2 Disease of colon [5] Flashcards
Types of IBD
Crohns disease
Ulcerative colitis
Suggestive symptoms of IBD
tx?
Diarrhea crampy abdominal pain bleeding >2 weeks \+ extra intestinal symp.
mange with corticosteroids
Crohns and UC presentation
both:
Diarrhea
weight loss
fatigue
Crohns: mid or lower abdominal pain n/v steatorrhea fistula symp
UC: lower abdominal pain hematochezia mucus in stool tenesmus (extreme urgency to defecate)
Crohns or UC? no fistula/abcess - protected by smoking - recurrance with colectomy - malignancy potential -
no fistula/abcess - UC
protected by smoking - UC
recurrance with colectomy - crohns (bc whole GI)
malignancy potential - both
Pathology of crohns
transmural inflammation deep and linear or focal ulcers - not superficial (UC) marked fibrosis granulomas (20%)
Pathology of UC
Inflammation at mucosa +/- submucosa - not transmural (Crohns) mild-no fibrosis no granulomas circumferential ulceration Pseudopolyps
Crohns or UC? Entire GI tract - Diffuse distribution - skip lesions - strictures - extra-intestinal manifestations -
Entire GI tract - crohns Diffuse distribution - UC skip lesions - crohns strictures - crohns extra-intestinal manifestations - UC
extra-intestinal manifestations of UC
eye
- scleritis, episcleritis
Skin
- pyoderma gangrenosum, erythema nodosum
Liver
- primary sclerosing cholangitis (PSC)
Joints
- sacroiliitis, ankylosing spondylitis
Different causes of colitis
Microscopic Colitis
ischemic colitis
infxn colitis
Diverticulosis
Microscopic colitis
- population affected
- what is it
- prognosis
elderly female (50-80) autoimmune with unknown trigger → causes salt and water loss in colon - chronic secretory water (non-bloody) diarrhea
dx of microscopic colitis
HISTOLOGY ONLY Lymphocitic colitis - chronic inflammation, lymphocyte infiltration (mucosa+submucosa) Collagenous colitis - thickened subepithelial collagen band
COLONOSCOPY IS NORMAL
Ischemic colitis
- population affected
- what is it
- commonly found where in the GI
old patients (>60) with no vascular or GI diseases
fundamental insult: acute compromise in colonic blood flow
- vasospasm, dehydration, hypotension, cardiopulmonary insult
Commonly found in watershed vascular areas
- Splenic flexure (IMA, SMA)
- rectosigmoid (IMA, sup rectal artery)
dx of ischemic colitis
endoscope std dx - colonoscopy
- edema, ulceration +/- bleeding confined to a vascular region
Support antibiotics, and volume support
- 1-2 weeks to recover completely
Infectious colitis
- risk
- presentation
- hx of traveling, sick contact, and being in hospital with antibiotic uses
- Inflammatory dirrhea +/- hematochezia, crampy lower abdominal pain
diverticulosis
- population
- presentation
outpouching of colon wall
> 50% in elderly
80% asymptomatic
20% result in diverticulitis and hemorrhage
Complications of diverticular disease
diverticular hemorrhage
- usually in R colon
- vasa recta w/in dome of diverticulum →
diverticulum erodes into adjacent vasa recta →
intraluminal bleeding →
painless hematochezia (stops in 2-3 days)
- occurs in 5% of those with diverticulosis
Acute diverticulitis - LLQ - fecalith obstructs a diverticulum → distention from bacterial gas + neutrophils + abcess → macroperforation with peritonitis - nausea, fever
Name that disease!
Chronic abdominal pain + diarrhea
IBD
Name that disease!
weight loss, new constipation, anemia
neoplasia
Name that disease!
sudden onset & cessation of bleeding, elderly pt
diverticulosis
Name that disease!
Hematochezia after surgery or MI
ischemic colitis
Name that disease!
acute dysentery, travel, ill contacts, ab use
infectious diarrhea
Name that disease!
chronic, microcytic anemia
neoplasia or AVMs
Name that disease!
NSAIDS
drug induced colitis
Name that disease!
radiation
radiation proctitis
presentation of colonic obstruction
n/v
upper abdominal distension
constipation
obstipation
tx: surgical resection or metal stent
majority of colonic obstruction caused by?
adenocarcinoma of the colon/rectum, volvulus, benign strictures from acute diverticulosis
