Sugery Exam II Part 2

Diverticular disease is a condition where small pouches called diverticula form in the colon. These pouches can become inflamed or infected, causing symptoms such as abdominal pain, bloating, and changes in bowel habits. These symptoms are actually complications of the disease, indicating that the statement "The symptoms of Diverticular disease are actually complications" is true.

Somatic abdominal pain occurs when pain fibers in the parietal peritoneum are irritated. This means that the pain is originating from the outer layer of the abdominal cavity, which is called the parietal peritoneum. When these pain fibers are irritated, it can result in somatic abdominal pain. Therefore, the statement "Somatic abdominal pain occurs when pain fibers in the parietal peritoneum are irritated" is true.

Diverticular perforation refers to a condition where small pouches called diverticula in the colon become infected or inflamed and develop a hole. This is a serious condition that can lead to complications such as peritonitis (inflammation of the lining of the abdominal cavity) or abscess formation. In such cases, colectomy, which is the surgical removal of part or all of the colon, is often necessary to treat the condition and prevent further complications. Therefore, diverticular perforation is indeed an indication for colectomy.

Ulcerative Colitis does not have a singular period of onset from ages 15-30. It is a chronic inflammatory bowel disease that can develop at any age, although it is most commonly diagnosed between the ages of 15 and 30. The onset of Ulcerative Colitis can vary from person to person, and it is not limited to a specific age range. Therefore, the statement is false.

Frequent watery stool mixed with blood, pus, and mucus is a characteristic symptom of ulcerative colitis. Ulcerative colitis is an inflammatory bowel disease that primarily affects the colon and rectum. It causes inflammation and ulcers in the lining of the colon, leading to symptoms such as diarrhea, rectal bleeding, abdominal pain, and mucus in the stool. The presence of blood, pus, and mucus in the stool is a distinguishing feature of ulcerative colitis and helps differentiate it from other conditions such as cecal volvulus, sigmoid volvulus, and cancer of the colon.

Patients with abdominal pain should not be discharged until they can tolerate fluids well because abdominal pain can be a symptom of various underlying conditions such as gastrointestinal infections, inflammation, or obstruction. Tolerating fluids well indicates that the patient's gastrointestinal function is improving, which is an important indicator of their overall health and recovery. Discharging a patient before they can tolerate fluids well may lead to complications or a worsening of their condition. Therefore, it is essential to ensure that patients with abdominal pain can tolerate fluids well before discharging them.

As people age, their pain threshold tends to increase, meaning they may not feel or perceive pain as easily as younger individuals. This can lead to a delay in the diagnosis of conditions such as acute appendicitis in the elderly. Due to their higher pain threshold, they may not experience the typical symptoms of appendicitis, such as severe abdominal pain, as intensely as younger individuals. This delay in recognizing and seeking medical attention for appendicitis can potentially lead to complications or a more advanced stage of the condition. Therefore, the statement that acute appendicitis in the elderly is usually delayed because of increased pain threshold is true.

Ulcerative Colitis is a risk factor for cancer of the large intestine. Ulcerative colitis is a chronic inflammatory bowel disease that affects the lining of the colon and rectum. People with ulcerative colitis have an increased risk of developing colorectal cancer compared to the general population. Therefore, it is true that ulcerative colitis is a risk factor for cancer of the large intestine.

The correct answer is surgical resection of colon and lymph nodes. This is because colon cancer often spreads to nearby lymph nodes, so removing both the affected part of the colon and the nearby lymph nodes is necessary to ensure that all cancerous tissue is removed. Surgical resection of the colon alone may not be sufficient to treat the cancer completely. Palpation of tumors to determine malignancy may be done as part of the diagnostic process, but it is not a treatment procedure. Surgical resection is typically not done after metastases, as the cancer has already spread beyond the colon.

dx in OR

The given options are types of abdominal pain except for "Inferred". Referred abdominal pain is felt in a different area than the actual source of pain, somatic abdominal pain arises from the walls of the abdominal cavity, and visceral abdominal pain originates from the internal organs. However, "Inferred" is not a recognized type of abdominal pain.

Polyphagia refers to excessive hunger or increased appetite, which is not typically associated with acute abdomen. Acute abdomen is a medical term used to describe sudden and severe abdominal pain that may be caused by various conditions such as appendicitis, intestinal obstruction, or pancreatitis. Common associated symptoms include abdominal tenderness, rigidity, nausea, vomiting, and changes in bowel movements. However, increased appetite is not a typical symptom of acute abdomen and is more commonly associated with conditions like diabetes or hyperthyroidism.

Adhesions are not a common cause of Large intestine obstruction. Adhesions refer to scar tissue that forms between organs and tissues in the body, typically as a result of surgery or inflammation. While adhesions can sometimes cause small intestine obstruction, they are not a common cause of large intestine obstruction. Large intestine obstruction is more commonly caused by factors such as colorectal cancer, diverticulitis, volvulus, or inflammatory bowel disease. Therefore, the correct answer is False.

