Term
|
Definition
defined as having a bowel movement less than 3 times a week.
Constipation is a SYMPTOM, not a DISEASE!!! |
|
|
Term
| Clinical definition of constipation is having any two of the 2 symptoms for at least 12 weeks, not always executive, in the past year: |
|
Definition
Straining
Hard, lumpy stool
Sensation of incomplete evacuation
Sensation of blockage or obstruction
Fewer than 3 BMs each week. |
|
|
Term
| One of the most common GI complaints |
|
Definition
|
|
Term
|
Definition
Decreased fiber intake
Elderly
ignoring the urge to have a BM
Dehydration
Inactivity
IBS
Pregnancy
Abuse of laxatives
Medications
Diseae (stroke, parkinsons, hypothyroidism, lupus, hyperparathryoidism, uremia, spinal cord injuries) |
|
|
Term
| Diseases that cause constipation |
|
Definition
| Stroke, Parkinson’s, DM, hypothyroidism, lupus, hyperparathryoidism, uremia, spinal cord injuries |
|
|
Term
|
Definition
Colorectal transit study
Anorectal manometry
Balloon expulsion Test
Defecography
Barium enema
Colonoscopy/sigmoidoscopy |
|
|
Term
|
Definition
Increase Fiber
Increase activity
Bulk-forming laxatives- generally the safest. Watch for medicine interference. Ex. Metamucil, citrucel. Watch for bloating and abd pain.
Stimulants – ex Correctol, Senokot, Dulcolax
Osmoitics- watch for electrolytes in pts with DM. |
|
|
Term
|
Definition
| draw water into colon. Watch for electrolyte imbalance in children and pts with renal disease. |
|
|
Term
|
Definition
| small or tear in the anal mucosa that may cause painful bowel movements and bleeding. |
|
|
Term
| Extremely common in young infants |
|
Definition
|
|
Term
|
Definition
Pain while having bowel movement
Blood on the surface of the stool and NOT mixed in with the stool.
Blood on toilet paper
A crack in the skin (usually in the midline) that is visible when the anus is stretch.
Constipation, usually with painful bowel movements. |
|
|
Term
|
Definition
Constipation and/or straining with bowel movements.
Inflammation of the anorectal area (i.e. IBD)
Prolonged diarrhea
In older individuals, decreased blood flow
Women after childbirth
Anal sex (rarely) |
|
|
Term
| Anal Fissure- Risk factors |
|
Definition
Infancy-80% will have one before age 1 (cause unknown)
Advanced age- circulatory problem with low flow to the rectum
Constipation- with straining increases risk of tearing.
Childbirth
IBD such as Crohn’s (chronic inflammation) |
|
|
Term
| Anal Fissure-Diagnosis and complications |
|
Definition
Diagnosis-
DRE
Visual examination of rectal mucosa
Complications-
Most (90%) heal on their own. However, some become chronic and may require minor surgery to relax the sphincter. |
|
|
Term
|
Definition
| Most heal on their own without medical treatment. Most symptoms go away within 2 weeks; however, it may take up to 6-8 weeks for the fissure to heal. |
|
|
Term
| Anal Fissures- Non surgical options |
|
Definition
Nitrogylcerin ointment to anus
Botox to the internal sphincter (can last up to 3 months)
Rectal corticosteroids such as Anusol or Preparation H
Add fiber to your diet (20-35gms)
Increase fluids
Exercise
Sitz bath
Avoid constipation/straining |
|
|
Term
|
Definition
Fecal incontinence is the inability to control one’s bowels.
Unable to hold your bowel movements until you get to a toilet or
Stool leaks from rectum |
|
|
Term
| Fecal Incontinence -Causes |
|
Definition
Constipation
Damage to anal sphincter muscles
Weakness of muscles (i.e. during childbirth and episiotomy or hemorrhoid surgery)
Nerve damage
--Unable to sense stool in rectum (i.e. childbirth, stroke, DM, MS)
Loss of storage capacity in rectum (decrease elasticity from radiation, IBS)
Rectal cancer
Diarrhea
Pelvic floor dysfunction |
|
|
Term
|
Definition
Decreased ability to sense stool
Increased muscle contractions
Rectal prolapse
Rectocele- protusion of the rectum through the vagina
General weakness of the muscles
Childbirth is often the culprit however, it does not show up until the 40+ |
|
|
Term
| Fecal Incontinence- Risk factors |
|
Definition
Female gender > male gender
Nerve damage (i.e DM, MS)
Alzheimer’s disease –often a late sign and is usually a combination of both nerve damage and memory problems.
