Surgery Marrow Pg 201-210 (GIT)
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Which of the following is the most common site for ulcerative bowel TB?

  • Terminal ileum (correct)
  • Cecum
  • Ascending colon
  • Sigmoid colon

    • Typhoid ulcers typically heal without complications.

    False

    What management strategies are used for ulcerative bowel TB?

    Biopsy, ATT, Resection and anastomosis, or Stricturoplasty.

    The _____ type of bowel TB is characterized by a weak immune response and is commonly found in the terminal ileum.

    <p>Ulcerative</p> Signup and view all the answers

    Match each type of ulcer with its associated feature:

    <p>Tubercular ulcer = Heals with stricture Typhoid ulcer = Perforates in 3rd week Transverse ulcer = Pain, Weight loss, Bowel obstruction</p> Signup and view all the answers

    What is the most common cause of obstructive acute appendicitis?

    <p>Fecolith</p> Signup and view all the answers

    Non-obstructive acute appendicitis accounts for less than 10% of cases.

    <p>False</p> Signup and view all the answers

    What is a common symptom of acute appendicitis?

    <p>Pain in the right iliac fossa</p> Signup and view all the answers

    The age group with the peak incidence of acute appendicitis is between ____ and early 20s.

    <p>teens</p> Signup and view all the answers

    Match the following signs with their descriptions:

    <p>Tachycardia = Increased heart rate as a response to pain Rovsing sign = Pain in right iliac fossa when pressing the left iliac fossa Psoas sign = Pain in right iliac fossa when flexing right hip against resistance Obturator sign = Pain due to internal rotation of the right hip</p> Signup and view all the answers

    Which of the following features is characteristic of Ulcerative Colitis?

    <p>Bloody diarrhea</p> Signup and view all the answers

    Toxic megacolon is a potential risk in Crohn's disease.

    <p>False</p> Signup and view all the answers

    What is the purpose of bowel decompression in the management of bowel conditions?

    <p>To relieve pressure and facilitate bowel function.</p> Signup and view all the answers

    The _____ sign of Kantor is a radiological feature associated with Crohn's disease.

    <p>String</p> Signup and view all the answers

    Match the following management strategies with their purpose:

    <p>Steroids = Reduce inflammation 5-ASA derivatives = Maintain remission Infliximab = Target perianal disease Vedolizumab = Manage acute symptoms</p> Signup and view all the answers

    What is considered a high output bowel condition?

    <blockquote> <p>500 cc/day</p> </blockquote> Signup and view all the answers

    Fistula tracts greater than 4 cm have a high probability of spontaneous closure.

    <p>False</p> Signup and view all the answers

    Name one of the FRIEND factors.

    <p>Foreign body</p> Signup and view all the answers

    Management of fistula involves the ______ principle.

    <p>SNAP</p> Signup and view all the answers

    Match the prognostic group with its predicted clinical course:

    <p>I (Low) = Exceptional mortality II (Intermediate) = Mortality 10-25% III (High) = Mortality &gt; 25%</p> Signup and view all the answers

    What is the output threshold below which a fistula is likely to spontaneously close?

    <p>&lt; 200 ml/day</p> Signup and view all the answers

    An albumin level greater than 25 g/L is a FRIEND factor indicating low complexity of fistula closure.

    <p>True</p> Signup and view all the answers

    What is the primary management approach for a fistula with an output exceeding 200 ml/day?

    <p>Surgical management</p> Signup and view all the answers

    What is a common symptom of hyperplastic bowel TB?

    <p>Pain and mass in the right iliac fossa</p> Signup and view all the answers

    Faecal fistula often leads to the patient being well-nourished.

    <p>False</p> Signup and view all the answers

    Which of the following signs is associated with retrocaecal appendicitis?

    <p>Psoas sign</p> Signup and view all the answers

    What is the typical management for a persistent mass or obstruction in bowel TB?

    <p>Right hemicolectomy</p> Signup and view all the answers

    The Dunphy sign indicates pain on coughing.

