Colon And Rectum: Diverticulosis- Hemorrhoids

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Quizzes Created: 7 | Total Attempts: 2,938

Questions: 66 | Attempts: 426 | Updated: Mar 22, 2023

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Colon And Rectum: Diverticulosis- Hemorrhoids - Quiz

Diverticulosis, acute diverticulitis, IBD, Ulcerative Colitis, Toxic Megacolon, Chron's Dz, hemorrhoids, rectal varacies, anal fissues, periananl perirectal abscess, rectal prolapse, pruritius ani, pilonidal cysts

Questions and Answers

1.

A patient's barium enema reveals outpouchings of mucosa/submucosa through the muscularis propria layer of the colon. The patient has mild symptoms of fluctuating bowel habits and abdominal pain. What is your likely diagnosis? (Image from Current not ppt- FYI- double contrast barium enema)
- A.
  
  Toxic megacolon
- B.
  
  Acute diverticulitis
- C.
  
  Diverticulosis
- D.
  
  Definite IBD
- E.
  
  Hemorrhoids
Correct Answer
C. Diverticulosis

Explanation
The correct answer is diverticulosis. Diverticulosis is characterized by the presence of outpouchings of the mucosa/submucosa through the muscularis propria layer of the colon. It is commonly asymptomatic, but in some cases, patients may experience mild symptoms such as fluctuating bowel habits and abdominal pain. Acute diverticulitis, on the other hand, is associated with inflammation and infection of these outpouchings, leading to more severe symptoms. Toxic megacolon, definite IBD, and hemorrhoids are not consistent with the given clinical presentation.

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2.

What is the result of low-fiber, high-fat diet, colonic motility disorder, chronic constipation, and increased age on the colon?
- A.
  
  Greater pressures within the segments of the colon causes hypertrophy, thickening, and out pouching of the mucosa through the muscularis resulting in diverticulosis
- B.
  
  Obstruction due to hypertrophy of circular muscle or from inflammation, edema and spasms causing acute diverticulitis
- C.
  
  Autoimmunity and impaired immune regulation leading to IBD
- D.
  
  Infections leading to IBD
- E.
  
  Complications of sever acute colitis leading to toxic megacolon
Correct Answer
A. Greater pressures within the segments of the colon causes hypertrophy, thickening, and out pouching of the mucosa through the muscularis resulting in diverticulosis

Explanation
A low-fiber, high-fat diet, colonic motility disorder, chronic constipation, and increased age can all contribute to greater pressures within the segments of the colon. This increased pressure can cause hypertrophy, thickening, and outpouching of the mucosa through the muscularis, resulting in diverticulosis. Diverticulosis is a condition where small pouches or sacs develop in the colon wall.

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3.

What is the treatment for diverticulosis? Click all that apply
- A.
  
  High fiber diet/ fiber supplements to increased stool bulk and decreased colonic transit times. Only done in non acute phase
- B.
  
  Stool softeners (Colace)
- C.
  
  Non chronic laxatives
- D.
  
  Avoid constipation
- E.
  
  Bowel rest
Correct Answer(s)
A. High fiber diet/ fiber supplements to increased stool bulk and decreased colonic transit times. Only done in non acute phase
B. Stool softeners (Colace)
C. Non chronic laxatives
D. Avoid constipation

Explanation
The treatment for diverticulosis includes a high fiber diet or fiber supplements to increase stool bulk and decrease colonic transit times. This should only be done in the non-acute phase. Stool softeners, non-chronic laxatives, and avoiding constipation are also recommended as part of the treatment plan. Bowel rest may be necessary in certain cases.

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4.

What tests do you perform to diagnose diverticulosis? (click all that apply)
- A.
  
  Barium Enema
- B.
  
  Digital dis impaction
- C.
  
  Abdominal x ray
- D.
  
  CBC
- E.
  
  Colonoscopy
Correct Answer(s)
A. Barium Enema
E. Colonoscopy

Explanation
To diagnose diverticulosis, two tests are commonly performed: Barium Enema and Colonoscopy. A Barium Enema involves the injection of a contrast material into the rectum, followed by X-rays to visualize the colon and identify any diverticula. A Colonoscopy is a procedure in which a flexible tube with a camera is inserted into the rectum to examine the entire colon for diverticula or any other abnormalities. The other options, digital disimpaction, abdominal X-ray, and CBC (Complete Blood Count), are not typically used for diagnosing diverticulosis.

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5.

What are the complications of diverticulosis? (Click all that apply)
- A.
  
  Diverticulitis
- B.
  
  Severe impaction
- C.
  
  Toxic megacolon
- D.
  
  Hemorrhage
- E.
  
  Vagal response
Correct Answer(s)
A. Diverticulitis
D. Hemorrhage

Explanation
Diverticulosis is a condition where small, bulging pouches called diverticula form in the lining of the digestive system, usually in the colon. Complications of diverticulosis can include diverticulitis, which is inflammation or infection of the diverticula, and hemorrhage, which is bleeding from the diverticula. Diverticulitis can cause symptoms like abdominal pain, fever, and changes in bowel habits, while hemorrhage can lead to rectal bleeding. Other complications like severe impaction, toxic megacolon, and vagal response are not directly associated with diverticulosis.

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6.

What diagnostic test is used as a standard approach for most colonic mucosal disease?
- A.
  
  Flexible sigmoidoscopy
- B.
  
  Colonoscopy
- C.
  
  Barium enema
- D.
  
  CT Colonography
Correct Answer
C. Barium enema

Explanation
Barium enema is used as a standard diagnostic test for most colonic mucosal diseases. This test involves the use of a contrast material called barium, which is inserted into the rectum and colon through a tube. X-rays are then taken to visualize the lining of the colon and detect any abnormalities or diseases such as polyps, ulcers, or tumors. Barium enema is a less invasive alternative to colonoscopy and provides valuable information about the condition of the colon.

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7.

What test uses a low density substance to coat the mucosa of the rectum then instills air into the rectum? This test also requires a preparatory enema or laxative and a clear liquid diet.
- A.
  
  Colonoscopy
- B.
  
  Flexible sigmoidoscopy
- C.
  
  Double contrast barium enema/ air contrast barium enema (ACBE)
- D.
  
