Unit 3 Lecture 5

Question 1

sxs of meckel’s diverticulum

Answer 1

asx, abd pain (SBO), GI bleeding

Question 2

dx of meckel’s diverticulum

Answer 2

meckel’s scan

Question 3

tx of meckel’s diverticulum

Answer 3

resection

Question 4

most common of the rule of 2’s for meckel’s

Answer 4

2 yo at presentation

Question 5

causes of diffuse abd pain

Answer 5

gastroenteritis, mesenteric ischemia, metabolic, malaria, bowel obstruction, peritonitis, IBS

Question 6

what is mesenteric ischemia

Answer 6

decreased perfusion to section or/entire colon due to embolic, atherosclerotic, aortic surgery, or hypotension

Question 7

risk factors for mesenteric ischemia

Answer 7

cardiac arrhythmias, advanced age, low CO states, valvular heart ds, MI, malignancy

Question 8

sxs of mesenteric ischemia

Answer 8

severe acute midabdominal pain, post-prandial, possible hematochezia/diarrhea

Question 9

PE of mesenteric ischemia

Answer 9

pain out of proportion to exam

Question 10

pneumatosis intestinalis

Answer 10

air within the wall of the ascending bolon;sx not a dx; a/w ischemic bowel

Question 11

tx of mesenteric ischemia

Answer 11

aggressive fluid resuscitation, NGT, foley cath, abx, anticoag, embolectomy or colon resection

Question 12

sxs of appendicitis

Answer 12

abd pain, anorexia, N/V, dysuria

Question 13

PE of appendicitis

Answer 13

mcburney’s point tender, guarding, rebound tenderness

Question 14

rebound tenderness

Answer 14

done anywhere on the abd; pain when released

Question 15

rovsing’s sign

Answer 15

done on the LLQ and pain when pressing in

Question 16

pecial tests for appendicitis

Answer 16

rovsing’s, psoas, obturator, DRE pain on right side

Question 17

dx of appendicitis

Answer 17

CT with contrast

Question 18

signs of appendicitis on CT

Answer 18

enlargement with wall thickening, fat stranding, and fecalith

Question 19

tx of appendicitis

Answer 19

periop abx, appendectomy

Question 20

complications of appendicitis

Answer 20

perforated (most common), peritonitis, abscess

Question 21

signs of perf append.

Answer 21

more diffuse pain after localized tenderness; pain may be relieved followed by peritonitis

Question 22

signs of peritonitis from perforated appendix

Answer 22

high fever, localized or generalized pain

Question 23

location of appendix during 5th month of pregnancy

Answer 23

level of the umbilicus

Question 24

causes of LLQ pain

Answer 24

diverticulitis, salpingitis, ectopic pregnancy, inguinal hernia, nephrolithiasis, IBS, IBD

Question 25

where is diverticulitis most prevalent

Answer 25

sigmoid colon

Question 26

sxs of diverticulitis

Answer 26

LLQ pain, fever, anorexia, N +/- V

Question 27

PE of diverticulitis

Answer 27

tenderness, guarding, distension, hypoactive/absent BS or hyperactive BS, +guaiac

Question 28

labs of divertic.

Answer 28

leukocytosis with left shift

Question 29

tx of divertic

Answer 29

oral abx->clear liquids->low residue diet->high fiber diet | surgery if repeated attacks, complications, or failure to improve with conserv. tx after 3-4d

Question 30

colostomy

Answer 30

colon divided->proximal end brought through the abdominal wall

Question 31

hartmann's procedure

Answer 31

colostomy with distal end oversewn and placed in peritoneal cavity as blind limb

Question 32

stoma

Answer 32

portion of the intesting outside the abd

Question 33

loop colostomy

Answer 33

both proximal and distal end drain to the abd wall

Question 34

proctocolectomy

Answer 34

removal of entire colon and rectum

Question 35

adominoperineal resection

Answer 35

removal of lower sigmoid colon, entire rectum, and anus (very low rectal CAs)

Question 36

low anterior resection

Answer 36

removal of distal sigmoid colon and 1/2 of rectum (CA of middle of upper sections of rectum)

Question 37

diff between internal or external hemorrhoid

Answer 37

internal above dentate line, external below dentate line

Question 38

most common cause of rectal bleeding

Answer 38

internal hemorrhoids

Question 39

grade I hemorrhoid

Answer 39

palpable, nonprolapsed

Question 40

grade II hemorrhoid

Answer 40

prolapse with straining and defecation

Question 41

grade III hemorrhoid

Answer 41

protrude spontaneously or with straining, require manual reduction

Question 42

grade IV hemorrhoid

Answer 42

chronically prolapsed and cannot be reduced

Question 43

tx of grade II and grade III internal hemorrhoids

Answer 43

rubber band ligation

Question 44

acute and chronic complication of infection of the anal glands

Answer 44

acute=abscess | chronic=fistula

Question 45

causative organisms or anorectal abscesses

Answer 45

E. coli, proteus sp., strep., bacteriodes

Question 46

tx of anorectal tx

Answer 46

surgical drainage, abx, wound care

Question 47

presentation of rectal FB

Answer 47

anorectal/abd pain, blood per rectum, mucus d/c

Question 48

complications of rectal FB

Answer 48

fistulas

Question 49

dx of enteric fistula

Answer 49

imaging/endoscopy

Question 50

tx of enteric fistula

Answer 50

fluid resus., bowel rest, nutritional support, op. tx

Question 51

what is fistula in ano

Answer 51

abnl communication b/t anal canal and the perianal skin

Question 52

dx of fistula in ano

Answer 52

goodsall's rule, cord like tract on DRE, drainage or granulation seen on PE

Question 53

tx of fistula in ano

Answer 53

drainage and curretage of fistula tract, placement of seton

Question 54

impact of starvation in Ebb phase

Answer 54

immediate, tissue hypoperfusion, decrease metabolism, catecholamin release

Question 55

impact of starvation in flow phase

Answer 55

catabolic and anabolic, increase CO, hypermetabolic, hyperglycemia

Question 56

kcal and protein needed in "stressed" patients

Answer 56

50 kcal/kg/day and 2.5g protein/kg/day