Colon/Small intestine Lecture

Question 1

Which gender is IBS seen more frequently in?

Answer 1

Women 2-3x more common

Question 2

IBS is a diagnosis of…

Answer 2

exclusion

Question 3

Pt education

Avoid triggers

Dietary therapy (high fiber)

Pharm therapy:
Antispasmodics, antidiarrheal, psychotropic, serotonin receptor agonists

Answer 3

Tx for IBS

(really specific/individualized for pt and case)

Question 4

Medical emergency most of the time

Can be due to physical obstruction (foreign body, tumor, etc)
Can be due dysfunction of peristalsis

Answer 4

Bowel obstruction

Question 5

Decrease or absence of intestinal paralysis

typically associated with trauma, surgery, infection or severe metabolic disease

Answer 5

Paralytic ileus

Question 6

Volvulus

Answer 6

Twisting of intestine

Question 7

Intussusception

Answer 7

Telescoping of intestine

Question 8

Severe cramping abdominal pain
N/V

Inability to pass stool, gas
Increased bowel sounds early on, decreased late**
Abdominal swelling, distention

Answer 8

Bowel obstruction

Question 10

Upright Xray may illustrate air fluid levels and multiple dilated loops of bowel

Answer 10

Bowel obstruction

Question 11

When can you NOT give a barium swallow/enema?

Answer 11

If you suspect a perforation

Question 12

NPO

Relieve pressure via nasal to stomach cannula

IV fluid, pain management

Relieve obstruction

Tx underlying issue if paralytic

Surgery often required

Answer 12

Bowel obstruction

Question 13

Tissue death

Perforation

Sepsis

Death

Answer 13

Complications of failue ro recognize or treat a bowel obstruction

Question 14

Inadequate flow of oxygenated blood to the intestines resulting in tissue death

Answer 14

Ischemic bowel

Question 15

Inflammation and injury to the small intestine resulting in decreased blood flow

Answer 15

Mesenteric ischemia

Question 16

Inflammation and injurt to the large intestine resulting in decreased blood flow

Answer 16

Ischemic colitis

Question 17

Acute= emergency!!!! high mortality rates

Chonic=blood supply present but insufficient to meet needs of intestines

Answer 17

Mesenteric ischemia

Question 18

Gold standard for diagnosing mesenteric ischemia?

Answer 18

CT of abdomen WITH contrast!

Question 19

Can be anywhere in GI tract

Multiple, interrupted lesions

Answer 19

Chron’s disease

Question 20

Only located in colon

Continuous lesions

Answer 20

Ulcerative colitis

Question 21

“Cure” for ulcerative colitis?

Answer 21

Colectomy

Question 22

Diagnostic test of choice for Chron’s/Ulcerative colitis?

Answer 22

Colonoscopy

Question 23

Acute toxic colitis with dilation and immbolity of colon

medical emergency!

Risk of rupture can lead to sepsis, death

Answer 23

Toxic megacolon

Question 24

Can occur as a complication of:

Ulcerative colitis
Chron’s
Psuedomembranous colitis
Infections: shigella, campylobacter, c.dif

Answer 24

Toxic megacolon

Question 25

Radiographic evidence of dilation..greater than 6cm in transverse colon

3 out of these 4:
temp over 101.5
HR over 120 bpm
Leukocytosis over 10.5
anemia

Answer 25

Toxic megacolon

Question 26

1. reduce distention
2. correct fluid/electrolytes
3. treat toxemia, any contributing factors

Answer 26

Tx goals of toxic megacolon

Question 27

Abdominal pain

Fever

Nausea

Answer 27

classic triad for appendicitis

Question 28

Initial symptom in intermittent periumbilical or epigastric pain

in about 12 hours, localizes to RLQ (McBurney’s point), becomes constant, and is worsened by movement leading to rebound tenderness on PE

Answer 28

Appendicitis

Question 29

Autoimmune disorder of the small intestine, genetic component, manifests as abdominal pain, intermittent diarrhea, constipation, fatigue and anemia

Answer 29

Celiac disease

Question 30

Intolerance to gluten, ingestion of gluten triggers an immune response in turn causing damage to small intestine leading to nutritional deficits secondary to absorption issues

Answer 30

Celiac disease

Question 31

Diarrhea
Steatorrhea
Excessive gas, bloating, abdominal distention
Bowel pattern changes
Weight loss
Fatigue
Weakness

Answer 31

Celiac disease

Question 32

How is diagnosis of celiac confirmed?

Answer 32

Biopsy of small intestine

Question 33

Rare! (2% of GI cancers)

Symptoms:
Vague abdominal discomfort
Nutritional deficiency
Anorexia
Jaundice
Obstruction
**often not diagnosed until mets to other places

Answer 33

Small intestine cancers

Question 34

Elevated alk phos…can mean?

Answer 34

Something going on with the bone!

clue that there may be cancer going on somewhere!!! (ie colon cancer)

Question 35

Apple core lesion on X ray…CLASSIC for..

Answer 35

Colon cancer

Question 36

How often do you check:

Fecal occult blood test?

Answer 36

Every year after age 50

Question 37

How often do you check:

Flex sig?

Answer 37

Every 5 years over 50

Question 38

How often do you do colonoscopies?

Answer 38

Every 10 years over 50