  CT Colonography
Correct Answer
C. Double contrast barium enema/ air contrast barium enema (ACBE)

Explanation
The correct answer is Double contrast barium enema/ air contrast barium enema (ACBE). This test involves the use of a low density substance, such as barium, to coat the mucosa of the rectum. Air is then instilled into the rectum to provide contrast during imaging. A preparatory enema or laxative and a clear liquid diet are required to ensure the colon is empty and clear for the procedure. This test is commonly used to evaluate the colon for abnormalities such as polyps or tumors.

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8.

What test is used to look at the distal third of the colon (sigmoid and rectum) and requires no sedation? This test also requires an enema and a clear liquid diet
- A.
  
  Barium enema
- B.
  
  Colonoscopy
- C.
  
  Flexible sigmoidoscopy
- D.
  
  CT scan
- E.
  
  CT colonography
Correct Answer
C. Flexible sigmoidoscopy

Explanation
A flexible sigmoidoscopy is a test used to examine the distal third of the colon, specifically the sigmoid and rectum. It does not require sedation and involves the use of a flexible tube with a camera to visualize the area. Prior to the procedure, an enema is given to clear the colon, and a clear liquid diet is followed. This test allows for a direct visual inspection of the lower part of the colon, making it a suitable option for examining the sigmoid and rectum without the need for sedation.

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9.

Which test looks at the entire colon including the cecum (and sometimes the terminal ileum for evaluation and bx)? This test also requires conscious sedation (demerol and versed) and Golytely and visicol to evacuate colon completely.
- A.
  
  Flexible sigmoidoscopy
- B.
  
  Barium enema
- C.
  
  CT Colonography
- D.
  
  Anoscopy
- E.
  
  Colonoscopy
Correct Answer
E. Colonoscopy

Explanation
Colonoscopy is the correct answer because it is a test that examines the entire colon, including the cecum and sometimes the terminal ileum. It requires conscious sedation and the use of medications like demerol and versed. Additionally, colonoscopy requires the use of bowel preparation medications like Golytely and visicol to completely empty the colon before the procedure.

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10.

What are the complications of a colonoscopy and a flexible sigmoidoscopy? Click all that apply
- A.
  
  Perforation
- B.
  
  Toxic megacolon
- C.
  
  Reaction to medication
- D.
  
  Vagal response
- E.
  
  Hemorrhage
Correct Answer(s)
A. Perforation
C. Reaction to medication
E. Hemorrhage

Explanation
During a colonoscopy and a flexible sigmoidoscopy, there are potential complications that can occur. Perforation is a serious complication where a hole or tear may develop in the colon or rectum wall. Reaction to medication is another possible complication, where a patient may have an adverse reaction to the medications used during the procedure. Hemorrhage refers to excessive bleeding that can occur during or after the procedure. These complications should be considered and monitored during colonoscopies and flexible sigmoidoscopies.

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11.

Which test will give you a 3-D image of the colon/bowel that uses air and liquid contrast, requires no sedation, and preparation incudes golytely and visicol?
- A.
  
  Colonoscopy
- B.
  
  Barium enema
- C.
  
  Flexible sigmoidoscopy
- D.
  
  Ultrasound
- E.
  
  CT Colonography
Correct Answer
E. CT Colonography

Explanation
CT Colonography, also known as virtual colonoscopy, is a test that uses a combination of air and liquid contrast to create a 3-D image of the colon/bowel. Unlike traditional colonoscopy, it does not require sedation. The preparation for CT Colonography includes drinking a solution called golytely and taking visicol. This test is a non-invasive and less uncomfortable alternative to colonoscopy, making it a suitable option for patients who may not be able to undergo sedation or prefer a less invasive procedure.

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12.

The difference between diverticulosis and diverticulitis is that in diverticulitis
- A.
  
  The greater pressures within the segments of the colon causes hypertrophy, thickening, and out pouching of the mucosa through the muscularis
- B.
  
  The pouches always lead to abscess formation
- C.
  
  The accumulation of gas causes marked dilation and necrosis of the colon
- D.
  
  The diverticula pouches have become inflamed or infected (macro or microperforations of the diverticulum)
- E.
  
  Bowel becomes inflamed
Correct Answer
D. The diverticula pouches have become inflamed or infected (macro or microperforations of the diverticulum)

Explanation
Diverticulosis refers to the presence of small pouches, called diverticula, that form in the colon wall. These pouches are usually asymptomatic and do not cause any inflammation or infection. On the other hand, diverticulitis occurs when the diverticula pouches become inflamed or infected due to macro or microperforations of the diverticulum. This inflammation and infection can lead to symptoms such as abdominal pain, fever, and changes in bowel habits. Therefore, the correct answer is that in diverticulitis, the diverticula pouches have become inflamed or infected.

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13.

The following are characteristics of complicated diverticulitis: (click all that apply)
- A.
  
  Abscess formation
- B.
  
  Fistula formation
- C.
  
  Constipation
- D.
  
  Obstruction
- E.
  
  Macroperforations
Correct Answer(s)
A. Abscess formation
B. Fistula formation
D. Obstruction
E. Macroperforations

Explanation
Complicated diverticulitis refers to a more severe form of diverticulitis where complications have occurred. Abscess formation is a common complication, where pus accumulates in the diverticula. Fistula formation is another complication, where abnormal connections form between the diverticula and other organs or structures. Obstruction can occur when the inflamed diverticula cause a blockage in the colon. Macroperforations refer to large perforations or tears in the diverticula, which can lead to serious infections. Constipation, however, is not a characteristic of complicated diverticulitis.

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14.

A patient presents with LLQ pain, with gradual onset and is progressively getting worse. The patient has had this pain before, but this pain is consistent and unrelenting. She has nausea, vomiting, diarrhea, low grade fever, and urinary urgency and frequency. CBC; leukocytosis, abd X ray: free air, CT: reveals soft tissue density of the pericolic fat (98%), diverticula (84%), bowel wall thickening of more than 4 mm (70%), and phlegmon or pericolic fluid (35%) (CT results from Current)What is your suspected diagnosis?
- A.
  
  Toxic Megacolon
- B.
  
  Adenocarcinoma
- C.
  
  Acute Diverticulitis
- D.
  
  Diverticulosis
- E.
  
