Large Bowel Disorders

Question 1

Acquired by 20% of patients through fecal-oral transmission in a hospital setting

Answer 1

Antibiotic associated colitis (Clostridium difficile infection)

Question 2

Signs and symptoms include: Moderate greenish, foul-smelling watery diarrhea. Mild LLQ tenderness. Stool has mucus but seldom blood. Fever up to 40C (104F)

Answer 2

Antibiotic Associated Colitis(C.diff)

Question 3

Treatment for Antibiotic Associated Colitis(C.diff)

Answer 3

D/C antibiotics. 1st Metronidazole(Flagyl) 500mg TID x 10-14/d. If fails, Vancomycin 125mg PO QID (more expensive). Probiotics

Question 4

If appendicitis is left untreated, how soon does gangrene and perforation develop?

Answer 4

within 36 hrs

Question 5

Most common abdominal surgical emergency

Answer 5

appendicitis

Question 6

Classic h/o of appendicitis

Answer 6

periumbilical pain followed by nausea

Question 7

point just below the middle of a line connecting the umbilicus and the anterosuperior iliac spine.

Answer 7

McBurney’s point

Question 8

Pain in the right lower quadrant with palpation of the left lower quadrant

Answer 8

Rovsing sign

Question 9

evaluated by passively flexing the right hip and knee and internally rotating the hip

Answer 9

obturator sign

Question 10

evaluated by placing patient in either the supine or the left lateral decubitus position and extending the right leg at the hip

Answer 10

psoas sign

Question 11

Has become the most important imaging study in patients with ATYPICAL presentations of appendicitis

Answer 11

CT scans

Question 12

condition of having diverticula of the colon. more common in the sigmoid colon. associated w/low fiber, high intake of fat/red meat, obesity, lack of excercise

Answer 12

diverticulosis

Question 13

which are outpocketings of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall (Mucosal layer herniates thru muscularis layer)

Answer 13

diverticula

Question 14

H/O includes: chronic constipation, some pts may c/o cramping, bloating, flatulence, and irregular defecation

Answer 14

diverticular disease

Question 15

PE may reveal LLQ tenderness and palpable sigmoid/descending colon

Answer 15

diverticular disease

Question 16

Treatment for diverticular disease

Answer 16

Bulk in diet to get one BM per day at minimum

Question 17

Swelling and inflammation of diverticulum in the intestinal wall

Answer 17

diverticulitis

Question 18

erosion of the diverticular wall by increased intraluminal pressure or inspissated stool within a diverticulum; inflammation and focal necrosis ensue, resulting in perforation

Answer 18

diverticulitis

Question 19

Signs and symptoms include: achy LLQ pain, N/V, low grade fever, palpable mass, distention, stool occult blood, leukocytosis

Answer 19

diverticulitis

Question 20

CI during initial stages of diverticulitis due to risk of perforation

Answer 20

barium enema or colonoscopy

Question 21

test of choice in pts suspected of having acute diverticulitis

Answer 21

CT scan

Question 22

Outpatient treatment for diverticulitis

Answer 22

clear liquid diet, analgesia, Augmentin or Flagyl + Cipro x 7 days

Question 23

Inpatient treatment for diverticulitis (ie the elderly, immunosuppressed, those with significant comorbidities, and those with high fever or significant leukocytosis)

Answer 23

IV fluids, NG tube, IV abx. Surgery- Drainage of abscess, temp or perm colostomy

Question 24

Most common form of congenital abnormality of the small intestine, resulting from an incomplete obliteration of the vitelline duct in 5th week of fetal development

Answer 24

Meckel’s Diverticulum

Question 25

Occurs on the antimesenteric border of the ileum, usually 60cm proximal to the ileocecal valve

Answer 25

Meckel's Diverticulum

Question 26

2% of the population, 2 feet from the ileocecal valve, and is about 2 inches long, 2% of patients develop a complication over their lifetime, present by age 2

Answer 26

rule of twos for Meckel's Diverticulum

Question 27

3 most common complications for Meckel's Diverticulum

Answer 27

GI bleeding, inflammation of diverticulum, intestinal obstruction

Question 28

Part of the intestines has prolapsed into another section of intestine. Usually occurs at the terminal ileum (ileocecal)

Answer 28

intussusception

Question 29

predominate cause of intestinal obstruction in persons aged 3 months to 6 years

Answer 29

intussusception

Question 30

Signs and symptoms include: colicky/intermittent pain, loose stools w/vomiting, blood or mucus passed through rectum (currant jelly stools)

Answer 30

intussusception

Question 31

Absence of bowel sounds in the RLQ

Answer 31

Dance's sign. Associated w/intussusception

Question 32

method of choice to detect intussusception

Answer 32

ultrasound- a bull's eye or coiled spring lesion often observed

Question 33

Treatment for intussusception

Answer 33

barium enema

Question 34

Twisting of the bowel on itself. Sigmoid if most common form. Occurs frequently in middle-aged men and elderly men

Answer 34

volvulus

Question 35

Patients experience abdominal pain, distension, and absolute constipation

Answer 35

volvulus

Question 36

Clinical syndromes caused by impaired intestinal motility and are characterized by symptoms and signs of intestinal obstruction in the absence of a lesion-causing mechanical obstruction

Answer 36

Ileus and intestinal pseudo-obstruction

Question 37

most frequently implicated cause of delayed discharge following abdominal operations

Answer 37

Ileus and intestinal pseudo-obstruction

Question 38

Treatment of ileus

Answer 38

Support patient with bowel rest, fluids and electrolytes. Avoid opiates

Question 39

Neurogenic or muscular impairment of peristalsis. Common after bowel surgery

Answer 39

paralytic ileus

Question 40

Signs and symptoms include: severe colicky pain, absolute constipation, distention, high pitched bowel sounds

Answer 40

mechanical intestinal obstruction

Question 41

Signs and symptoms include: pain, absolute constipation, distention, SILENT abdomen

Answer 41

paralytic intestinal obstruction

Question 42

A cyst at the bottom of the tailbone (coccyx) that can become infected and filled with pus

Answer 42

Pilonidal Cyst

Question 43

Caused by ingrown hairs

Answer 43

Pilonidal Cyst

Question 44

Signs and symptoms include: pain, swelling, redness at bottom of spine, draining pus, fever, leukocytosis

Answer 44

pilonidal cyst

Question 45

Involves incision and draining, removal of pus and hair, and sewing of the edges of the fibrous tract to the wound edges to make a pouch

Answer 45

marsupialization

Question 46

A tear in the anoderm distal to the dentate line, resulting in linear or rocket shaped ulcer. Results from high anal pressure :trauma to the anal canal during defection

Answer 46

anal fissure

Question 47

Symptoms include: Severe, tearing pain during defecation. Throbbing discomfort. Mild hematochezia

Answer 47

anal fissure

Question 48

Subepithelial vascular cushions with connective tissue, smooth muscle fibers, AV communications with the superior rectal artery and rectal veins located proximal to the dentate line

Answer 48

internal hemorrhoids

Question 49

Arise from the inferior hemorrhoidal veins located below the dentate line.

Answer 49

external hemorrhoids

Question 50

Conservative treatment of hemorrhoids

Answer 50

fiber, increased fluids, anusol, tucks pads, sitz baths