Physical disability |
|
|
Term
| Fecal incontinence- Diagnosis |
|
Definition
Visual examination- hemorrhoids, infections
Check nerve damage with pin or probe
DRE |
|
|
Term
| measures the function of the anal sphincter and the function of the rectum |
|
Definition
|
|
Term
| evaluates structures of the rectum and sphincter. |
|
Definition
|
|
Term
| the barium helps to visualize the walls of the rectum and to measure the amount of stool your rectum can accommodate and how it is evacuated from the rectum. |
|
Definition
|
|
Term
| - visualize last 2 feet of colon for inflammation and tumors |
|
Definition
|
|
Term
| looks for signs of nerve damage. |
|
Definition
|
|
Term
| Fecal incontinence- Treatment |
|
Definition
Changes in diet i.e. constipation or diarrhea causing the problem.
Medications
Stool softeners
Laxatives
Anti-diarrheal
Bowel training |
|
|
Term
| which helps to repair damaged muscles surrounding the anal sphincter |
|
Definition
|
|
Term
abscess in the natal cleft
99% are actually abscesses NOT cysts |
|
Definition
|
|
Term
| Pilonidal Cyst –Risk Factors |
|
Definition
Male sex
Obesity
Inactive lifestyle
Excessive body hair
Poor hygiene
Increased sweating |
|
|
Term
| Pilonidal Cyst- Treatment |
|
Definition
Incision and drainage
Surgery
Watch out for bleeding and infection after surgery!! |
|
|
Term
| Pilonidal Cyst- Prevention |
|
Definition
Basic hygiene
Remove hair i.e shaving, depilatories, or laser hair removal.
Clean and wash area daily.
Keep area clean and dry |
|
|
Term
| an inflammation of the rectum |
|
Definition
|
|
Term
|
Definition
STDs –Most common
Inflammatory Bowel Disease i.e. Crohn’s, UC
Non-sexually transmitted infections (strep, Salmonella, shigella, Campylobacter)
Radiation
Antibiotic Use
Chemicals/Medication i.e enemas
Trauma |
|
|
Term
| most common cause of proctitis |
|
Definition
|
|
Term
|
Definition
Bloody stools
Rectal discharge
Rectal pain
Tenesmus |
|
|
Term
|
Definition
Anal sex
IBS
Using antibiotics
Radiation therapy (i.e. prostate cancer) |
|
|
Term
|
Definition
Rectal Culture
Colonoscopy/sigmoidoscopy
Stool culture
Blood test/culture
STD screening |
|
|
Term
|
Definition
Treat STDs with abx
For proctitis associated with abx use- Flagyl or vanc |
|
|
Term
|
Definition
|
|
Term
|
Definition
Corticosteroids and/or anti-inflammatories (Sulfasalazine or mesalamine)
Surgery |
|
|
Term
|
Definition
Anemia
Fistulas (i.e. recto-vaginal fistula, anal fistula) |
|
|
Term
|
Definition
Hemorrhoids are enlarged, painful veins in the rectum.
Internal hemorrhoids- cluster of tissue within the anal canal and are located above the pectinate line.
External hemorrhoids are enlarged blood vessels around the anus. |
|
|
Term
|
Definition
BRBPR
Painful bowel movement
Constipation
Itching
Painful, swollen area around the anus. |
|
|
Term
|
Definition
Constipation
Diarrhea
Inactivity
Obesity
Pregnancy (increased weight/pressure and hormonal changes. |
|
|
Term
|
Definition
DRE
Internal hemorrhoids may not be felt.
Flexible sigmoidoscopy or colonoscopy |
|
|
Term
|
Definition
Usually try non-surgical options
Stool softeners
Hemorrhoidal creams/suppositories (Anusol, preparation H)
Increasing water and fiber consumption
Warm soaks/sitz bath
Astringents (burning, itching, pain)
Calamine, zinc oxide, witch hazel |
|
|
Term
| Treatment for internal hemorrhoids |
|
Definition
Rubber band ligation
Sclerotherapy
Infrared Coagulation
Hemorrhoidectomy |
|
|
Term
|
Definition
Complications include bleeding, cellulitis/abscess, sepsis
Treatment for internal hemorrhoids |
|
|
Term
| Phenol or quinine urea injected at base of hemorrhoid—causes inflammation then scarring |
|
Definition
|
|
Term
| 1-2 second burst of light cut off circulation to small internal hemorrhoids. |
|
Definition
|
|
Term
| Hemorrhoids- Complications |
|
Definition
Internal hemorrhoids –bleeding, prolapse, incarceration, and gangrene. PAIN IS NOT COMMON!