  Ulcerative Colitis
Correct Answer
C. Acute Diverticulitis

Explanation
The patient's symptoms, including LLQ pain, nausea, vomiting, diarrhea, low grade fever, and urinary urgency and frequency, along with the imaging findings of diverticula, bowel wall thickening, and pericolic fat density, are consistent with a diagnosis of acute diverticulitis. This condition occurs when small pouches in the colon become infected or inflamed. The patient's history of previous episodes of pain, along with the worsening and consistent nature of the current pain, further supports this diagnosis.

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15.

What is the test of choice to diagnose acute diverticulitis. (remember that an endoscopy is contraindicated because it may lead to bowel perforation)
- A.
  
  Abdominal x ray
- B.
  
  Barium enema with water soluble contrast
- C.
  
  CT scan
- D.
  
  Flexible sigmoidoscopy
- E.
  
  Colonoscopy
Correct Answer
C. CT scan

Explanation
The test of choice to diagnose acute diverticulitis is a CT scan. This imaging technique allows for a detailed visualization of the colon and can accurately detect the presence of diverticula and any signs of inflammation or infection. Unlike endoscopy, a CT scan does not carry the risk of bowel perforation, making it a safer and more appropriate option for diagnosing acute diverticulitis. Abdominal x-ray, barium enema with water soluble contrast, flexible sigmoidoscopy, and colonoscopy are not typically used as the initial diagnostic tests for acute diverticulitis.

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16.

Treatment for acute diverticulitis includes: (click all that apply)
- A.
  
  Bowel rest (clear liquids only)
- B.
  
  High fiber diet
- C.
  
  Antibiotics
- D.
  
  Ciprofloxacin and metronidazole for gram negative rods and anaerobes
- E.
  
  Ciprofloxacin and metronidazole for gram positive rods and anerobes
Correct Answer(s)
A. Bowel rest (clear liquids only)
C. Antibiotics
D. Ciprofloxacin and metronidazole for gram negative rods and anaerobes

Explanation
The correct answer is: Bowel rest (clear liquids only), Antibiotics, Ciprofloxacin and metronidazole for gram-negative rods and anaerobes.

Acute diverticulitis is an inflammation or infection of small pouches (diverticula) that develop along the walls of the intestines. Treatment for acute diverticulitis involves bowel rest, which means limiting solid food intake and consuming clear liquids only. This helps to reduce inflammation and allow the intestines to heal. Antibiotics are also prescribed to treat the infection. Ciprofloxacin and metronidazole are commonly used antibiotics for acute diverticulitis as they cover a broad spectrum of bacteria, including gram-negative rods and anaerobes, which are commonly involved in the infection.

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17.

How can a complicated diverticulitis such as a perforated diverticulum lead to death?
- A.
  
  Perforation of diverticulum leads to hemorrhage when mucosal perforation penetrates into a submucosal artery
- B.
  
  Perforation of ulcerated diverticulum can lead to bloody stool
- C.
  
  Perforation of ulcerated diverticulum allows feces into peritoneal cavity which causes fecal peritonitis and produces septic shock
- D.
  
  Pneumaturia leading to death
Correct Answer
C. Perforation of ulcerated diverticulum allows feces into peritoneal cavity which causes fecal peritonitis and produces septic shock

Explanation
Perforation of an ulcerated diverticulum can lead to the leakage of feces into the peritoneal cavity. This can result in fecal peritonitis, which is a severe inflammation of the lining of the abdominal cavity. Fecal peritonitis can cause infection and lead to septic shock, a life-threatening condition characterized by low blood pressure and organ failure. Therefore, the presence of feces in the peritoneal cavity due to a perforated diverticulum can ultimately result in death.

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18.

A patient presents with painless pneumaturia (air in urine) and or feces mixed in with their urine. What complication of acute diverticulitis should you consider?
- A.
  
  Diverticular hemorrhage due to mucosal ulceration of a diverticulum that penetrated into a submucosal artery
- B.
  
  Colonic obstruction due to the hypertrophy of circular muscle or inflammation, edema, and spasms that accompany diverticulitis
- C.
  
  Colovesical fistula as a reult of a chronically inflamed diverticulum that adhered to the bladder and ruptured into the lumen to form a fistula. This is a non-fatal problem and can be surgically resected.
- D.
  
  Perforated diverticulum that allowed air and feces into the peritoneal cavity
- E.
  
  Colovescial fistula as a result of a perforated diverticulum that allowed air into the bladder. This is a non-life threatening condition and can be surgically resected.
Correct Answer
C. Colovesical fistula as a reult of a chronically inflamed diverticulum that adhered to the bladder and ruptured into the lumen to form a fistula. This is a non-fatal problem and can be surgically resected.

Explanation
The correct answer is colovesical fistula as a result of a chronically inflamed diverticulum that adhered to the bladder and ruptured into the lumen to form a fistula. This is a non-fatal problem and can be surgically resected. This is the most likely complication in a patient presenting with painless pneumaturia (air in urine) and feces mixed in with their urine. A colovesical fistula occurs when a diverticulum, which is a pouch-like protrusion in the wall of the colon, becomes chronically inflamed and adheres to the bladder. This can lead to the formation of a fistula, an abnormal connection between the colon and the bladder, allowing air and feces to pass into the bladder. Surgical resection is the recommended treatment for this condition.

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19.

What are the two chronic idiopathic diseases characterized by inflammation of the bowel?
- A.
  
  Ulcerative Colitis and Crohn's disease
- B.
  
  Toxic Megacolon and Ulcerative Colitis
- C.
  
  Toxic Megacolon and Crohn's disease
- D.
  
  Diverticulosis and Diverticulitis
Correct Answer
A. Ulcerative Colitis and Crohn's disease

Explanation
Ulcerative colitis and Crohn's disease are both chronic idiopathic diseases characterized by inflammation of the bowel. Ulcerative colitis primarily affects the colon and rectum, causing inflammation and ulcers in the lining of the colon. Crohn's disease, on the other hand, can affect any part of the digestive tract, from the mouth to the anus, and causes inflammation that extends through the entire thickness of the bowel wall. Both conditions can cause symptoms such as abdominal pain, diarrhea, and rectal bleeding.

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20.

Which of the following is associated with and is a possible cause genetic predisposition of IBD? (Click all that apply)
- A.
  
  Caucasian and European Jewish heritage
- B.
  
  Impaired immune regulation and autoimmunity
- C.
  
  Genetic Markers/ mutations
- D.
  
  Turner's syndrome, Glycogen Storage Dz type I, Hermansky-Pulak syndrome
- E.
  
