2 Disease of colon [5]

Question 1

Types of IBD

Answer 1

Crohns disease

Ulcerative colitis

Question 2

Suggestive symptoms of IBD

tx?

Answer 2

Diarrhea
crampy abdominal pain
bleeding
>2 weeks
\+ extra intestinal symp.

mange with corticosteroids

Question 3

Crohns and UC presentation

Answer 3

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)

Question 4

Crohns or UC?
no fistula/abcess - 
protected by smoking - 
recurrance with colectomy - 
malignancy potential -

Answer 4

no fistula/abcess - UC
protected by smoking - UC
recurrance with colectomy - crohns (bc whole GI)
malignancy potential - both

Question 5

Pathology of crohns

Answer 5

transmural inflammation
deep and linear or focal ulcers
- not superficial (UC)
marked fibrosis
granulomas (20%)

Question 6

Pathology of UC

Answer 6

Inflammation at mucosa +/- submucosa 
- not transmural (Crohns)
mild-no fibrosis
no granulomas
circumferential ulceration 
Pseudopolyps

Question 7

Crohns or UC?
Entire GI tract - 
Diffuse distribution - 
skip lesions - 
strictures - 
extra-intestinal manifestations -

Answer 7

Entire GI tract - crohns
Diffuse distribution - UC
skip lesions - crohns
strictures - crohns
extra-intestinal manifestations - UC

Question 8

extra-intestinal manifestations of UC

Answer 8

eye
- scleritis, episcleritis

Skin
- pyoderma gangrenosum, erythema nodosum

Liver
- primary sclerosing cholangitis (PSC)

Joints
- sacroiliitis, ankylosing spondylitis

Question 9

Different causes of colitis

Answer 9

Microscopic Colitis
ischemic colitis
infxn colitis
Diverticulosis

Question 10

Microscopic colitis

• population affected
• what is it
• prognosis

Answer 10

elderly female (50-80)
autoimmune with unknown trigger → causes salt and water loss in colon
- chronic secretory water (non-bloody) diarrhea

Question 11

dx of microscopic colitis

Answer 11

HISTOLOGY ONLY
Lymphocitic colitis 
- chronic inflammation, lymphocyte infiltration (mucosa+submucosa)
Collagenous colitis
- thickened subepithelial collagen band

COLONOSCOPY IS NORMAL

Question 12

Ischemic colitis

• population affected
• what is it
• commonly found where in the GI

Answer 12

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)

Question 13

dx of ischemic colitis

Answer 13

endoscope std dx - colonoscopy
- edema, ulceration +/- bleeding confined to a vascular region

Support antibiotics, and volume support
- 1-2 weeks to recover completely

Question 14

Infectious colitis

• risk
• presentation

Answer 14

• hx of traveling, sick contact, and being in hospital with antibiotic uses
• Inflammatory dirrhea +/- hematochezia, crampy lower abdominal pain

Question 15

diverticulosis

• population
• presentation

Answer 15

outpouching of colon wall

> 50% in elderly
80% asymptomatic
20% result in diverticulitis and hemorrhage

Question 16

Complications of diverticular disease

Answer 16

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

Question 17

Name that disease!

Chronic abdominal pain + diarrhea

Answer 17

IBD

Question 18

Name that disease!

weight loss, new constipation, anemia

Answer 18

neoplasia

Question 19

Name that disease!

sudden onset & cessation of bleeding, elderly pt

Answer 19

diverticulosis

Question 20

Name that disease!

Hematochezia after surgery or MI

Answer 20

ischemic colitis

Question 21

Name that disease!

acute dysentery, travel, ill contacts, ab use

Answer 21

infectious diarrhea

Question 22

Name that disease!

chronic, microcytic anemia

Answer 22

neoplasia or AVMs

Question 23

Name that disease!

NSAIDS

Answer 23

drug induced colitis

Question 24

Name that disease!

radiation

Answer 24

radiation proctitis

Question 25

presentation of colonic obstruction

Answer 25

n/v
upper abdominal distension
constipation
obstipation

tx: surgical resection or metal stent

Question 26

majority of colonic obstruction caused by?

Answer 26

adenocarcinoma of the colon/rectum, volvulus, benign strictures from acute diverticulosis