PANCE 2.0 > GI #2 > Flashcards

GI #2 Flashcards

(47 cards)

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1
Q

Management of fecal impaction

A
  • Digital disimpaction followed by warm-water enema with mineral oil
  • Polyethylene Glycol
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2
Q

MCC of anorectal abscess

A

-Staphyloccus Aureus

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3
Q

MC site of anorectal abscess

A

Posterior rectal wall

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4
Q

Symptoms of an anorectal abscess

A
  • Swelling
  • Rectal pain worse with sitting, coughing, defecation
  • Focal edema, induration, and fluctuance
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5
Q

Treatment for anorectal abscess/fistula

A
  • Incision and drainage

- -Followed by WASH (warm water cleaning, analgesic, sitz baths, high-fiber diet)

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6
Q

Causes of anal fissures

A
  • Low-fiber diet
  • Passage of large hard stools
  • Constipation
  • Other anal trauma
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7
Q

Symptoms of anal fissures

A
  • Severe rectal pain with bowel movements

- bright red blood per rectum

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8
Q

Describe the MC type and location of anal fissure

A

-Longitudinal tear at posterior midline

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9
Q

True or False: 80% of anal fissures resolve spontaneously

A

True

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10
Q

However, what is the treatment for an anal fissure if it does not resolve?

A

Supportive measures (warm water sitz baths, analgesics, high fiber diet, laxatives, mineral oil)

-Topical vasodilators, Nitroglycerin, Botox injections, Surgery for refractory cases

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11
Q

Internal hemorrhoids originate from ________ and what symptoms do they have?

A

Proximal (above) the dentate line

-Bleed and are painless

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12
Q

Describe the four grades of internal hemorrhoids

A
  • Grade I: does not prolapse
  • Grade II: prolapses with defecation but spontaneously reduces
  • Grade III: Requires manual reduction
  • Grade IV: Irreducible and may strangulate
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13
Q

External hemorrhoids originate from ________ and have symptoms such as

A
  • Distal (below) dentate line

- Do not bleed and are painful

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14
Q

Management of hemorrhoids

A
  • Conservative treatment: high fiber, increased fluids, warm sitz baths, topical corticosteroids
  • Rubber band ligation, sclerotherapy, infrared coagulation
  • Hemorrhoidectomy: for Stage IV or non responsive to other therapy, or external hemorrhoids
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15
Q

Regarding diverticulosis, what is the MC area for occurrence and what is the MC area for bleeding?

A
  • Left colon (MC in incidence)

- Right colon (MC in bleeding)

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16
Q

Risk factors for diverticulosis

A
  • Low fiber diet
  • Constipation
  • Obesity
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17
Q

What is the MCC of acute lower GI bleeding (Painless hematochezia) in adults?

A

Diverticulosis

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18
Q

What is the diagnostic of choice for diverticulosis?

A

Colonoscopy

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19
Q

If bleeding is not visualized on colonoscopy for diverticulosis, what is the next diagnostic step?

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A

Radionuclide imaging followed by arteriography

20
Q

In most cases of diverticulosis, the bleeding stops spontaneously. However, if it does not, what should you do?

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A

-Resuscitation (2 large bore IVs, fluids, blood products)

21
Q

Asymptomatic diverticulosis can be followed by (3 things)

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A
  • High fiber diet
  • Psyllium
  • Use of Bran
22
Q

MC area of diverticulitis

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A

-Sigmoid colon (due to high intraluminal pressure)

23
Q

Symptoms of diverticulitis

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A
  • LLQ abdominal pain
  • Low grade fever
  • Nausea, vomiting
  • Constipation, Diarrhea
  • Changes in bowel habits
24
Q

Diagnostic of choice for diverticulitis

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A

-CT scan (initial)

