GI -- Abdominal pain
Terms
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- What are ileal causes of abdominal pain?
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1) Crohns
2) Mesenteric adenitis/ileitis
3) Ileal diverticulitis - Inflammation region of cecum: DDx?
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Acute appendicitis
Segmental colitis
Carcinoma (if painful, perforated)
Cecal diverticulitis
Cecal ischemia
Typhlitis - When you see inflammation adjacent to the cecum what should you think of?
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Appendicitis first.
Then consider the possiblility of epiploic appendagitis. - What is the appearance of epiploic appendagitis?
- Round or oval shaped area of increased attenuation fat with surrounding enhancement. here may be associated thickening/enhancement of the adjacent colonic wall.
- What is the DDx for this appearance?
- Right-sided omental infarction
- Is this more or less common than epiploic appendagitis?
- Much less common
- Where is right sided omental infarction located?
- Anterior to ascending colon, between it and the abdominal wall.
- Which is larger? Epiploic appendagitis or right sided omental infarct?
- Omental infarct larger
- Thickened right colonic wall with numerous enlarged lymph nodes in the mesentery?
- Mesenteric adenitis
- What is mesenteric adenitis associated with?
- TI/R colon infection with Yersinia, Campylobacter, salmonella, MAI, and MTb.
- What makes a diagnosis of Crohn's?
- Thickening of terminal ileum IN ASSOCIATION WITH fibrofatty proliferation of the ileal mesentery
- What should always take you to a diagnosis of Crohn's?
- The fibrofatty proliferation of the ileal mesentery. The mesentery gets BIG
- Common complications of Crohn's?
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Fistula and sinus tract formation
Abscess - What is the first thing you must do whenever you encounter a patient with abd pain?
- R/O appendicitis, before considering other entities, because it is the most common diagnosable etiology.