  Familial aggregation
Correct Answer(s)
A. Caucasian and European Jewish heritage
C. Genetic Markers/ mutations
D. Turner's syndrome, Glycogen Storage Dz type I, Hermansky-Pulak syndrome
E. Familial aggregation

Explanation
The correct answer choices are all associated with and possible causes of genetic predisposition of IBD. Caucasian and European Jewish heritage have been identified as risk factors for developing IBD. Genetic markers and mutations play a role in the development of IBD, as certain genes have been linked to the disease. Turner's syndrome, Glycogen Storage Dz type I, and Hermansky-Pulak syndrome are genetic disorders that can increase the risk of developing IBD. Familial aggregation suggests that there is a genetic component to the disease, as it tends to run in families.

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21.

List the categories for IBD associations and possible causes

Correct Answer(s)
Genetic predisposition
Impaired immune regulation
Autoimmunity
infection
smoking

Explanation
The given answer lists the categories for IBD associations and possible causes. These include genetic predisposition, impaired immune regulation, autoimmunity, infection, and smoking. These factors have been found to be associated with the development of inflammatory bowel disease (IBD). Genetic predisposition refers to certain genes that increase the risk of developing IBD. Impaired immune regulation refers to dysregulation of the immune system, which can contribute to the development of IBD. Autoimmunity refers to the immune system mistakenly attacking the body's own tissues, which is believed to play a role in IBD. Infection and smoking have also been identified as potential factors that can increase the risk of developing IBD.

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4
22.

T/F. Smoking causes a two fold increased risk for Crohn's disease?
- A.
  
  True
- B.
  
  False
Correct Answer
A. True

Explanation
Smoking has been identified as a risk factor for Crohn's disease, a chronic inflammatory bowel disease. Multiple studies have shown that smoking increases the risk of developing Crohn's disease by approximately two-fold. The harmful effects of smoking on the gastrointestinal tract can lead to inflammation and damage, contributing to the development and progression of the disease. Therefore, it is true that smoking causes a two-fold increased risk for Crohn's disease.

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23.

The onset of Ulcerative Colitis is usually between the ages of ________ and a second peak at ________ years old
- A.
  
  30-50, 60
- B.
  
  20-40, 60
- C.
  
  18-25, 50
- D.
  
  25-55, 70
- E.
  
  22-28, 50
Correct Answer
B. 20-40, 60

Explanation
Ulcerative Colitis typically begins between the ages of 20 and 40, with a second peak occurring around the age of 60. This means that individuals are most likely to develop Ulcerative Colitis during their early adulthood and then again later in life.

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24.

Ulcerative colitis is limited to the _______ to ___________. Inflammation is confined to the ____________ and is noted for the formation of _______________. The _________ is almost always involved
- A.
  
  Ileum to cecum, all layers of the intestinal wall, cobblestone appearance, ileocecal region
- B.
  
  Ileum to cecum, all layers of the intestinal wall, skip lesions, cecum
- C.
  
  Rectum to cecum, mucosa, crypt abscesses, rectum
- D.
  
  Rectum to cecum, mucosa, skip lesions, rectum
Correct Answer
C. Rectum to cecum, mucosa, crypt abscesses, rectum

Explanation
Ulcerative colitis is a type of inflammatory bowel disease that is limited to the rectum to cecum region of the intestine. The inflammation is confined to the mucosa, which is the innermost layer of the intestinal wall. It is characterized by the formation of crypt abscesses, which are pockets of pus within the intestinal crypts. The rectum is almost always involved in ulcerative colitis.

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25.

T/F Pancolitis is inflammation of the entire colon and the risk of colonic malignancy is higher in pts with pancolitis that have the disease before age 15
- A.
  
  True
- B.
  
  False
Correct Answer
A. True

Explanation
Pancolitis refers to inflammation of the entire colon, which can increase the risk of colonic malignancy. This means that individuals with pancolitis have a higher likelihood of developing colon cancer. Additionally, the risk of colonic malignancy is even higher in patients who have had the disease before the age of 15. Therefore, the statement is true.

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26.

What complications should you look for in pts that have ulcerative colitis?
- A.
  
  Malignancy that is difficult to detect
- B.
  
  Chronic inflammation
- C.
  
  A higher risk for malignancy in patients that have had the dz for more than 10 years or were diagnosed before age 15
- D.
  
  Perforated diverticulum
- E.
  
  Colonic obstruction
Correct Answer(s)
A. Malignancy that is difficult to detect
B. Chronic inflammation
C. A higher risk for malignancy in patients that have had the dz for more than 10 years or were diagnosed before age 15

Explanation
Patients with ulcerative colitis are at an increased risk for developing malignancy, particularly colorectal cancer. This risk is higher in patients who have had the disease for more than 10 years or were diagnosed before the age of 15. However, detecting malignancy in these patients can be challenging due to the chronic inflammation present in the colon. Therefore, healthcare providers should be vigilant in monitoring for signs of malignancy and consider additional screening measures in these patients. Additionally, complications such as perforated diverticulum and colonic obstruction may also arise in patients with ulcerative colitis.

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27.

A 22 year old female presents with an abrupt onset of bloody diarrhea and blood per rectum. She has abdominal pain and a fever. She has a normal pulse, and does not have abdominal distension or signs of peritonitis, and does not appear dehydrated. Her labs indicate that she has leukocytosis. What diagnosis would you consider? (click all that apply)
- A.
  
  Acute diverticulitis
- B.
  
  Toxic Megacolon
- C.
  
  Ulcerative Colitis
- D.
  
  Toxic colitis
- E.
  
  Diverticulosis
Correct Answer
C. Ulcerative Colitis

Explanation
Based on the symptoms described, including bloody diarrhea, abdominal pain, fever, and leukocytosis, along with the absence of signs such as abdominal distension, peritonitis, and dehydration, the most likely diagnosis would be Ulcerative Colitis. This is a chronic inflammatory bowel disease that affects the colon and rectum, causing symptoms such as bloody diarrhea and abdominal pain. Acute diverticulitis, toxic megacolon, toxic colitis, and diverticulosis can also cause similar symptoms, but the absence of certain signs and the presence of leukocytosis make Ulcerative Colitis a more likely diagnosis.

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28.

What diagnostic tests would you order if you suspected Ulcerative Colitis? (Click all that apply)
- A.
  
