major risk factors for anal cancer?
HIV+ and anal receptive sex
What is this characteristic of?
“There are subcutaneous sinuses that open onto pits found midline in the intergluteal fold. These pits, sinuses, and tracts (all the same thing) can have hair grow into them. There can also be skin, debris, and fluid. These sinuses chronically drain and can become acutely infected. The pits go unnoticed and unseen until an abscess forms. The abscess is treated like any other, with incision and drainage.”
Pilonidal disease
What medical therapies help with anal fissures?
Dietary changes and regular defecationwill prevent the fissure from worsening. Then, it is all about relaxation of the anal sphincter. Medical therapy, including topical nitroglycerin, calcium-channel blockers (nifedipine), and botulinum toxin injections (try topical agents first), should be exhausted before going to surgery.
diverticulitis
Autoimmune disease that causes shallow, broad-based ulcers starting in colon and are continuous through the proximal colon Pt presents w/ Abdominal pain, bloody diarrhea, no malabsorption
Dx:Colonoscopy = Broad-based ulcers, pseudopolypsBiopsy = Crypt abscesses
Ulcerative colitis
How does the presentation differ in left versus right sided colon cancer?
Left-sided colon cancer obstructs, and stricture causes pencil-thin stools, alternating constipation with diarrhea
Right-sided colon cancer bleeds
How do we make sure dx before rushing domone off for an appendectomy?
Though point-of-care ultrasound may eventually replace CT for the diagnosis of acute appendicitis, CT remains the best radiological test to diagnose and stage the disease (just use low-dose radiation CTs).
What are the hichney stages?
Its used to assess diverticulitis
Which hichney stage gets you to the OR?
3 and 4
Hinchey stage 0 does not need treatment, Hinchey stage 1 needs antibiotics and bowel rest, Hinchey stage 2 needs IV antibiotics and a drain, and Hinchey stages 3 and 4 need sigmoidectomy.
What is the process for treating anal fissures?
Anal fissures are treated first by getting the stool soft and bowel movements frequent;
second by relaxing the anal sphincter with topical medications or botulinum injections;
finally by performing a lateral internal sphincterotomy.
How can you discern an ileocecal volvulus on XR?
There is distension of the proximal colon (the dilation is on the left side of the image, right side of the patient) without gas patterns for the transverse, descending, or sigmoid colon, indicating that this is an ileocecal volvulus (cecal volvulus)
deep palpation of the LLQ leading to RLQ pain . . . which is a more brutal version of the rebound method described in Approach to Abdominal Pain; do not perform a maneuver to elicit this sign
Rovsings sign
appendicitis