    <p>True</p> Signup and view all the answers

    The discharge of faecal matter from the main wound is associated with a _____ fistula.

    <p>faecal</p> Signup and view all the answers

    What is the common imaging method used for diagnosing appendicitis in children?

    <p>USG</p> Signup and view all the answers

    Pelvic appendicitis can lead to _____ irritation, resulting in increased frequency of micturition.

    <p>bladder</p> Signup and view all the answers

    Match each feature with its associated condition:

    <p>Barium meal follow-through = Hyperplastic bowel TB assessment Excruciating pain = Faecal fistula Weight loss = Hyperplastic bowel TB Skin excoriations = Faecal fistula</p> Signup and view all the answers

    Match the types of appendicitis with their corresponding characteristics:

    <p>Retrocaecal = Psoas sign present Pelvic = Bladder irritation Post ileal = Absence of signs General = Increased TLC and neutrophils</p> Signup and view all the answers

    What is the most common site for angiodysplasia in the gastrointestinal tract?

    <p>Cecum</p> Signup and view all the answers

    Angiodysplasia is often associated with aortic stenosis and von Willebrand Factor.

    <p>True</p> Signup and view all the answers

    What steps should be taken first when managing a patient with lower GI hemorrhage?

    <p>Rule out local causes.</p> Signup and view all the answers

    The most sensitive imaging modality for detecting obscure GI hemorrhage is the __________ scan.

    <p>Technetium pertechnetate</p> Signup and view all the answers

    Match the following diagnostic techniques with their respective uses in the workup of lower GI hemorrhage:

    <p>Colonoscopy = Visualize the lower GI tract Capsule endoscopy = Assess small intestine bleeding Upper GI endoscopy = Evaluate bleeding in stomach/duodenum CT angiography = Identify vascular abnormalities in GI tract</p> Signup and view all the answers

    Which of the following are indications for surgery in patients with Ulcerative Colitis? (Select all that apply)

    <p>Extra intestinal manifestations</p> Signup and view all the answers

    Pouchitis is a complication associated with total proctocolectomy and IPAA.

    <p>True</p> Signup and view all the answers

    Name one extra intestinal manifestation associated with Ulcerative Colitis.

    <p>Erythema nodosum</p> Signup and view all the answers

    Total Proctocolectomy is often combined with _____ for Ulcerative Colitis.

    <p>IPAA</p> Signup and view all the answers

    Match the extra intestinal manifestations with their respective organ systems:

    <p>Episcleritis = Ophthalmologic Primary sclerosing cholangitis = Hepatobiliary Migratory polyarthritis = Musculoskeletal Calcium oxalate nephrolithiasis = Renal</p> Signup and view all the answers

    What is the most common position of the appendix?

    <p>Retrocaecal</p> Signup and view all the answers

    The appendix has a constant position at the appendicular base.

    <p>True</p> Signup and view all the answers

    What is McBurney's point?

    <p>Maximum tenderness at the base of the appendix.</p> Signup and view all the answers

    The appendicular artery is a branch of the lower division of the _____ artery.

    <p>ileocolic</p> Signup and view all the answers

    Match the types of appendicular positions with their corresponding percentages:

    <p>Preileal = 1% Retrocaecal = 74% Postileal = 0.5% Pelvic = 21%</p> Signup and view all the answers

    What is a major difference in gender prevalence between Crohn's Disease and Ulcerative Colitis?

    <p>Ulcerative Colitis is more common in males than females.</p> Signup and view all the answers

    Skipping lesions are common in Ulcerative Colitis.

    <p>False</p> Signup and view all the answers

    What are pseudopolyps associated with?

    <p>Ulcerative Colitis</p> Signup and view all the answers

    In Crohn's Disease, the __________ are common occurrences that show non-continuous inflammation.

    <p>skip lesions</p> Signup and view all the answers

    Which complication is associated with both Crohn's Disease and Ulcerative Colitis?