  Abdominal X ray to rule out toxic megacolon
- B.
  
  Colonoscopy
- C.
  
  Barium Enema
- D.
  
  Air contrast barium enema
- E.
  
  Small bowel series
Correct Answer(s)
A. Abdominal X ray to rule out toxic megacolon
B. Colonoscopy
D. Air contrast barium enema
E. Small bowel series

Explanation
The diagnostic tests that would be ordered if Ulcerative Colitis is suspected include an Abdominal X-ray to rule out toxic megacolon, a Colonoscopy to visualize the colon and take biopsies, an Air contrast barium enema to evaluate the extent and severity of the disease, and a Small bowel series to rule out Crohn's disease or other small bowel involvement. These tests are commonly used to diagnose and evaluate the extent of Ulcerative Colitis.

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29.

A patient's presents to you with bloody diarrhea, abdominal pain, and a fever. You order labs and the they reveal, leukocytosis, anemia, thrombocytosis (low platelets), elevated sedimentation rate and C reactive protein, hypoalbuminemia,hypokalemia, hypomagnesemia, and an elevated alkaline phosphatase. What disease is consistant with these findings?
- A.
  
  Crohn's disease
- B.
  
  Ulcerative Colitis
- C.
  
  Diverticular disease
- D.
  
  Angiodysplasia
- E.
  
  Celiac Sprue
Correct Answer
B. Ulcerative Colitis

Explanation
The given symptoms and laboratory findings are consistent with ulcerative colitis. Ulcerative colitis is a type of inflammatory bowel disease that primarily affects the colon and rectum. The symptoms of bloody diarrhea, abdominal pain, and fever are common in ulcerative colitis. The laboratory findings of leukocytosis, anemia, thrombocytosis, elevated sedimentation rate and C reactive protein, hypoalbuminemia, hypokalemia, hypomagnesemia, and elevated alkaline phosphatase are also commonly seen in ulcerative colitis. Therefore, based on the symptoms and laboratory findings, ulcerative colitis is the most likely disease.

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30.

Identify the disease that causes this appearance of the colon
- A.
  
  Ulcerative Colitis
- B.
  
  Crohn's disease
- C.
  
  Diverticulosis
- D.
  
  Diverticulitis
- E.
  
  Rectal varices
Correct Answer
A. Ulcerative Colitis

Explanation
Ulcerative colitis is a chronic inflammatory bowel disease that primarily affects the colon and rectum. It causes inflammation and ulcers in the inner lining of the colon, leading to symptoms such as abdominal pain, diarrhea, and rectal bleeding. This appearance of the colon is characteristic of ulcerative colitis, as it shows inflammation and ulceration throughout the colon. Crohn's disease, diverticulosis, diverticulitis, and rectal varices may have different presentations and are not typically associated with this specific appearance of the colon.

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31.

What medications do prescribe to treat Ulcerative Colitis? (Click all that apply)
- A.
  
  5-aminosalicylic Acid agents to reduce inflammation
- B.
  
  Immunosupressive agents
- C.
  
  Biologics- Remicade (Infliximab)
- D.
  
  Antibiotics
- E.
  
  Corticosteroids
Correct Answer(s)
A. 5-aminosalicylic Acid agents to reduce inflammation
B. Immunosupressive agents
C. Biologics- Remicade (Infliximab)
D. Antibiotics
E. Corticosteroids

Explanation
The correct answer is a combination of 5-aminosalicylic Acid agents to reduce inflammation, Immunosuppressive agents, Biologics- Remicade (Infliximab), Antibiotics, and Corticosteroids. These medications are commonly prescribed to treat Ulcerative Colitis as they help reduce inflammation, suppress the immune system, target specific proteins involved in the inflammatory process, fight off infections, and alleviate symptoms. The use of different medications depends on the severity and specific needs of each individual patient.

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32.

What three things will you include in your treatment of Ulcerative Colitis?
- A.
  
  Medication
- B.
  
  Ongoing care- screening and surveillance colonoscopies
- C.
  
  Non surgical treatment
- D.
  
  Surgical treatment- colon resection sparing anal sphincter (ileoanal anastomosis)
- E.
  
  Ligation
Correct Answer(s)
A. Medication
B. Ongoing care- screening and surveillance colonoscopies
D. Surgical treatment- colon resection sparing anal sphincter (ileoanal anastomosis)

Explanation
The three things that should be included in the treatment of Ulcerative Colitis are medication, ongoing care such as screening and surveillance colonoscopies, and surgical treatment in the form of colon resection sparing the anal sphincter (ileoanal anastomosis). Medication is important for managing the symptoms and inflammation associated with the condition. Ongoing care, including regular screenings and surveillance colonoscopies, is necessary to monitor the disease and catch any complications early. In some cases, surgical treatment may be required, specifically colon resection sparing the anal sphincter, which involves removing the affected part of the colon and connecting the small intestine to the anus.

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33.

Surveillance colonoscopy is highly recommended for pts with UC. Screening _____ years after onset of pancolitis, or ___-____ years of onset of left-sided colitis. Surveillance than every __-___ years after initial colonoscopy.
- A.
  
  5, 5-10, 1-2
- B.
  
  8, 12-15, 1-2
- C.
  
  10, 5-6, 1-2
Correct Answer
B. 8, 12-15, 1-2
34.

What treatment option would be indicated if a patient had an unresolving toxic megacolon?
- A.
  
  Colonoscopy
- B.
  
  Colon resection
- C.
  
  Antibiotics
- D.
  
  Potent analgesics
- E.
  
  Immunosuppressants
Correct Answer
B. Colon resection

Explanation
If a patient has an unresolving toxic megacolon, colon resection would be the indicated treatment option. This procedure involves removing a portion of the colon to alleviate the symptoms and complications associated with toxic megacolon. Colon resection is often performed when other treatment options, such as antibiotics or immunosuppressants, have failed to resolve the condition. It is a more aggressive approach but may be necessary to prevent further complications and improve the patient's condition.

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35.

What disease is characterized by a diffuse infestation of bacterial enterotoxins in the muscle layers that results from severe acute colitis and leads to a paralytic ileus? Eventually, the inflammation and accumulation of gas cause atony, marked dilatation and necrosis of involved segment of colon
- A.
  
  Sepsis due to a macropreforation of acute diverticulitis
- B.
  
  Perforation
- C.
  
