Gallbladder disorders + Anal disorders

Question 1

what is obstructed in cholecystitis

Answer 1

cystic duct

Question 2

sx cholecystitis

Answer 2

RUQ pain (> 6 hours)
fever

Question 3

dx cholecystitis

Answer 3

US first
then HIDA scan / cholescintigraphy

Question 4

tx cholecystitis

Answer 4

IV fluids first
then abx (Cef + Metro)
then cholecystectomy (definitive)

Question 5

RF cholecystitis

Answer 5

Obesity
female
advancing age
pregnancy

Question 6

RF for acalculous cholecystitis

Answer 6

critically ill

Question 7

cause of acalculous cholecystitis

Answer 7

no stones - stasis and ischemia of bile

Question 8

will pts a acalculous cholecystitis be jaundiced

Answer 8

yes

Question 9

where does infection from ascending cholangitis ascend from

Answer 9

duodenum - e coli

Question 10

what is ascending cholangitis

Answer 10

infection/inflammation in common bile duct

Question 11

MC cause ascending cholangitis

Answer 11

choledocholithiasis

Question 12

sx cholangitis

Answer 12

charcots triad - fever, RUQ pain, jaundice
Reynold’s pentad - hypotension/shock + AMS

Question 13

dx cholangitis

Answer 13

US first
then ERCP (diagnostic and therapeutic)

Question 14

labs for cholangitis

Answer 14

leukocytosis
increased alk phos
increased GGT
increased bilirubin > 2
ALT and AST can be elevated too

Question 15

labs for choledocholithiasis

Answer 15

same for cholangitis

Question 16

dx choledocholithiasis

Answer 16

US first
then ERCP (diagnostic and therapeutic)

Question 17

will pts w choledocholithiasis be jaundiced

Answer 17

yes

Question 18

what gallbladder diseases will need abx

Answer 18

cholecystitis (including acalculous)
cholangitis

Question 19

what is an anal fissure

Answer 19

linear tear/crack in the anal mucosa distal to the dentate line; MC posterior midline

Question 20

what other disease is anal fissure closely associated with

Answer 20

Crohn

Question 21

sx anal fissure

Answer 21

painful defection; pain may last for minutes to hours; better before next BM

“passing glass” “passing a knife”

hematochezia

Question 22

dx anal fissure

Answer 22

clinical
anoscopy for hematochezia

Question 23

tx anal fissure

Answer 23

fiber, warm sitz bath
topical nifedipine, nitroglycerin, hydrocortisone, or diltiazem

botox injection - risk of fecal incontinence
lateral internal sphincterotomy - risk of fecal incontinence

Question 24

acute vs chronic anal fissure

Answer 24

acute < 8 weeks
chronic > 8 weeks

Question 25

anorectal/perianal abscesses arise from

Answer 25

anal crypt glands

Question 26

MC organism involved in anorectal/perianal abscess

Answer 26

staph aureus

Question 27

where are anorectal/perianal abscesses MC located

Answer 27

posterior rectal wall

Question 28

sx anorectal/perianal abscess

Answer 28

severe, constant rectal pain worse with sitting, defecating, coughing fluctuant = abscess

Question 29

tx anorectal/perianal abscess

Answer 29

I & D then abx (augmentin or Cef + Metro)

Question 30

what is an anal fistula

Answer 30

abnormal communication btwn anus and perirectal skin

Question 31

what is anal fistula MC due to

Answer 31

drainage from abscess

Question 32

Parks classifications for anal fistula

Answer 32

type 1 - Intersphincteric type 2 - Transphincteric type 3 - suprasphincteric type 4 - extrasphincteric

Question 33

which parks classification for anal fistula is MC

Answer 33

type 1

Question 34

describe type 1 anal fistula

Answer 34

Intersphincteric - only through internal sphincter; due to perianal abscess

Question 35

describe type 2 anal fistula

Answer 35

Transsphincteric - through internal and external sphincter; from ischiorectal abscess

Question 36

describe type 3 anal fistula

Answer 36

Suprasphincteric - through internal sphincter and the extends superiorly btwn sphincters; from supralevator abscess

Question 37

describe type 4 anal fistula

Answer 37

Extrasphincteric - begins at rectum (not the anus, unlike the other three types) and extends down through the levator ani muscle

Question 38

what type of anal fistula is not included in the parks classification

Answer 38

superficial fistula; this is submucosal and does not involve sphincters

Question 39

tx anal fistula

Answer 39

fistulotomy -- open it and get rid of fistula by secondary intention partial sphincterectomy - more likely to cause fecal incontinence

Question 40

what are hemorrhoids

Answer 40

engorgement of venous plexus

Question 41

what type of cells are internal hemorrhoids covered by

Answer 41

columnar cells

Question 42

what type of cells are external hemorrhoids covered by

Answer 42

squamous cells

Question 43

where do internal hemorrhoids originate from

Answer 43

superior hemorrhoid vein

Question 44

where do external hemorrhoids originate from

Answer 44

inferior hemorrhoid vein

Question 45

internal and external hemorrhoids in relation to dentate line

Answer 45

internal - proximal to (above) external - distal to (below)

Question 46

difference in sx internal vs external hemorrhoids

Answer 46

internal - bleed, no pain external - pain, no bleed

Question 47

if there is bleeding from the rectum, what test do you have to do

Answer 47

anoscopy

Question 48

tx hemorrhoids

Answer 48

fiber supplementation, fuids topical hydrocortisone or topical lidocaine internal - rubber band ligation, sclerotherapy, etc external - hemorrhoidectomy

Question 49

grading for internal hemorrhoids

Answer 49

grade 1 - no protrusion grade 2 - protrusion but spontaneously reduce grade 3 - protrusion but manually reduce grade 4 - protrusion and no reduction; risk strangulation