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GI -- Abdominal pain

Terms

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What are ileal causes of abdominal pain?
1) Crohns



2) Mesenteric adenitis/ileitis



3) Ileal diverticulitis
Inflammation region of cecum: DDx?
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?
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?
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.

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