  Obstruction
- D.
  
  Toxic Megacolon
Correct Answer
D. Toxic Megacolon

Explanation
Toxic Megacolon is a disease characterized by a diffuse infestation of bacterial enterotoxins in the muscle layers that results from severe acute colitis. This condition leads to a paralytic ileus, causing inflammation and accumulation of gas. Eventually, the affected segment of the colon experiences atony, marked dilatation, and necrosis. Therefore, Toxic Megacolon is the correct answer as it matches the description given in the question.

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36.

What is the treatment for toxic megacolon? click all that apply
- A.
  
  NG suction
- B.
  
  Parenteral steroids
- C.
  
  antibiotics and IV steroids
- D.
  
  Laxatives and anti-motility agents
- E.
  
  Complete bowel rest and surgery if no improvement is seen within 24-48 hours
Correct Answer(s)
A. NG suction
C. antibiotics and IV steroids

Explanation
The treatment for toxic megacolon includes NG suction, antibiotics, and IV steroids. NG suction helps to decompress the colon and reduce the pressure. Antibiotics are necessary to treat the underlying infection causing the condition. IV steroids are administered to reduce inflammation and promote healing. The other options, parenteral steroids and laxatives/anti-motility agents, are not mentioned in the treatment for toxic megacolon. Complete bowel rest and surgery may be necessary if there is no improvement within 24-48 hours.

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37.

What are possible outcomes of toxic megacolon? Click all that apply
- A.
  
  Death
- B.
  
  Perforation
- C.
  
  Cachexia
- D.
  
  Sepsis
- E.
  
  Toxic colitis
Correct Answer(s)
A. Death
B. Perforation
D. Sepsis

Explanation
Toxic megacolon is a severe complication of inflammatory bowel disease, characterized by the dilation of the colon and the potential for life-threatening complications. Death can occur as a possible outcome due to the severity of the condition and its associated complications. Perforation refers to the rupture of the colon, which can lead to infection and further complications. Sepsis, a systemic infection, can also arise from toxic megacolon, as the damaged colon allows bacteria to enter the bloodstream. Cachexia, which refers to severe weight loss and muscle wasting, is not typically associated with toxic megacolon.

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38.

A patient presents with abdominal distension, pain, fever (39C), tachycardia (120bpm), diarrhea and dehydration. The result of the abdominal x ray is the following: What is your diagnosis?
- A.
  
  Ascities
- B.
  
  Bowel Obstruciton
- C.
  
  Toxic Megacolon
- D.
  
  Bowel Perforation
- E.
  
  Diverticular Hemorrhage
Correct Answer
C. Toxic Megacolon

Explanation
Based on the symptoms described (abdominal distension, pain, fever, tachycardia, diarrhea, and dehydration) and the result of the abdominal x-ray, the correct diagnosis is Toxic Megacolon. Toxic Megacolon is a severe complication of inflammatory bowel disease, characterized by the dilation and inflammation of the colon, leading to symptoms like abdominal distension and pain. The presence of fever, tachycardia, and diarrhea further support this diagnosis. The abdominal x-ray may show signs of colonic dilation, which is consistent with Toxic Megacolon.

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39.

What disease is characterized by transmural inflammation of the bowel wall that can involve any segment of the GI tract from mouth to anus, but the Ileocecal region is the most common?
- A.
  
  Chrohn's Disease
- B.
  
  Ulcerative Colitis
- C.
  
  Diverticulosis
- D.
  
  Irritable bowel syndrome
- E.
  
  Pilonidal cysts
Correct Answer
A. Chrohn's Disease

Explanation
Crohn's Disease is a chronic inflammatory condition that can affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. It is characterized by transmural inflammation, meaning that it affects all layers of the bowel wall. While Crohn's Disease can involve any segment of the GI tract, the most common area affected is the ileocecal region, which is the junction between the small intestine and the large intestine. This inflammation can lead to various symptoms such as abdominal pain, diarrhea, weight loss, and fatigue.

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40.

The onset of crohn's disease is usually between the ages of ____ -____, with a second peak between ____ to _____. Most cases begin before age ____.
- A.
  
  25-50, 60-80, 40
- B.
  
  15-30, 60-80, 30
- C.
  
  40-50, 60-80, 30
- D.
  
  10-20, 50-60, 20
Correct Answer
B. 15-30, 60-80, 30

Explanation
Crohn's disease typically starts between the ages of 15-30, with a second peak occurring between 60-80. Most cases of Crohn's disease begin before the age of 30.

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41.

Granulomas in the intestinal wall, "skip lesions" in the bowel, and submucosal inflammation that has a "cobblestone" appearance and mesentery abscesses are all characteristics of what disease?
- A.
  
  Inflammatory bowel disease
- B.
  
  Ulcerative Colitis
- C.
  
  Crohn's Disease
- D.
  
  Internal hemorrhoids
Correct Answer
C. Crohn's Disease

Explanation
Granulomas in the intestinal wall, "skip lesions" in the bowel, and submucosal inflammation that has a "cobblestone" appearance and mesentery abscesses are all characteristic findings of Crohn's Disease. This chronic inflammatory condition primarily affects the gastrointestinal tract, causing inflammation and damage to the lining of the digestive system. The presence of granulomas, skip lesions, cobblestone appearance, and abscesses are key diagnostic features of Crohn's Disease, distinguishing it from other conditions such as ulcerative colitis or internal hemorrhoids.

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42.

A 25 year old female presents with an insidious onset of RLQ abdominal pain and cramping, prolonged diarrhea that floats and is foul smelling, anorexia, fatigue, and weight loss. Her labs indicate the presence of inflammatory activity and nutritional deficiencies. What is the most likely diagnosis?
- A.
  
  Crohn's disease
- B.
  
  Ulcerative Colitis
- C.
  
  Toxic Megacolon
- D.
  
  Mesenteric Ischemia
- E.
  
  Gastritis
Correct Answer
A. Crohn's disease

Explanation
The patient's symptoms, including RLQ abdominal pain, prolonged diarrhea, anorexia, fatigue, and weight loss, along with the presence of inflammatory activity and nutritional deficiencies in the labs, are consistent with Crohn's disease. Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract, causing symptoms such as abdominal pain, diarrhea, and weight loss. The other options, including ulcerative colitis, toxic megacolon, mesenteric ischemia, and gastritis, do not fully explain the combination of symptoms and lab findings seen in this patient.