25
What is the criteria for admission with diverticulitis?
- Perforation, abscess, obstruction or fistula | - High fever, sepsis, immunocompromised, increased age, unable to tolerate oral intake
26
Treatment for uncomplicated diverticulitis
- Treat as outpatient with oral antibiotics (Metronidazole + Ciprofloxacin or Levofloxacin) for 7-10 days - Metro + Bactrim (alternative)
27
What is toxic megacolon?
-Nonobstructive, extreme colon dilation > 6 cm + signs of systemic toxicity
28
What are some common etiologies of toxic megacolon?
-Complications of IBD, C. diff, radiation, volvulus
29
Symptoms of toxic megacolon
- Profound bloody diarrhea - Lower abdominal tenderness - Distention - Signs of toxicity: AMS, fever, tachycardia, hypotension, dehydration
30
What is the initial imaging of choice for toxic megacolon?
Abdominal radiographs
31
What do the abdominal radiographs for toxic megacolon usually show?
-Radiologic evidence of colon > 6 cm
32
Treatment for toxic megacolon
Supportive mainstay: bowel rest, bowel decompression with NG tube, Ceftriaxone + Metro, fluid and electrolyte replacement
33
What is Olgivie Syndrome?
-Colonic pseudo-obstruction (no mechanical obstruction present)
34
What are some etiologies of olgivie syndrome?
- Postoperative state - Medications (opiates) - Metabolic (hypokalemia, hypercalcemia) - Hypothyroidism - DM
35
Symptoms of Olgivie Syndrome
- Abdominal distention! | - Tympanitic abdomen
36
Although abdominal radiographs are the initial test for Olgivie Syndrome, what is the most accurate test?
CT scan
37
Treatment for Olgivie Syndrome
- Conservative: electrolyte and fluid repletion (if < 12 cm) - Medical decompression: Neostigmine (if > 12 cm or failed 24-48 hours of conservative) - Colonoscopic decompression: if failed conservative and Neostigmine - Surgical decompression: if all other options fail
38
Name risk factors for IBD
- Jewish population, Caucasians - 15-35 years old - UC in males, Crohn's in females - Smoking bad for Crohn's and protective in UC - Western diet - Medications: NSAIDs, OCP
39
Name some extra-intestinal manifestations for IBD
- Anterior uveitis/iritis - B12 and iron deficiency - Increased risk of thromboembolism - Arthritis, osteoporosis
40
Name 8 factors about UC
- Limited to colon, rectum always involved, contiguous spread - Mucosa and submucosa only - LLQ pain, bloody diarrhea - Smoking decreases risk - Uniform inflammation and pseudopolyps (colonoscopy) - Stovepipe sign (barium studies) - no haustral markings - P-ANCA labs - Surgery is curative
41
Name 8 factors about Crohn's Disease
- Any segment of GI tract, MC in terminal ileum - Transmural - RLQ pain, no bloody diarrhea - Smoking does not decrease risk - Perianal disease (fistulas, abscesses, granulomas) and B12/Fe deficiency common - Skip lesions and cobblestone appearance (Colonoscopy) - String sign (barium studies) - ASCA (labs) - Surgery is noncurative
42
Initial test of choice for Crohn's Disease and UC
-Upper GI series
43
Treatment for Crohn's Disease
- Limited ileocolonic disease: 5-ASA (Mesalamine) or oral glucocorticoids - Ileal and proximal: Glucocorticoids (Pred, Budesonide) - Severe: Azathioprine, Methotrexate, Infliximab
44
What is shown on the following imaging studies for Crohn's Disease? - Upper GI series: - Endoscopy: - Biopsy: - Labs:
- Upper GI series: string sign - Endoscopy: Skip areas, cobbles-toning - Biopsy: Transmural inflammation, noncaseating granulomas - Labs: ASCA, B12 and Iron Deficiency
45
What is shown on the following diagnostics for UC? - Flexible sigmoidoscopy: - Biopsy: - Barium Enema: - Labs:
- Flexible sigmoidoscopy: uniform erythema and ulceration - Biopsy: crypt abscesses and atrophy, contiguous involvement - Barium Enema: stovepipe or leadpipe sign - Labs: P-ANCA
46
What are some maintenance therapy options for Crohn's and UC?
- Azathioprine - Methotrexate - Cyclosporine - Tacrolimus - Anti-TNF agents (Infliximab, Adalimumab)
47
For mild to moderate UC and Crohn's, what is the first-line therapy?
-5-ASA (Mesalamine) Topical | Oral if needed, can be added
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