Internal hemorroids present with?
Painless bleed
how do you treat hemorrhoids
Sitz bath, vasoconstrictors, band ligation, High fiber, stool softeners
Linear tear in anal mucosa, posterior, + more pain with defecation is?
Anal fissure
how do you tx anal fissure?
stool softeners, sitz, fiber, water
bacteria in the dentate line with fistulas are?
perianal abscess - deep dull pain, pain out of proportion
how do you diag perianal abscess?
CT/MRI - Hx
how do you tx perianal abscess?
I+D, vanco/bactrum if MRSA
Risk of colorectal cancers are (3)
MSM, HPV, Tobacco
Colorectal cancer bio marker?
CEA, biopsy
RLQ pain, anorexia, N/V?
appendicitis
mcburry point, rosvings, psoas, obturator tx?
Abx, pal appey
Bacterial ascites is?
peritonitis
peritonitis presents with
pain, fever, N/V and HX
Diag of peritonitis?
CT, labs
Tx of peritonitis?
Gram - abx and hemodyanic stability
what are 3 complications to constipation?
Hemorrohoids, fissure, rectal prolaps
Tx for constipation?
Luboprostone, Linaclotide, Fiber, Polyethylene glycol, Manual disimpaction, enemas, Change diet
Diag of mega colon?
6cm on Xray
mega colon causes?
IBD, Infection (salmonella, shigella) ischemic colitis,
Mega colon presents like?
Left shift, N/V/D, fever, tachy, dehydrated, abd pain
Mega colon treatment?
NG tube, Abx, ICS, colectomy
Divreticulosis is?
colonic outpatches
Diverticulitis is?
infection/inflame LLQ + fever
Diagnose diverticula?
CBC, CT
Treatment for diverticula?
Abx, liquids, surgery
Causes of Bowel Obs?
adhesions (Sx), malignancy, hernias, volvulus, intussusception
SBO presents with?
Burbury, high pitch tingling sounds
BO diagnoses are..
Xray (ladder loops of bowel)
Tx BO?
NPO, NG tube, IV fluids
whats an ileus?
Bowel isnt moving
Causes of ileus?
Narcotics, Sx. Painless obstruction
S/S of ileus?
painless, N/V,
Ileus is diag with?
No air/fluid levels, bowel isnt working.
How do you treat an ileus
NPO, NG tube, what was the trigger (narcotics)
How do you diag intussusception?
telescoping (US), barium enema
intussusception present with?
sausage mass, currant jelly stool, Post viral,
How do you tx intussusception
air enema
twisting of the sigmoid colon is a ?
Volvulus, colicky pain in older pts
How do you tx a volvulus
distended, tympany, - tx is sigmoid flex, colonoscopy
ischemic bowel disease is caused by?
lack of blood, CAD, DM, Lipids, A fib
ischemic bowel disease presents with
Pain out of prop, pain post meal
ischemic bowel disease diagnoses?
Angio, CT, LDH
Tx of ischemic bowel disease
NPO, IVF, Abx, surgery
PSC is associateed with?
UC
IBD sxs are also
Arthrlgia, fatigue, hematochezia, eyes, liver
Tx of IBD
ICS, MTX, Azathioprine, 6-ME, surgery for UC, natalizumab
IBS tx
TCA, SSRI, CBT, fiber
IgA transglutaminase is?
Celiacs
Diag Celiacs?
EGD Biopsy - TTG, endomysial, villous atrophy
Tx for Celiacs?
eliminate gluten, ICS
s/s of celiacs?
burburmgi, dermatitis herpetiformis, pook Vit K, tympanitic abd
most polyps are
adenocarcinomas
Lynch and FAP, Peutz-jeghrs (freckles)
FAP = 100% by 40, risk factors for colon cancer
1-2 polyps when do you repeat colonoscopy
5 years (tubular adenomas)
infections that cause diarrhia?
rotavirus, noro, ecoli, C.diff, camplybacter, cholera, vibro, entameoba, giardia, crypto
keys for diarrhea?
daycare, camping, pets, recent abx
Tx diarrhea?
Rehydrate hypo-osmolar, abx if needed
abx for diahhrea?
1 enterohemorragic (beef)
2 salmonella (chicken) - ICS FQ
C.diff - flagyl/vanco
enterohemorragic