    <p>Fistula formation</p> Signup and view all the answers

    Match the complication with the corresponding disease:

    <p>Proctitis = Ulcerative Colitis Cobble-stone appearance = Crohn's Disease Continuous spread = Ulcerative Colitis Non-caseating granulomas = Crohn's Disease</p> Signup and view all the answers

    Toxic megacolon is characterized by a large bowel diameter greater than 6 cm.

    <p>True</p> Signup and view all the answers

    Name one common symptom of toxic megacolon.

    <p>Pain</p> Signup and view all the answers

    Study Notes

    Bowel TB

    • Bowel TB commonly presents with caking of the omentum, often mimicking cancer.
    • Pyoperitoneum is a clinical emergency, manifesting as peritonitis requiring emergency laparotomy and anti-tubercular therapy (ATT).
    • Ulcerative bowel TB is more common, primarily affecting the terminal ileum. It often presents with pain, weight loss, and bowel obstruction.
    • Hyperplastic bowel TB is characterized by a strong immune response and can occur at the terminal ileum or ileocaecal junction (ICJ).
    • Treatment for ulcerative bowel TB typically involves investigation through biopsy and management with ATT, resection and anastomosis for close strictures, or stricturoplasty for far strictures.

    Acute Appendicitis

    • Obstructive appendicitis is the most common type, frequently caused by fecoliths, food particles, or other blockages.
    • Non-obstructive (Catarrhal) appendicitis accounts for 10-15% of cases and is more common in children.
    • Appendicitis is uncommon in infants and the elderly.
    • The peak incidence occurs in teenagers and early 20s, with males being more affected than females.

    Clinical Features

    • The most common symptom of appendicitis is periumbilical pain that shifts to the right iliac fossa.
    • Other symptoms include nausea, vomiting, fever, and anorexia.
    • Physical signs include tachycardia, fever, tenderness at McBurney's point, and a positive pointing sign.

    Benign Conditions of Small & Large Bowel

    • High-output fistulas have an output greater than 500 cc/day, while low-output fistulas produce less than 200 cc/day.
    • The probability of fistula closure depends on factors like the location and size of the fistula tract, abdominal wall defects, albumin levels, FRIEND factors, and output.
    • Management of fistulas varies depending on the probability of closure, ranging from conservative to surgical approaches.
    • FRIEND factors encompass external factors like foreign bodies, radiation, inflammation, infection, etc., influencing the nature of fistulas.
    • Treatment primarily focuses on controlling skin excoriation, managing sepsis, promoting nutritional buildup, delineating the anatomy, and planning appropriate surgery.
    • Prognosis is categorized into three groups based on complexity and predicted clinical course: Low (Exceptional Mortality), Intermediate (10-25% Mortality), and High (> 25% Mortality).

    Crohn's Disease

    • Crohn's disease can mimic acute appendicitis, presenting with abdominal pain and diarrhea.
    • Radiological signs include the string sign of Kantor and aphthous ulcers indicative of target sign.
    • Severity is classified using the modified Montreal classification, delineating mild, moderate, severe, and fulminant stages based on the number of stools and systemic signs.

    Ulcerative Colitis

    • UC is characterized by bloody diarrhea and the risk of toxic megacolon, a potentially fatal condition.
    • Diagnosis involves colonoscopic biopsy.
    • Medical management includes steroids, 5-ASA derivatives, Infliximab, and Vedolizumab.
    • Treatment strategies involve top-down or step-up approaches depending on symptom progression and response.
    • Surgical intervention is not definitive and aims to prevent short bowel syndrome or address specific complications.

    Appendicitis (Appendix)

    • The appendix is most commonly located in the retrocecal position (74%).
    • The base of the appendix is consistently situated at the junction of the three taeniae coli, and McBurney's point marks the location of maximum tenderness.
    • The appendicular artery is a branch of the ileocolic artery, supplying blood to the appendix.
    • Deficient blood supply near the apex of the appendix can lead to thrombosis and potential perforation.
    • The appendix undergoes developmental changes from birth to 2 years, transitioning from a broad structure to a tubular one.

