Large Intestine II: Diverticular Dz, Rectal Dz, and Carcinoid
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| A pt has dyspnea, hilar lymphadenopathy on CXR with hypercalcemia. What is the dx? | Sarcoidosis
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| What characteristics favor carcinoma in an isolated pulmonary nodule? | New onset lesion (or larger compared to old film), smoking, age >45yo, absence of calcification/irreg calcification, size >2cm, and irregular margins
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| What is the tx for normal pressure hydrocephalus? What is the tx for pseudotumor cerebri? | NPH: ventriculoperitoneal shunt. Pseudotumor cerebri: wt loss, acetazolamide, serial lumbar punctures, and CSF shunting (if other measures unsuccessful)
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| A 65yo lady that presented to the ER with severe abdominal pain is found to have leukocytosis and an abscess in the region of the sigmoid colon. What is the most likely predisposing lesion, and what is the next step in mgmt? | Diverticulosis-> diverticulitis-> abcess. Tx with CT-guided or US-guided percutaneous drainage and IV abx
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| What are risk factors for diverticulosis? | Age >60yo, low fiber and high fat diet
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| What is the tx for mild diverticulitis? | Bowel rest (liquids only), Abx (broad spectrum against anaerobes)
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| What is the tx for diverticulitis with abscess formation? | Bowel rest, abx, percutaneous drainage, IVF
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| What abx combinations are used in the tx of diverticulitis as an outpt? | TMP-SMX (bactrim) + metronidazole (flagyll).
Amox + clav (Augmentin).
Fluoroquinolones + metronidazole.
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| What are the classic features of carcinoid syndrome? | B FDR: Bronchospasm, Flushing, Diarrhea, Right-sided valvular dysfunction/murmurs
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| What is the main drug used to tx carcinoid syndrome? | octreotide (an SST analog)
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| What drugs can be used to tx diarrhea in carcinoid syndrome? | cyproheptadine (also tx anorexia), codeine, and/or cholestyramine
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| What drugs can be used to tx bronchospasm in carcinoid syndrome? | Albuterol or theophylline
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| If octreotide does not work in treating carcinoid syndrome, what other drug may be added as combination therapy? | IFN-alpha
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| What vitamin deficiency can be caused by carcinoid syndrome? What is the pathogenesis and what are the s/s of this deficiency? | Pts can develop pellagra (dermatitis, dementia, diarrhea, and death) due to niacin deficiency. Tryptophan is a precursor of both 5HT and niacin. In carcinoid synd, the tryptophan gets shunted towards forming 5HT. Niacin becomes deficient-> pellagra.
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| What is the next step in the mgmt of a pt younger than 50 with minimal bright red blood per rectum (BRBPR) only seen on the toilet paper after wiping? | Anoscopy
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| What is the most likely cause of acute pain and swelling of the midline sacrococcygeal skin and subcutaneous tissues? | Pilonidal cyst
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| What is the most likely cause of recurrent LLQ abdominal pain that improves after defecation? | Diverticulosis
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| How are anal fissures managed? | Stool softeners, topical nitroglycerin.
Other topicals: nifedipine, diltiazem, bethanechol.
Botox.
Partial sphincterotomy (last resort b/c it causes fecal incontinence
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| MCC of acute lower GI bleeding in pts over 40yo? | Diverticular dz in sigmoid colon
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| Which type of hemorrhoids are painless? Where are they located? | Internal; come from the superior rectal vv above the pectinate line (columnar rectal epithelium)
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| Which type of hemorrhoids are painful? WHere are they located? | External hemorrhoids arising from inferior rectal vv beclow the pectinate line (squamous rectal epithelium)
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| MC tumor of the appendix? | carcinoid
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