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2010-07-15 #1
Gastrointestinal disorder
| Question | Answer |
|---|---|
| halitosis(due to trapped food particles); dysphagia; obstruction: Dx? definition? | Zenker's diverticulum; herniation of mucosa at junction of pharynx & esophagus |
| MC site for diverticula in the GIT | sigmoid colon |
| MCC of sigmoid diverticula | low-fiber diet > ↑constipation |
| MC complication of sigmoid diverticula: cause? | diverticulitis(inflammation of diverticula); stool impacted(fecalith) in diverticulum sac |
| "left-sided appendicitis"? | sigmoid "diverticulitis" |
| best Dx for sigmoid diverticulitis | CT scan or water-soluble barium study |
| MCC of hematochezia & fistula | sigmoid diverticula: sigmoid "diverticulosis" with hematochezia(painless massive bleeding); X "diverticulitis" because of scarring preventing the gut from bleeding |
| a common fistula in GIT; associated with pneumaturia(air in urine) and recurrent UTI: Dx? cause? | colovesical fistula; mostly caused by sigmoid diverticula |
| MCS for "false" diverticulum(X organ-related) | where vasa recta perforate muscularis externa |
| MC inflammatory bowel disease; ulcerations in continuity but limited to mucosa/submucosa of rectum & colon: Dx? | ulcerative colitis |
| chronic granulomatous disease; transmural inflammation; noncaseating granuloma discontinuous throughout GIT: Dx? | Crohn's disease |
| definition of irritable bowel syndrome | intrinsic colonic motility disorder |
| MC functional bowel disorder | irritable bowel syndrome(IBS) |
| alternating bouts of diarrhea & constipation; increased mucus in stool; normal flexible endoscopy & sigmoidoscopy: Dx? | irritable bowel syndrome(IBS) |
| criteria for IBS | pain relieved by defecation; change in stool frequency; change in appearance of stool(+mucus) |
| Rx: IBS | mainstay: adequate fiber intake; antiplasmodics-anticholinergics; loperamide: dirrhea; lubiprostone: constipation; rifaximin: bacterial overgrowth |
| least common site for malignancy in GI tract | small bowel |
| MCS of 1' adenocarcinoma in SB | duodenum |
| MC SB malignancy | carcinoid tumor |
| definition of carcinoid tumor: metastasis-related, organs-related | neuroendocrine tumor; metastatic potential: size > 2cm, ~50% of bowel thickness; foregut & hindgut: X metastasis and midgut: O metastasis |
| MCS of carcinoid tumor | vermiform appendix; too small to metastasize to liver |
| MCS of carcinoid tumor in SB: Cc? | terminal ileum; metastasize to liver > serotonin > metabolized in liver > X carcinoid syndrome |
| Cx: carcinoid syndrome | bright yellow; flushing; diarrhea; wheezing; TR & PS(collagen production);↑urine 5-HIAA |
| bowel primary lymphoma: MCS, origin | Peyer's patches of terminal ileum; B-cell origin |
| Rx: carcinoid syndrome | somatostatin analogue |
| MCS for gastrointestinal polyps, diverticula, cancer | sigmoid colon |
| MC polyp in adults | hyperplastic polyp |
| MC polyp in children | juvenile polyp |
| polyp in sigmoid colon in adult; "saw-tooth" appearance: Dx? malignancy? | hyperplastic polyp; X malignant potential |
| solitary polyp in rectum: Dx? epidemiology? malignancy? | juvenile(retention) polyp in children; common in children < 5yrs; X malignant potential |
| AD; multiple polyps in GI tract in children: Dx? Ax? | juvenile polyposis syndrome; ↑risk of adenocarcinoma |
| AD; multiple polyps throughout GI tract; hypersegmented mouth, lips, hands, genitalia: Dx? type? location? Ax? | Peutz-Jeghers polyposis; hamartomatous polyps in small bowel; associated with ↑risk of CRC & breast, gynecologic cancers(even though it's hamartoma) |
| MC neoplastic polyp? | tubular adenoma(aka adenomatous polyps) |
| neoplastic polyp in sigmoid colon: Dx? type? | tubular adenoma; stalked polyp |
| hypoalbuminemia; hypokalemia; sessile polyp in rectosigmoid: Dx? type? feature? | villous adenoma; sessile polyp with primarily a villous component; secretion of protein & potassium-rich mucus |
| greatest risk for developing colon cancer? | the more villous the polyp, the more likely it is to be malignant |
| familial adenomatous polyposis: MOI, gene, chromosome, CRC chance, MCS? | AD; APC suppressor gene inactivation; chromosome 5q; 100% to CRC; rectum |
| Gardner's syndrome: MOI? definition? | AD; FAP + benign osteomas & desmoid tumors + retinal hyperplasia |
| Turcot's polyposis: MOI? definition? | AR; FAP + brain tumor(astrocytoma + medulloblastoma) |
| 3rd MC cancer in men & women; 3rd MC COD in United States: Dx? | colon cancer |
| risk factors for colon cancer | age > 50yrs; smoking; 25% family history (1st degree relatives); IBD; S.bovis(distal colon: L side); colonic polyps(large villous adenoma, juvenile polyposis syndrome, PJP) |
| carcinogenesis of colon cancer: sporadic & HNPCC syndrome | 15%; microsateillite instability pathway; DNA mismatch repair gene mutations > sporadic & HNPCC syndrome; accumulated mutation without defined morphologic correlates |