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43.

What diagnostic tests would you order for a patient you suspect has Crohn's Disease? (Click all that apply)
- A.
  
  Colonoscopy
- B.
  
  Abdominal x rays and small bowel series
- C.
  
  CT scan
- D.
  
  Air contrast barium enema
- E.
  
  Labs
Correct Answer(s)
A. Colonoscopy
B. Abdominal x rays and small bowel series
D. Air contrast barium enema
E. Labs

Explanation
The diagnostic tests that would be ordered for a patient suspected to have Crohn's Disease include colonoscopy, abdominal x rays and small bowel series, air contrast barium enema, and lab tests. These tests are commonly used to evaluate the gastrointestinal tract and identify any abnormalities or inflammation associated with Crohn's Disease. Colonoscopy allows for direct visualization of the colon and small bowel series helps to evaluate the small intestine. An air contrast barium enema is used to examine the colon and rectum. Lab tests can include blood tests to check for inflammation markers and other indicators of Crohn's Disease.

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44.

Why do patients suffering from Crohn's disease have anemia? (click all that apply)
- A.
  
  Iron malabsorption
- B.
  
  Immune destruction of IF
- C.
  
  Chronic blood loss
- D.
  
  Malabsorption of vitamin B-12 or folate which leads to a decrease in RBC production
- E.
  
  Malabsorption of vitamin B-12 wich leads to an increase in RBC production
Correct Answer(s)
A. Iron malabsorption
C. Chronic blood loss
D. Malabsorption of vitamin B-12 or folate which leads to a decrease in RBC production

Explanation
Patients suffering from Crohn's disease can have anemia due to multiple factors. Iron malabsorption is one of the reasons, as Crohn's disease can affect the small intestine's ability to absorb iron from the diet. Chronic blood loss is another factor, as inflammation in the intestines can lead to ulcers and bleeding. Malabsorption of vitamin B-12 or folate can also contribute to anemia, as these vitamins are necessary for red blood cell production. However, malabsorption of vitamin B-12 does not lead to an increase in RBC production, as mentioned in the incorrect answer choice.

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45.

Hypoalbuminema, hypocholesterolemia, hypocalcemia, hypomagnesemia, and hypoprothombinemia are all a result of ______________ in Chron's disease?
- A.
  
  Malabsorption
- B.
  
  Malnutrition
- C.
  
  Inflammation
- D.
  
  Abscess formation
- E.
  
  Fistula formation
Correct Answer
A. Malabsorption

Explanation
The correct answer is malabsorption. In Crohn's disease, the inflammation in the intestines can lead to damage and dysfunction of the intestinal lining, impairing the absorption of various nutrients and substances. This can result in decreased levels of albumin, cholesterol, calcium, magnesium, and prothrombin, leading to hypoalbuminemia, hypocholesterolemia, hypocalcemia, hypomagnesemia, and hypoprothrombinemia, respectively. Malabsorption is a common complication of Crohn's disease and can contribute to malnutrition and various deficiencies.

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46.

What two labs would you order to assess the activity of Crohn's disease? (Click the two that apply)
- A.
  
  PT/PTT
- B.
  
  Albumin levels
- C.
  
  Magnesium levels
- D.
  
  C- reactive protein
- E.
  
  Erythrocyte sedimentation rate
Correct Answer(s)
D. C- reactive protein
E. Erythrocyte sedimentation rate

Explanation
C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are two commonly ordered labs to assess the activity of Crohn's disease. CRP is an acute phase reactant that increases in response to inflammation, making it a useful marker for disease activity in Crohn's disease. ESR measures the rate at which red blood cells settle in a tube, which can also be elevated in the presence of inflammation. Therefore, both CRP and ESR can provide valuable information about the activity of Crohn's disease.

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47.

In Crohn's diseased patients, what microbes should be routinely tested for? (click all that apply)
- A.
  
  Ova
- B.
  
  Parasites
- C.
  
  Pathogens
- D.
  
  Clostidium difficile toxin
- E.
  
  Food-borne illnesses
Correct Answer(s)
A. Ova
B. Parasites
C. Pathogens
D. Clostidium difficile toxin

Explanation
In Crohn's diseased patients, routine testing should be done for ova, parasites, pathogens, and Clostridium difficile toxin. This is because Crohn's disease is associated with inflammation in the gastrointestinal tract, and these microbes can contribute to or worsen the symptoms of the disease. Additionally, testing for food-borne illnesses is important as they can also trigger or exacerbate symptoms in Crohn's disease patients.

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48.

What is the treatment for Crohn's Disease? (Click all that apply)
- A.
  
  5-ASA
- B.
  
  Immunosupressants- Azathioprine (Imuran)
- C.
  
  Antibiotics- Ciproflozacin and Metronidazole
- D.
  
  Corticosteroids- Prednisone and budesonide
- E.
  
  Biologics- Remicade, Humira
Correct Answer(s)
A. 5-ASA
B. Immunosupressants- Azathioprine (Imuran)
C. Antibiotics- Ciproflozacin and Metronidazole
D. Corticosteroids- Prednisone and budesonide
E. Biologics- Remicade, Humira

Explanation
The correct answer includes multiple treatment options for Crohn's Disease. 5-ASA is a type of anti-inflammatory medication that can help reduce inflammation in the digestive tract. Immunosuppressants like Azathioprine (Imuran) can help suppress the immune system and reduce inflammation. Antibiotics such as Ciprofloxacin and Metronidazole can be used to treat infections that may occur with Crohn's Disease. Corticosteroids like Prednisone and Budesonide can help reduce inflammation and provide relief from symptoms. Biologics like Remicade and Humira are medications that target specific proteins in the immune system to reduce inflammation. All of these treatment options can be used in various combinations depending on the severity and specific needs of the individual with Crohn's Disease.

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1
0
49.

T/F Crohn'd Disease is surgically curable
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Crohn's Disease is a chronic inflammatory condition that primarily affects the gastrointestinal tract. It is not currently considered surgically curable because it cannot be completely eliminated through surgery. While surgery may be performed to remove damaged portions of the intestine or to alleviate complications, it does not provide a permanent cure for the disease. The underlying cause of Crohn's Disease is not fully understood, and it typically requires long-term management with medication and lifestyle changes.

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50.

T/F Peripheral arthritis is an extraintestinal manifestation of both Crohn's disease and Ulcerative Colitis?