Ulcerative colitis is an inflammatory bowel disease that primarily affects the colon and rectum. Ankylosing spondylitis is a type of arthritis that mainly affects the spine, causing inflammation and stiffness. Pyoderma gangrenosum is a rare skin condition characterized by painful ulcers that usually develop on the legs. Pericarditis is inflammation of the pericardium, the sac-like membrane that surrounds the heart. All of these conditions can be associated with ulcerative colitis, making "all of the above" the correct answer.

Vague abdominal discomfort followed by nausea is related to appendicitis. Appendicitis is characterized by pain that starts around the belly button and then moves to the lower right abdomen. This pain can be vague and difficult to pinpoint. Nausea is also a common symptom of appendicitis, often accompanied by a loss of appetite. If left untreated, the appendix can rupture, leading to more severe symptoms and complications. Therefore, recognizing the early signs such as vague abdominal discomfort and nausea is important for timely diagnosis and treatment of appendicitis.

Volvuli refers to the twisting or rotation of a loop of the intestine, which can lead to various complications. One of these complications is vascular impairment, meaning that the twisted intestine can compress the blood vessels, leading to a decrease in blood flow. This can result in ischemia (lack of blood supply) and potentially lead to tissue damage or even necrosis. Therefore, the statement "Volvuli may cause vascular impairment" is true.

pain out of proportion to PE

The statement "most easily diagnoses in women 20-40" is not true about appendicitis. Appendicitis can affect individuals of any age or gender, and the ease of diagnosis is not specifically linked to women aged 20-40.

Grey-Turner sign and Cullen's sign are both physical examination findings that suggest internal hemorrhage. Grey-Turner sign refers to the presence of bruising or discoloration around the flanks, while Cullen's sign refers to bruising or discoloration around the umbilicus. These signs occur due to the leakage of blood into the surrounding tissues as a result of internal bleeding. Therefore, the correct answer is internal hemorrhage.

Ultrasound is not the best imaging modality for the diagnosis of appendicitis. Computed tomography (CT) scan is considered the gold standard for diagnosing appendicitis due to its high sensitivity and specificity. Ultrasound can be useful in certain cases, such as in children or pregnant women, but it is not as reliable as a CT scan. Therefore, the statement "Ultrasound is the best imaging modality for diagnosis of appendicitis" is false.

When treating obstructions of the large intestine, it is important to remember that cancer is common in elderly patients without a history of adhesions. This means that even if there is no previous indication of adhesions, cancer should still be considered as a potential cause of the obstruction in elderly patients. This highlights the importance of thorough evaluation and consideration of all possible causes when treating obstructions in this population.

Volvuli, which refers to the twisting of the bowel, can be treated through resection and anastomosis, which involves removing the twisted portion of the bowel and reconnecting the healthy ends. Additionally, cecal decompression, which involves relieving the pressure in the cecum (the first part of the large intestine), can also be used as a treatment for volvuli. Therefore, the correct answer is A & C, as both resection and anastomosis and cecal decompression are viable treatment options for volvuli.

The correct answer is low anterior resection. Low anterior resection is a surgical procedure commonly used to treat colon cancer. It involves removing the diseased portion of the colon and reconnecting the remaining healthy sections. This procedure is often the preferred treatment option for localized colon cancer that has not spread to other parts of the body. Radiation therapy, on the other hand, is typically used as an adjuvant treatment after surgery to kill any remaining cancer cells. Abdominoperitoneal resection is a different surgical procedure used for rectal cancer, not colon cancer.

Visceral pain is characterized by being midline when pure, meaning it is felt in the middle of the body. It can also be caused by obstruction, which is a common cause of this type of pain. Additionally, visceral pain is described as crampy, colicky, and intermittent. Therefore, all of the statements mentioned in the options are true about visceral pain.

Sonograms are a type of imaging technique that use sound waves to create images of the body's internal structures. They are particularly useful for imaging the RUQ (right upper quadrant) and pelvic region because they can provide detailed images of organs such as the liver, gallbladder, and uterus. Unlike radiographs, which use X-rays, and CT scans, which use multiple X-ray images to create cross-sectional images, sonograms do not involve ionizing radiation, making them safer and more suitable for certain populations, such as pregnant women. Binoculars are not a medical imaging tool and would not provide any useful information for imaging the RUQ and pelvic region.

pain would be to the left

A patient suffering from diverticulitis would not typically have generalized abdominal pain. Diverticulitis is characterized by localized pain in the lower left abdomen, often accompanied by fever, nausea, and changes in bowel habits. The other options listed in the question, such as constipation relieved by passing flatus, stranding of pericolic fat on CT, and not likely to have blood in the stool, are all consistent with diverticulitis.

The correct answer states that the first attack of Ulcerative Colitis has a high risk of perforation. This means that during the initial episode of the disease, there is a significant chance of the colon becoming perforated or developing a hole. This is a serious complication that requires immediate medical attention and intervention. It is important for healthcare providers to be aware of this risk and closely monitor patients experiencing their first episode of Ulcerative Colitis to prevent this potentially life-threatening complication.