| carcinogenesis of colon cancer: adenoma-carcinoma | 85%; APC/β-catenin pathway; normal colon > loss of APC gene (↓intercellular adhesion & ↑proliferation) > colon at risk > K-RAS mutation (unregulated intracellular signal transduction) > adenoma > loss of p53 (↑tumorigenesis) > carcinoma |
| MC site for colon cancer | rectosigmoid |
| disadvantage of fecal occult blood test | not very sensitive or specific for colon cancer because it doesn't distinguish hemoglobin from myoglobin; false[+]: myoglobin in meat; plant peroxidase(radish); false[-] |
| mechanism of FOBT | detection of peroxidase activity of heme in HB |
| obstruction; colicky pain; hematochezia: Dx? | distal colon (left-sided) due to small diameter; S.bovis endocarditis |
| dull pain; iron deficiency anemia; fatigue: Dx? | proximal colon (right-sided) due to large diameter; iron deficiency in older males |
| ProRx: colon cancer | aspirin; FOBT; dietary alternations; stop smoking |
| Dx: colon cancer | barium edema: "apple-core" lesion; colonoscopy & FOBT; CEA (serum carcinoembryonic antigen) marker |
| MC abdominal surgical emergency in children | acute appendicitis |
| viral infected; lymphoid hyperplasia; surgical intervention required: Dx? epidemiology | acute appendicitis |
| colonoscopy; fecalith obstructing the proximal lumen; mucosal injury & bacterial invasion: Dx? epidemiology? | acute appendicitis |
| pain in acute appendicitis in sequence | initial diffuse periumbilical pain (C fiber on visceral peritoneal surface) > RLQ in 12 to 18hrs (Αδ fibers on parietal peritoneum) + Blumberg's(rebound tenderness at McBurney's) + psoas sign(pain with R thigh extension) + Rovsing's (on palpation of LLQ) |
| exact location of McBurney's point | 1/3 the distance from iliac crest to umbilicus |
| Cx: acute appendicitis | pain > nausea & fever > perforation > peritonitis |
| DDx: acute appendicitis | diverticulitis(in elderly vs all age groups in appendicitis); ectopic pregnancy(Β-hCG to rule out); viral gastroenteritis; ruptured follicular cyst |
| Dx: rectocecal appendicitis | sentinel loop; localized ileus from subjacent appendicitis |
| Cc of acute appendicitis: MC, Rest | periappendiceal abscess with or without perforation; subpherenic abscess with persistent fever(usually due to Bacteroides fragilis); pyelophelbitis of portal vein > portal thrombosis(gas in portal vein) |
| Dx & Rx: acute appendicitis | spiral CT RLQ after gastrografin enema; plain CT scan with rectal contrast agent; cefoxitin(proRx if perforation suspected) |
| MCC of anorectal bleeding | "painless" internal hemorrhoids; receive visceral innervation = X painful |
| rectum prolapse; stool coated with bright red blood; painless bleeding: Dx? MCC? C? Ax? | internal hemorrhoids; straining at stool; pregnancy, obesity, anal intercourse, "portal HTN"; constipation and low-fiber diet |
| adult; blood coating stool; DDx? | internal hemorrhoid (MC); colorectal & anal cancer "NEVER assume that blood coating stool is always due to an internal hemorrhoid" |
| pRx: internal hemorrhoids | topical hydrocortisone |
| anal pruritis; soiling of underwear: Dx? | internal hemorrhoids |
| arterial supply from sup. rectal artery (of IMA); venous drainage to sup. rectal vein > inf. mesenteric vein > portal system: location? Ax? | above pectinate line; internal hemorrhoids and adenocarcinoma |
| arterial supply from inf. rectal artery (of internal pudendal artery); venous drainge to inf. rectal vein > internal pudendal vein > internal iliac vein > IVC: location? Ax? | below pectinate line; external hemorrhoids and squamous carcinoma |
| painful thrombosis of inferior rectal vein: Dx? Why painful? | external hemorrhoids; dilated inf.hemorrhoidal veins below the pectinate line(inf. plexus); somatic innervation by inferior rectal nerve of pudendal n. |
| causes of rectal prolapse in children | whooping cough; trichuriasis; cystic fibrosis "World Cup Team" |
| causes of rectal prolapse in elderly | straining at stool |
| cause of rectal prolapse in power lifters | heavy squates |
| definition of pilonidal sinus & abscess | painful pass in deep gluteal fold |
| causes of pruritus ani | internal hemorrhoids (Common); pinworm; diabetes |
| MCC of anorectal fistulas; Rest? Ax? | nonspecific cryptoglandular infection; inflammatory bowel disease (Crohn's disease > ulcerative colitis); associated with constipation |
| film bowel movement; aggravated by spasm of internal sphincter; prominent proximal papilla: Dx? Cx? | anal fissures; most posteriorly located; anal tag and verge marks location |
| MC anal carcinoma | basaloid(epidermoid or cloacogenic) carcinoma in transitional zone above dentate line |
| squamous cell anal carcinoma: Ax? | HPV16 & 18 relationship |
Created by:
mataos
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