Correct Answer
True

Explanation
Peripheral arthritis is indeed an extraintestinal manifestation of both Crohn's disease and Ulcerative Colitis. This means that individuals with these inflammatory bowel diseases may experience inflammation and swelling in their joints, commonly in the peripheral joints such as the knees, ankles, and wrists. This condition is often characterized by pain, stiffness, and limited mobility in the affected joints. It is important for healthcare providers to be aware of this association and consider it when managing patients with Crohn's disease or Ulcerative Colitis.

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4

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Current Version
Mar 22, 2023

Quiz Edited by
ProProfs Editorial Team
Nov 05, 2009

Quiz Created by
Nsched

Colon And Rectum: Diverticulosis- Hemorrhoids

A patient's barium enema reveals outpouchings of mucosa/submucosa through the muscularis propria layer of the colon. The patient has mild symptoms of fluctuating bowel habits and abdominal pain. What is your likely diagnosis? (Image from Current not ppt- FYI- double contrast barium enema)

What is the result of low-fiber, high-fat diet, colonic motility disorder, chronic constipation, and increased age on the colon?

What is the treatment for diverticulosis? Click all that apply

What tests do you perform to diagnose diverticulosis? (click all that apply)

What are the complications of diverticulosis? (Click all that apply)

What diagnostic test is used as a standard approach for most colonic mucosal disease?

What test uses a low density substance to coat the mucosa of the rectum then instills air into the rectum? This test also requires a preparatory enema or laxative and a clear liquid diet.

What test is used to look at the distal third of the colon (sigmoid and rectum) and requires no sedation? This test also requires an enema and a clear liquid diet

Which test looks at the entire colon including the cecum (and sometimes the terminal ileum for evaluation and bx)? This test also requires conscious sedation (demerol and versed) and Golytely and visicol to evacuate colon completely.

What are the complications of a colonoscopy and a flexible sigmoidoscopy? Click all that apply

Which test will give you a 3-D image of the colon/bowel that uses air and liquid contrast, requires no sedation, and preparation incudes golytely and visicol?

The difference between diverticulosis and diverticulitis is that in diverticulitis

The following are characteristics of complicated diverticulitis: (click all that apply)

What is the test of choice to diagnose acute diverticulitis. (remember that an endoscopy is contraindicated because it may lead to bowel perforation)

Treatment for acute diverticulitis includes: (click all that apply)

How can a complicated diverticulitis such as a perforated diverticulum lead to death?

A patient presents with painless pneumaturia (air in urine) and or feces mixed in with their urine. What complication of acute diverticulitis should you consider?

What are the two chronic idiopathic diseases characterized by inflammation of the bowel?

Which of the following is associated with and is a possible cause genetic predisposition of IBD? (Click all that apply)

List the categories for IBD associations and possible causes

T/F. Smoking causes a two fold increased risk for Crohn's disease?

The onset of Ulcerative Colitis is usually between the ages of ________ and a second peak at ________ years old

Ulcerative colitis is limited to the _______ to ___________. Inflammation is confined to the ____________ and is noted for the formation of _______________. The _________ is almost always involved

T/F Pancolitis is inflammation of the entire colon and the risk of colonic malignancy is higher in pts with pancolitis that have the disease before age 15

What complications should you look for in pts that have ulcerative colitis?

What diagnostic tests would you order if you suspected Ulcerative Colitis? (Click all that apply)

Identify the disease that causes this appearance of the colon

What medications do prescribe to treat Ulcerative Colitis? (Click all that apply)

What three things will you include in your treatment of Ulcerative Colitis?

Surveillance colonoscopy is highly recommended for pts with UC. Screening _____ years after onset of pancolitis, or ___-____ years of onset of left-sided colitis. Surveillance than every __-___ years after initial colonoscopy.

What treatment option would be indicated if a patient had an unresolving toxic megacolon?

What disease is characterized by a diffuse infestation of bacterial enterotoxins in the muscle layers that results from severe acute colitis and leads to a paralytic ileus? Eventually, the inflammation and accumulation of gas cause atony, marked dilatation and necrosis of involved segment of colon

What is the treatment for toxic megacolon? click all that apply

What are possible outcomes of toxic megacolon? Click all that apply

A patient presents with abdominal distension, pain, fever (39C), tachycardia (120bpm), diarrhea and dehydration. The result of the abdominal x ray is the following: What is your diagnosis?

What disease is characterized by transmural inflammation of the bowel wall that can involve any segment of the GI tract from mouth to anus, but the Ileocecal region is the most common?

The onset of crohn's disease is usually between the ages of ____ -____, with a second peak between ____ to _____. Most cases begin before age ____.

Granulomas in the intestinal wall, "skip lesions" in the bowel, and submucosal inflammation that has a "cobblestone" appearance and mesentery abscesses are all characteristics of what disease?

A 25 year old female presents with an insidious onset of RLQ abdominal pain and cramping, prolonged diarrhea that floats and is foul smelling, anorexia, fatigue, and weight loss. Her labs indicate the presence of inflammatory activity and nutritional deficiencies. What is the most likely diagnosis?

What diagnostic tests would you order for a patient you suspect has Crohn's Disease? (Click all that apply)

Why do patients suffering from Crohn's disease have anemia? (click all that apply)

Hypoalbuminema, hypocholesterolemia, hypocalcemia, hypomagnesemia, and hypoprothombinemia are all a result of ______________ in Chron's disease?

What two labs would you order to assess the activity of Crohn's disease? (Click the two that apply)

In Crohn's diseased patients, what microbes should be routinely tested for? (click all that apply)

What is the treatment for Crohn's Disease? (Click all that apply)

T/F Crohn'd Disease is surgically curable

T/F Peripheral arthritis is an extraintestinal manifestation of both Crohn's disease and Ulcerative Colitis?

The onset of Ulcerative Colitis is usually between the ages of and a second peak at years old

Ulcerative colitis is limited to the _ to _. Inflammation is confined to the and is noted for the formation of _. The ___ is almost always involved

Surveillance colonoscopy is highly recommended for pts with UC. Screening ___ years after onset of pancolitis, or _- years of onset of left-sided colitis. Surveillance than every -_ years after initial colonoscopy.

The onset of crohn's disease is usually between the ages of __ -, with a second peak between to _. Most cases begin before age __.