GI Precision & Pearls #2 Flashcards
(50 cards)
By definition, toxic megacolon is…
What are some symptoms of this condition?
Nonobstructive colonic dilation > 6 cm + signs of systemic toxicity
-Profound bloody diarrhea, vomiting, pain, diarrhea
-Distention
-Fever, AMS, tachycardia, hypotension, dehydration, peritonitis signs
You need three things to diagnose a patient with toxic megacolon. Name them.
-Abdominal radiographs
-3 of the following: fever, pulse > 120, leukocytosis, anemia
-1 of the following: dehydration, AMS, hypotension, lyte abnormalities
Treatment for toxic megacolon
-Supportive: decompression with NG tube, bowel rest, ABX (Metro + Ceftriaxone)
-Correct fluid/electrolyte problems
-Steroids if UC is the cause
Diverticulosis is outpouchings due to herniation of mucosa into the wall of the colon. What are some risk factors for this condition?
Symptoms?
Constipation, low fiber, obesity
-May be asymptomatic
-Painless hematochezia (MCC of lower GI bleed)
What is the MCC of a lower GI bleed?
Diverticulosis
Diverticulosis is MC an incidental finding on a colonoscopy. However, if the bleed is NOT seen on colonoscopy, what diagnostic can you do for this condition?
Radionuclide imaging (tech-99)
Treatment for diverticulosis
-Most spontaneously resolve
–Resuscitation (2 large bore IV lines/blood products if needed)
-high fiber diet, bran, Psyllium
On the other hand, diverticulitis is infection/inflammation of the diverticulum. What part of the colon does this MC occur in?
What are the symptoms of this condition?
Sigmoid colon
LLQ pain, fever, change in bowel habits, n/v
What imaging study is done for diverticulitis?
What oral ABX are used in treatment for diverticulitis?
CT scan
-Labs show leukocytosis
Oral ABX: Metro + Cipro/Levofloxacin for 7-10 days
With diverticulitis, when should you admit the patient?
If complicated (abscess, fistula, perforation) = CT guided percutaneous drainage
If uncomplicated with high risk (sepsis, high fever, old age, immunocompromised)
A small bowel obstruction, or blockage of the small intestine, MC occurs due to what? Other etiologies, though, include…
Post-surgical adhesions (MC)
Others: Malignancy, hernias, volvulus, intussusception
Symptoms of a small bowel obstruction include CAVO, as well as…
Crampy abdominal pain
Abdominal distention
Vomiting
Obstipation (no flatus)
-High pitched tinkles on auscultation
-Visible peristalsis (early) –> hypoactive bowel sounds (late)
Diagnostics done for a small bowel obstruction. What is shown on them?
Upright abdominal XR:
CT scan:
XR: multiple air fluid levels in a step ladder appearance
CT: transition zone = dilated loops with contrast to area without contrast
Management for nonstrangulated and strangulated small bowel obstruction
Nonstrangulated: NPO, IVF, bowel decompression
Strangulated: Surgery!
A paralytic ileus is ________. A few etiologies of this are
-Decreased peristalsis without mechanical obstruction
-Postoperative state, Opioids, DM, hypothyroidism, hypokalemia, hypercalcemia
What are the symptoms of a paralytic ileus (how does it differ from a SBO)?
Decreased or absent bowel sounds, symptoms like SBO
-However, this is painLESS
What do abdominal XR’s show for a paralytic ileus?
Dilated loops of bowel without a transition zone (there is no mechanical obstruction in this case)
Treatment for a paralytic ileus?
Supportive: NPO, electrolyte and fluid replacement
NG suction if persistent nausea/vomiting
Encourage walking to get the bowels moving!
What is intussusception? Where does it MC occur?
Telescoping of an intestinal segment into adjoining segment –> obstruction
Ileocolic junction
Intussusception is the MCC of bowel obstruction in kids < 4 years old. What are risk factors associated with this condition? What is the MCC of this?
Children, males, post infections
Idiopathic (MCC), Meckel Diverticulum, Foreign body, Tumors
What symptoms are associated with intussusception?
What diagnostics should you do and what is seen on them?
Triad: Vomiting + Abdominal pain + Passage of blood per rectum (currant jelly stools)
-Sausage shaped mass in RUQ
-Emptiness in RLQ (Dance’s Sign)
-Pull knees to chest due to pain
US (initial) = target/donut sign
Air or contrast enema: diagnostic and therapeutic
Management for intussusception
-Fluid and electrolyte replacement then
-Pneumatic or hydrostatic NG decompression
-Admit for observation
A volvulus is twisting of part of the bowel at the mesenteric attachment site. This MC involves what two parts of the colon?
Sigmoid colon or cecum
Symptoms of a volvulus in an adult.
Symptoms in a neonate
-Tympanic abdomen, tenderness, crampy pain, distention, n/v, colicky
-Fever, tachycardia, guarding, rigidity
Neonate: non bilious vomiting within first weeks of life
