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WorksheetsCM - Small Intestine & Colorectal
Total questions: 35
Worksheet time: 18mins
Pt reports periumbilical pain that has shifted to the RLQ. It is worse with walking and coughing. Pt also reports N/V and constipation. PE with RLQ tenderness at McBurney's point, + psoas and obturator signs, + rebound tenderness, and + Rovsing's sign. Labs show leukocytosis. What do you suspect?
Acute appendicitis
Small bowel obstruction
Small intestine polyps
Ischemic bowel disease
C diff infection
What is the MOST ACCURATE diagnostic test for acute appendicitis?
US
CT scan
WBC count
RLQ tenderness at McBurney's poitn
What is the treatment for acute appendicitis? (choose 2)
Metronidazole
Vancomycin
Cefoxitin
Laparoscopic appendectomy
Pt reports periumbilical pain that shifted to the RLQ and they are now coming in because it has lasted 36 hrs. They now have a fever and diffuse abd tenderness. What complicatio do you suspect?
Strangulation/ ischemia
Perforation
Toxic megacolon
What is NOT part of the treatment for a STABLE pt with acute appendicitis complicated by perforation?
Interval appendectomy in 6 wks
IV ABX
IR drain percutaneously
Bowel rest for a few days
What is NOT part of the treatment for an UNSTABLE pt with acute appendicitis complicated by perforation with CT that reveals an abscess?
Interval appendectomy in 6 wks
IV ABX
Percutaneous IR drain
Immediate surgical intervention
What is the treatment for an UNSTABLE pt with acute appendicitis complicated by perforation who is not improving with conservative management?
Interval appendectomy in 6 wks
IV ABX
Percutaneous IR drain
Immediate surgical intervention
What are the 2 categories of small bowel obstruction? (choose 2)
Stricture
Paralytic ileus
Mechanical
Volvulus
Mechanical small bowel obstruction type that is secondary to scar formation from prior abdominal surgery.
Adhesion
Hernia
Neoplasms
Mechanical small bowel obstruction type that is the MOST COMMON cause in pts w/o prior abd surgery.
Adhesion
Hernia
Neoplasms
Mechanical small bowel obstruction type that is the MOST COMMON OVERALL
Adhesion
Hernia
Neoplasms
Pt with recent abd surgery presents with N/V, colicky abd pain, and obstipation. PE reveals distended abd, tympanic to percussion, and generalized tenderness. Labs show leukocytosis, electrolyte imbalances, and increased creatinine. What do you suspect?
Acute appendicitis
Small bowel obstruction
Small intestine polyps
Ischemic bowel disease
C diff infection
A plain abd x-ray done with pt supine, then upright shows dilated small bowel loops with air fluid levels. CT scan of a/p with IV and oral contrast can also be done. What do you suspect?
Acute appendicitis
Small bowel obstruction
Small intestine polyps
Ischemic bowel disease
C diff infection
All of the following are treatments for small bowel obstruction, but which is the MAINSTAY?
NGT decompression
Bowel rest
Fluid resuscitation
Gastrografin challenge
Surgical intervention
All of the following are treatments for small bowel obstruction, but which is done if there is no improvement after 48 hrs?
NGT decompression
Bowel rest
Fluid resuscitation
Gastrografin challenge
Surgical intervention
Therapeutic and diagnostic test for small bowel obstruction where water soluble contrast is given and serial x-rays are taken. Considered "last ditch effort" before surgery.
NGT decompression
Bowel rest
Fluid resuscitation
Gastrografin challenge
Surgical intervention
Which of the following is FALSE regarding small bowel obstruction complications?
Worsening abd complaints, fever, tachycardia
Perforation: tissue friable and a hole develops
Tx: emergent surgical intervention
Strangulation/ ischemia: blood supply is being cut off
Classic sign of "pain out of proportion" to PE
What etiology of large bowel obstruction is from scarring and narrowing that is usually preceding by an inflammatory process like diverticulitis?