External hemorrhoids- bleeding and PAIN! |
|
|
Term
|
Definition
|
|
Term
|
Definition
| bleeding, prolapse, incarceration, and gangrene. PAIN IS NOT COMMON! |
|
|
Term
|
Definition
rectal tissue protrudes through the anal canal.
May see a red colored mass protruding from the anus.
Caused by weak ligaments and muscles that hold rectum in place. |
|
|
Term
|
Definition
| when only the rectal mucosa is expelled from anus and not the entire wall. |
|
|
Term
|
Definition
| when the rectum collapses but does NOT expel from the anus. |
|
|
Term
| Rectal Prolapse - Symptoms |
|
Definition
Painful bowel movements.
BRBPR
Fecal incontinence
Awareness of tissue protruding
Loss of urge to have a bowel movement.
Often similar to hemorrhoids but rectal prolapse originates higher in the rectum than hemorrhoids. |
|
|
Term
|
Definition
Pinworms
Cystic fibrosis
Malnutrition (ex. Celiac disease)
Long-term constipation/diarrhea/straining
Injury to anus
Pregnancy
MS
COPD |
|
|
Term
| child under 6 with rectal prolapse: rule out |
|
Definition
|
|
Term
| helps to differentiate between mucosal prolapse and complete prolapse. |
|
Definition
|
|
Term
| Rectal Prolapse - Treatment |
|
Definition
Fiber as bulking agent
Stool softeners
Surgery |
|
|
Term
| surgery for rectal prolapse |
|
Definition
Abdominal approach usually used in younger patients has higher morbidity rate with 3-7 day hospital stay
Perineal approach usually on older patients because no anesthesia is needed with lower morbidity rate; however, it has a higher recurrence rate. |
|
|
Term
|
Definition
| Early pain is often generalized (periumbilical). Once the irritation enlarges and the peritoneum around the appendix becomes inflamed, then the pain is localized to the RLQ. |
|
|
Term
|
Definition
|
|
Term
| appendicitis Often hard to diagnose in the following population of people: |
|
Definition
Pregnant females
Children
Elderly
Immunosuppressed
DM
Obese |
|
|
Term
| an outpouching of the small intestines usually located in the RLQ. |
|
Definition
|
|
Term
| pelvic exam in females for |
|
Definition
|
|
Term
|
Definition
PID
Right-sided diverticulitis
Kidney disease – (ex. Stones, abscess)
Crohn’s
Right ovarian cyst
Ectopic pregnancy
diverticulitis |
|
|
Term
|
Definition
CBC
BMP
UPT
UA
CT scan of the abd/pelvis WITH CONTRAST! |
|
|
Term
| Tests the iliopsoas muscle group (hip flexers) |
|
Definition
Psoas Sign
Test by passively extending the thigh of the patient with knees flexed.
Position patient of left side and passively extend right leg behind patient
Or, with patient supine- flex hips to 90 degrees and ask patient to flex knee against resistance |
|
|
Term
| Patient is supine with right leg flex at 90 degrees. The provider holds the patients right ankle in his right hand. With the left hand, the provider rotates the right hip by pulling the right knee to and away from the patient's body. |
|
Definition
|
|
Term
|
Definition
Surgery (appendectomy)
Open vs Lap
Once perforation AND abscess formation- Abx therapy and CT guided drainage tube places with surgery several weeks/months later.
The risk of perforation after 36 hours of symptoms is at least 15%!! |
|
|
Term
|
Definition
Peritonitis is inflammation of the peritoneum which is the membrane that lines the abdominal cavity and organs
Can be localized or generalized
Can be infectious or non-infectious
Usually is a surgical emergency!!! |
|
|
Term
| Usually is a surgical emergency!!! |
|
Definition
|
|
Term
|
Definition
Abdominal pain
Abdominal distension
Washboard abdomen often with generalized
Fever
Nausea/vomiting
Decreased urine output
Constipation
Tachycardia
Cloudy dialysis fluid |
|
|
Term
|
Definition
Peritoneal dialysis
Cirrhosis causes ascites
Perforation (appy, stomach, colon)
Leakage of sterile body fluids (gastric juice, bile, urine)
Pancreatitis
Diverticulitis
Crohn’s
Penetrating trauma |
|
|
Term
| Peritonitis –Risk Factors |
|
Definition
History of peritonitis
Cirrhosis
Appendicitis
Diverticulitis
Pancreatitis
Ulcers
ESRD on peritoneal dialysis |
|
|
Term
|
Definition
Peritoneal fluid counts and culture
CBC
CMP (liver profile ? Cirrhosis)
Xrays to look for free air
CT scan
In trauma –exploratory peritoneal lavage |
|
|
Term
|
Definition
Antibiotics
Broad spectrum (remember fungal)
Most are Staph aureus and coagulase-neg staph
Surgery to remove the infection
Except SBP
Supportive measures
IVF
Electrolytes |
|
|
Term
| Peritonitis - Complications |
|
Definition
sepsis
With early and appropriate treatment, mortality rate is <10%
However, this number increases to 40% in people with numerous medical problems, the elderly, and individuals who present late!!!! |
|
|
Term
| Intestinal Obstruction -Signs |
|
Definition
Cramping abdominal pain
Nausea/vomiting
No bowel movements or passing gas
Abdominal distension
Abdominal tenderness |
|
|
Term
| Intestinal Obstruction -Causes |
|
Definition
Small intestines causes include: adhesions, hernia, and tumors (less likely intussusception, volvulus, or stricture)
Obstruction of the large intestines is less common (10-15%) where adhesions and hernias RARELY cause the obstruction.
