Family Medicine EOR: Gastrointestinal and Nutritional (Smarty PANCE)
Study online at https://quizlet.com/_ditlbe
1. What is an anal fissure?: Tear or fissure in the anal epithelium
2. What is the most common site?: Posterior midline (comparatively low blood
flow)
3. What is the cause?: Hard stool passage (constipation), hyperactive sphincter,
disease process (e.g., Crohn's disease)
4. What are the signs/symptoms?: Pain in the anus, painful (can be excruciating)
bowel movement, rectal bleeding, blood on toilet tissue after bowel movement,
sentinel tag, tear in the anal skin, extremely painful rectal exam, sentinel pile,
hypertrophic papilla
5. What is a sentinel pile?: Thickened mucosa/skin at the distal end of an anal
fissure that is often confused with a small hemorrhoid
6. What is the anal fissure triad for a chronic fissure?: 1. Fissure
2. Sentinel pile
3. Hypertrophied anal papilla
7. What is the conservative treatment?: Sitz baths, stool softeners, high fiber diet,
excellent anal hygiene, topical nifedipine, Botox®
8. What disease processes must be considered with a chronic anal fissure?: -
Crohn's disease, anal cancer, sexually transmitted disease, ulcerative colitis, AIDS
9. What are the indications for surgery?: Chronic fissure refractory to conserva-
tive treatment
10. What is one surgical option?: Lateral internal sphincterotomy (LIS)—cut the
internal sphincter to release it from spasm
11. What is the "rule of 90%" for anal fissures?: 90% occur posteriorly 90% heal
with medical treatment alone 90% of patients who undergo an LIS heal successfully
12. What is the most common cause of acute abdomen?: Acute appendicitis is
the most common cause of acute abdomen.
13. How does acute appendicitis classically present?: Acute appendicitis clas-
sically presents with nausea/vomiting, fever, and diffuse periumbilical pain migrating
to the McBurney point.
14. What is McBurney's point?: The McBurney point is an anatomical landmark
located one-third of the distance from the right anterior superior iliac spine to the
umbilicus.
15. What is a positive Rovsing sign?: A positive Rovsing sign is indicative of acute
appendicitis, and occurs when a patient experiences severe lower right quadrant
abdominal pain upon palpation of the lower left quadrant of the abdomen.
16. Pain on active hip flexion constitutes what?: Pain on active hip flexion con-
stitutes a positive psoas sign, which is indicative of acute appendicitis.
17. What constitutes a positive obturator sign?: A positive obturator sign, pain on
passive flexion and internal rotation of either hip, is indicative of acute appendicitis.
, Family Medicine EOR: Gastrointestinal and Nutritional (Smarty PANCE)
Study online at https://quizlet.com/_ditlbe
18. How does a ruptured appendix present?: A ruptured appendix results in
peritonitis that presents with guarding and rebound tenderness.
19. Pain referral in early appendicitis usually involves what dermatome?: Pain
referral in early appendicitis usually involves the T10 dermatome at the level of the
umbilicus
20. In addition to clinical signs what imaging study can help make the diagno-
sis of appendicitis?: In addition to clinical signs a CT scan or ultrasound can help
make the diagnosis of appendicitis.
21. What is the best treatment for appendicitis?: The curative treatment of ap-
pendicitis is appendectomy.
22. A 71-year-old male with abdominal distension and colicky pain. Physical
exam reveals high-pitched bowel sounds and diffuse abdominal tenderness.
The abdominal radiograph demonstrates a distended proximal colon with
haustra, air -fluid-levels and no gas in the rectum. What's the diagnosis?: Large
bowel obstruction
23. A 35-year-old male presents with colicky abdominal pain, nausea, bilious
vomiting, obstipation, abdominal distention, hyperactive bowel sounds (early)
or hypoactive bowel sounds (late), and prior abdominal surgery. What's the
diagnosis?: Small bowel obstruction
24. How does small bowel obstruction differ from large bowel obstruction in
it's presentation?: Generally speaking:
ÏIn small bowel obstruction, vomiting is more common and the pain tends to be
periumbilical, cramping, and intermittent - with bouts that last for a few minutes at
a time. Hyperactive bowel sounds occur early as GI contents attempt to overcome
the obstruction; hypoactive bowel sounds occur later in the disease process
ÏIn large bowel obstruction, vomiting is less common and the pain is lower in the
abdomen and the bouts of pain are less frequent but last a bit longer. The bowel
sounds may be normal early on but usually become quiet, and the abdomen is
hyperresonant to percussion.