    Angiodysplasia & Lower GI Hemorrhage Work Up

    • Angiodysplasia is characterized by dilated vessels in the large intestine, predominantly affecting the elderly population.

    • It commonly affects the cecum and can cause severe lower GI hemorrhage.

    • Diagnosis is made through colonoscopy or capsule endoscopy.

    • Management involves endoscopic or colonoscopic ligation of the affected vessels.

    • Lower GI hemorrhage work up includes, initially, ruling out local causes like hemorrhoids, fissures, and polyps.

    • Patient stabilization with IV fluids and NPO (nothing by mouth) is crucial.

    • Colonoscopy is performed to visually inspect the rectum up to the cecum.

    • Upper GI endoscopy or NG tube placement assists in evaluating for bleeding in the stomach or duodenum.

    • Obscure GI hemorrhage, typically arising from small intestine bleeds, can be diagnosed through capsule endoscopy, CT angiography, or technetium pertechnetate scan, the most sensitive test.

    Inflammatory Bowel Disease

    • Crohn's disease affects individuals between 20-40 years, with a peak around 70 years, and is more common in females.
    • Ulcerative Colitis primarily impacts those aged 25-40 years and is more prevalent in males.
    • Risk factors for Crohn's disease include smoking, refined diet, and genetic predispositions like NOD2/CARD15.
    • Smoking is also a known risk factor for Ulcerative Colitis.

    Bowel Involvement

    • Crohn's disease can affect any part of the bowel, with skip lesions common. It often spares the anal area but can lead to sinuses, abscesses, stricture formation, and fistulae.
    • Ulcerative Colitis involves a continuous spread of inflammation, with skip lesions being infrequent. The most common presentation is proctitis, followed by pancolitis.

    Additional Features

    • Crohn's disease presents with creeping fat, cobblestone appearance on the mucosal surface, non-caseating granulomas, and a risk of toxic megacolon.
    • Ulcerative Colitis manifests with pseudopolyps, crypt abscesses, and an increased risk of toxic megacolon.

    Toxic Megacolon

    • Toxic megacolon is diagnosed when the large bowel diameter exceeds 6 cm.
    • Clinical features include pain, fever, and increased white blood cell count.
    • This condition carries a significant risk of perforation.

    Ulcerative Colitis Management

    • Medical management includes steroids, 5-ASA derivatives, and monoclonal antibodies.
    • Surgical intervention involves a total proctocolectomy followed by an ileoanal pouch anastomosis (IPAA).
    • Indications for surgery include steroid side effects, complications like toxic megacolon, obstruction, cancer, lack of response to medication, and extra-intestinal manifestations.
    • Complications of surgery include pouchitis, adhesive obstruction, and rectal bleeding.

    Extra Intestinal Manifestations

    • These manifestations can affect various organ systems, including skin, hepatobiliary, ophthalmologic, hematologic, renal, and musculoskeletal systems, even persisting after surgery.

    • Hepatobiliary manifestations include primary sclerosing cholangitis (PSC), fatty liver, autoimmune liver disease, and cholelithiasis.

    • Ophthalmologic manifestations include episcleritis, scleritis, uveitis, iritis, and conjunctivitis.

    • Musculoskeletal manifestations include migratory polyarthritis, sacroiliitis, and ankylosing spondylitis, associated with HLA-B27.

    Faecal Fistula

    • Faecal fistulas are characterized by the discharge of faecal matter from a wound, along with skin excoriations, malnutrition, and severe pain.

    Barium meal Follow-Through of Bowel TB

    • Barium meal follow-through is a radiographic method used to visualize the bowel tract.
    • Features of hyperplastic bowel TB include a "goose neck" or "swan neck" deformity, a pulled up ICJ, showing a string sign of Kantor, and a stricture in the ileum.
    • These imaging findings can help in diagnosing and managing bowel tuberculosis.

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    Description

    This quiz focuses on the clinical features and treatment of Bowel TB and Acute Appendicitis. Participants will learn about the different presentations of bowel TB, its complications, and the common causes of appendicitis. Knowledge of treatment options will also be examined.

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