Causes are cancer, diverticulitis, volvulus
Less common is intussusception, stricture, FB, impaction of feces. |
|
|
Term
| Intestinal Obstruction –Risk factors |
|
Definition
Crohn’s –chronic inflammation causing narrowing of lumen
Cancer
Constipation
Malrotation of intestines (congenital) |
|
|
Term
|
Definition
|
|
Term
| Intestinal obstruction- treatment |
|
Definition
Supportive care (electrolytes, IVF)
NG tube for decompression
Watchful waiting
Surgery |
|
|
Term
|
Definition
Is when the bowel does NOT function properly but there in NOT a mechanical issue.
Very common in infant, children, and post-op |
|
|
Term
|
Definition
Metabolic( especially K)
Medications
Mesenteric ischemia
Intra-abdominal surgery
Injury to blood supply |
|
|
Term
|
Definition
Abd distension
Abd pain
Cramping
N/V
Constipation/diarrhea
Bad breath |
|
|
Term
|
Definition
Abd xrays
CT scan with contrast
Barium enema
Upper GI series with SBFT |
|
|
Term
| Adynamic Ileus Vs Mechanical Obstruction |
|
Definition
LISTEN WITH STETHOSCOPE!!!
Adynamic ileus will have quiet or absent bowel sounds.
Mechanical obstruction will have high pitched sounds!! |
|
|
Term
| auscultations for adynamic ileus |
|
Definition
| quiet/absent bowel sounds |
|
|
Term
| auscultations for mechanical obstruction |
|
Definition
|
|
Term
| Adynamic Ileus -Treatment |
|
Definition
NG Tube to suction
Correct electrolytes
Limit narcotics!!
Watchful waiting
Surgery (watch for necrotic tissue) |
|
|
Term
| Adynamic Ileus- Complications |
|
Definition
Infection
Gangrene
Perforation/Peritonitis |
|
|
Term
|
Definition
Non-specific term for a variety of conditions
Diarrhea, abdominal pain, bowel spasms, tenesmus
Mild or severe, benign or serious
Systemic illness and/or localized
Includes Inflammatory Bowel Disease |
|
|
Term
|
Definition
IBS
Ischemic
Hemolytic-Uremic Syndrome (E. coli)
Collagen Vascular dz, Autoimmune dz
Radiation, Medication
Metastatic or Vascular disease
Lymphoma
Infectious |
|
|
Term
|
Definition
Common bowel complaint of elderly
Acute or Chronic
Crampy left abd pain partly relieved by defecation
Usually BRBPR or hematochezia
Usually with other manifestations vascular disease |
|
|
Term
|
Definition
Gut blood flow
Celiac artery supplies stomach, pancreas, hepatic arteries
Ischemia rare here
Superior mesenteric supplies most of small bowel and ascending and transverse colon
Inferior mesenteric supplies distal transverse to rectum
Extensive collateralization |
|
|
Term
|
Definition
Sudden onset but may have prodrome of chronic ischemia
SMA embolus 50%
Non-occlusive ischemia 30%
SMA thrombus 25%
Venous thrombus 5% |
|
|
Term
| Acute Ischemic Colitis symptoms/signs |
|
Definition
Rapid onset severe pain
Pain precedes vomiting
Initial exam non-specific
Peritoneal signs as infarction occurs
Non-specific lab studies
Mesenteric angiography gold standard |
|
|
Term
| Acute Ischemic Colitis treatment |
|
Definition
Treat supportively
Surgical consult
Angioplasty or thrombolysis
Treat or manage embolic source
Hypercoagulation work-up |
|
|
Term
| Persistent Severe Colitis May Be Inflammatory Bowel Disease (IBD) |
|
Definition
Crohn’s Disease or Ulcerative Colitis
Pathogenesis poorly understood
Crohn’s Disease - transmural mucosal inflammation
Ulcerative colitis – inflammation limited to mucosa and submucosa |
|
|
Term
| Crampy left abd pain partly relieved by defecation |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Second cause of death from cancer in US!! |
|
Definition
|
|
Term
| Abnormal cell growth in colon. |
|
Definition
|
|
Term
|
Definition
Rectal Bleeding
BRBPR
Melena
Pain
Constipation
Obstruction |
|
|
Term
| can be either small or large but ARE FLAT!!! |