25. What is the most common cause of large bowel obstruction in the elderly?
What are other causes?: Neoplasm is the most common cause of large bowel
obstruction in the elderly. Other causes include diverticular disease, colonic volvulus,
and fecal impaction
26. What is an apple core sign?: An "apple core sign", suggests constriction of the
colonic lumen and it's often due to a ring-shaped colon cancer
27. What are the 4 cardinal signs of strangulated bowel?: The 4 cardinal signs
of strangulated bowel: fever, tachycardia, leukocytosis, and localized abdominal
tenderness
28. Roundworm is associate with what GI problem?: Small bowel obstruction
Study online at https://quizlet.com/_ditlbe
1. What is an anal fissure?: Tear or fissure in the anal epithelium
2. What is the most common site?: Posterior midline (comparatively low blood
flow)
3. What is the cause?: Hard stool passage (constipation), hyperactive sphincter,
disease process (e.g., Crohn's disease)
4. What are the signs/symptoms?: Pain in the anus, painful (can be excruciating)
bowel movement, rectal bleeding, blood on toilet tissue after bowel movement,
sentinel tag, tear in the anal skin, extremely painful rectal exam, sentinel pile,
hypertrophic papilla
5. What is a sentinel pile?: Thickened mucosa/skin at the distal end of an anal
fissure that is often confused with a small hemorrhoid
6. What is the anal fissure triad for a chronic fissure?: 1. Fissure
2. Sentinel pile
3. Hypertrophied anal papilla
7. What is the conservative treatment?: Sitz baths, stool softeners, high fiber diet,
excellent anal hygiene, topical nifedipine, Botox®
8. What disease processes must be considered with a chronic anal fissure?: -
Crohn's disease, anal cancer, sexually transmitted disease, ulcerative colitis, AIDS
9. What are the indications for surgery?: Chronic fissure refractory to conserva-
tive treatment
10. What is one surgical option?: Lateral internal sphincterotomy (LIS)—cut the
internal sphincter to release it from spasm
11. What is the "rule of 90%" for anal fissures?: 90% occur posteriorly 90% heal
with medical treatment alone 90% of patients who undergo an LIS heal successfully
12. What is the most common cause of acute abdomen?: Acute appendicitis is
the most common cause of acute abdomen.
13. How does acute appendicitis classically present?: Acute appendicitis clas-
sically presents with nausea/vomiting, fever, and diffuse periumbilical pain migrating
to the McBurney point.
14. What is McBurney's point?: The McBurney point is an anatomical landmark
located one-third of the distance from the right anterior superior iliac spine to the
umbilicus.
15. What is a positive Rovsing sign?: A positive Rovsing sign is indicative of acute
appendicitis, and occurs when a patient experiences severe lower right quadrant
abdominal pain upon palpation of the lower left quadrant of the abdomen.
16. Pain on active hip flexion constitutes what?: Pain on active hip flexion con-
stitutes a positive psoas sign, which is indicative of acute appendicitis.
17. What constitutes a positive obturator sign?: A positive obturator sign, pain on
passive flexion and internal rotation of either hip, is indicative of acute appendicitis.
, Family Medicine EOR: Gastrointestinal and Nutritional (Smarty PANCE)
Study online at https://quizlet.com/_ditlbe
18. How does a ruptured appendix present?: A ruptured appendix results in
peritonitis that presents with guarding and rebound tenderness.
19. Pain referral in early appendicitis usually involves what dermatome?: Pain
referral in early appendicitis usually involves the T10 dermatome at the level of the
umbilicus
20. In addition to clinical signs what imaging study can help make the diagno-
sis of appendicitis?: In addition to clinical signs a CT scan or ultrasound can help
make the diagnosis of appendicitis.
21. What is the best treatment for appendicitis?: The curative treatment of ap-
pendicitis is appendectomy.
22. A 71-year-old male with abdominal distension and colicky pain. Physical
exam reveals high-pitched bowel sounds and diffuse abdominal tenderness.
The abdominal radiograph demonstrates a distended proximal colon with
haustra, air -fluid-levels and no gas in the rectum. What's the diagnosis?: Large
bowel obstruction
23. A 35-year-old male presents with colicky abdominal pain, nausea, bilious
vomiting, obstipation, abdominal distention, hyperactive bowel sounds (early)
or hypoactive bowel sounds (late), and prior abdominal surgery. What's the
diagnosis?: Small bowel obstruction
24. How does small bowel obstruction differ from large bowel obstruction in
it's presentation?: Generally speaking:
ÏIn small bowel obstruction, vomiting is more common and the pain tends to be
periumbilical, cramping, and intermittent - with bouts that last for a few minutes at
a time. Hyperactive bowel sounds occur early as GI contents attempt to overcome
the obstruction; hypoactive bowel sounds occur later in the disease process
ÏIn large bowel obstruction, vomiting is less common and the pain is lower in the
abdomen and the bouts of pain are less frequent but last a bit longer. The bowel
sounds may be normal early on but usually become quiet, and the abdomen is
hyperresonant to percussion.
25. What is the most common cause of large bowel obstruction in the elderly?
What are other causes?: Neoplasm is the most common cause of large bowel
obstruction in the elderly. Other causes include diverticular disease, colonic volvulus,
and fecal impaction
26. What is an apple core sign?: An "apple core sign", suggests constriction of the
colonic lumen and it's often due to a ring-shaped colon cancer
27. What are the 4 cardinal signs of strangulated bowel?: The 4 cardinal signs
of strangulated bowel: fever, tachycardia, leukocytosis, and localized abdominal
tenderness
28. Roundworm is associate with what GI problem?: Small bowel obstruction