Volvulus
Neoplasm
Stricture
What etiology of large bowel obstruction is most common in the descending colon and is associated with anemia?
Volvulus
Neoplasm
Stricture
What etiology of large bowel obstruction where the colon flips over on itself and is most common in the sigmoid/descending colon?
Volvulus
Neoplasm
Stricture
Pt presents with constipation, obstipation, abd distention, and pain. PE reveals abd distention and generalized tenderness. CT scan with IV contrast reveals colonic distention (possible a mass or narrowing as well). What do you suspect?
Acute appendicitis
Large bowel obstruction
Small intestine polyps
Ischemic bowel disease
C diff infection
What is NOT included in the diagnosis and treatment of a large bowel obstruction if stricture or mass is suspected?
Surgical intervention
CT w/ IV contrast
Stent placement
Colonoscopy w/ biopsies 1st
Decompressive colonoscopy
What is NOT included in the diagnosis and treatment of a large bowel obstruction if volvulus is suspected?
CT w/ IV contrast
Stent placement
Colectomy
Decompressive colonoscopy
Pt presents with severe abd pain. PE with absence of focal tenderness or distention. You note that pain is out of proportion to physical exam findings. Labs show leukocytosis, lactic acidosis, hypotention, and increasing abd distention. What is NOT something that can be done for diagnostic workup and treatment?
Flexible sigmoidoscopy
CT w/ contrast
CTA
Emergent abd explorationw/ arterial stenting, bypass, or resection
What is the most common artery for acute mesenteric ischemia?
Middle colic artery
Ileocolic artery
Superior mesenteric artery
Inferior pancreaticoduodenal arteries
50 yo pt with hx of CAD presents with epigastric/periumbilical postprandial pain that lasts about 1-3 hrs. Pt has developed a "fear of eating," which has led to weight loss. Labs show electrolyte imbalances and hypotension. You suspect something also known as intestinal angina. What is NOT part of the diagnostic work up and treatment?
CTA
Emergent small bowel exploration
CT with IV contrast
Angioplasty & stenting
Artery bypass
Generally 2-3 major vessels must be affected before symptoms occur in chronic mesenteric ischemia.
True
False
A variant of mesenteric ischemia that usually occurs in the distribution of the inferior mesenteric artery.
Ischemic colitis
Chronic mesenteric ischemia
Acute mesenteric ischemia
Pt presents with LLQ pain, tenderness, abd cramping, bloating, and rectal discharge that appears mucus-like or bloody. What would you use to diagnose?
CTA
CT with IV contrast
Flexible sigmoidoscopy
Gastrografin challenge
What is the treatment for ischemic colitis?
Angioplasty
Stenting
IV fluids
Artery bypass
Pt with recent ABX treatment presents with malaise, watery and foul-smelling diarrhea, lower abd pain and tenderness, Labs show leukocytosis and diarrheal stool sample was taken. What do you suspect?
Acute appendicitis
Small bowel obstruction
Small intestine polyps
Ischemic bowel disease
C diff infection
What is the gold standard for diagnosis of C diff infection?
Leukocytosis
Colonoscopy
Diarrheal stool sample w/ c diff cytotoxin
CT w/ IV contrast
What is NOT part of treatment for c diff?
Vancomycin for severe
Surgical intervention w/ subtotal colectomy
Isolation
Metronidazole for mild/mod
What is NOT a symptom that is worrisome for toxic megacolon in a pt with c diff?
Decreasing serum creatinine
High fever, hypotenstion, leukocytosis
Excess of 10 loose stools per day
Abrupt reduction diarrhea w/ no clinical improvement
Increasing abd pain and distention
What is the treatment for c diff with the complication of toxic megacolon?
Vancomycin for severe
Surgical intervention w/ subtotal colectomy
Isolation
Metronidazole for mild/mod