|
Definition
|
|
Term
| are attached to a stalk and mushroom shaped. |
|
Definition
| Pedunculated colon polyps |
|
|
Term
| less likely cancerous than large, sessile polyps |
|
Definition
| Small polyps and pedunculated polyps |
|
|
Term
|
Definition
Adenomatous
Hyperplastic
Inflammatory |
|
|
Term
|
Definition
Increased risk of malignancy if >5mm or greater (1/4 inch)
Malignancy increases even more if >10mm
Account for 75% of all polyps |
|
|
Term
| Hyperplastic colon polyps |
|
Definition
Usually on the Left side/ rectum
Usually <5mm
Rarely malignant |
|
|
Term
| Colon Polyps risk factors |
|
Definition
Overweight
Smoker
Family history
High fat, low fiber diet
Over age 50
Genetic mutation
Adenamatous polyposis coli (APC) |
|
|
Term
|
Definition
DRE
Hemocult
Colonoscopy/ Sigmoidoscopy
Barium Enema
Genetic Test
Pillcam –small bowel |
|
|
Term
| Familial Adenomatous Polyposis(FAP) |
|
Definition
Defect of APC gene
Rare
People develop thousands of polyps throughout the colon.
Start in the teenage years
Risk of colon cancer is 100% if left untreated. |
|
|
Term
| Risk of colon cancer is 100% if left untreated. |
|
Definition
| Familial Adenomatous Polyposis(FAP) |
|
|
Term
|
Definition
Variant of FAP
Mutation of APC
Develop thousands of polyps throughout colon AND small intestines
Also have tumors develop throughout body.
Skin (lipomas, cysts)
Bone (osteomas)
Abdomen (desmoids) |
|
|
Term
|
Definition
Rare (100 cases)
Mutation of APC (location 5q21)
Autosomal dominant or recessive
Characterized by colon polyps AND tumors of the central nervous system
Gliomas
Medulloblastoma
People with TS are at a 92% increased risk to develop CNS tumors. |
|
|
Term
| Characterized by colon polyps AND tumors of the central nervous system |
|
Definition
|
|
Term
| Develop thousands of polyps throughout colon AND small intestines |
|
Definition
|
|
Term
|
Definition
Mutation of the STK11 gene.
Autosomal dominant
Characterized by hamartomatous polyps in GI tract
Average age of diagnosis is age 23
Half of population die by age 57 and risk of cancer between ages of 15-64 is 93%
Most patients die from complications associated with obstruction or cancers of pancreas, liver, lungs, breast, ovaries, testicles |
|
|
Term
Characterized by hamartomatous polyps in GI tract
Mutation of the STK11 gene. |
|
Definition
|
|
Term
3 Main criteria for diagnosis
Peutz-Jeghers Syndrome |
|
Definition
Family history
Mucocutaneous lesions of hyperpigmentation on mouth, hands and feet (usually on gingivia, hard palate, and cheek.
Hamartomatous polyps in GI tract (benign)
Having 2 out of the three is a positive diagnosis |
|
|
Term
|
Definition
Mutation of the BMPR1A (20%) and SMAD4 gene
Autosomal Dominant
Development of polyps in stomach, small intestines, colon, rectum.
The term juvenile refers to type of polyp NOT the age of onset, although most people do develop polyps by age 20.
Risk of cancer varies from 9-50% (stomach, Upper GI tract, and pancreas. |
|
|
Term
| Cronkite-Candida Syndrome |
|
Definition
Not hereditary
Rare
Idiopathic (unknown cause)
Age range of 50-65
Two-thirds are Japanese with male to female ratio of 2:1 |
|
|
Term
Associated with chronic diarrhea and protein loss.
May have alopecia, atrophy of nails, skip pigmentation of skin |
|
Definition
| Cronkite-Candida Syndrome |
|
|
Term
|
Definition
Autosomal Dominant
Neural crest origin and therefore can affect any organ system.
Several subtypes but GI involvement is associated with NF1
Associated with neurofibromas in liver and GI tract.
Associated with SB leiomyomas, GIB, obstruction and large bowel intussusception. a |
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|
