6 Feb 24 Flashcards
Minimal Bright Red Blood per rectum
Def
Few drops of blood in toilet bowl after defecation
Causes hemorrhoids or anal fissures
BRBPR factors that suggest colonoscopy
Age >45
Large amount of blood mixed in stool
Systemic SS (fever,wt loss)
Changes in bowel habits /stool caliber
Workup : colonoscopy
BRBPR in younger pt workup
Dx : anoscopy before colonoscopy
If bening finding eg hemorrhoid
Inc fibre intake
Topical analgesics
Interval followup
Pt with down syndrome and constipation
Assess for sec endorine causes of constipation
Hypothyroidism
DM
Hypercalcemia
IBD ulcerative colitis Areas involved
Rectum always and colon
Continuous lesions
Colonoscopy findings of UC
Mucosal and submucosal inflammation
Pseudopolyps
Microscopy shows no granulomas.
Complication of UC
Toxic megacolon
CF of UC
Age 14-40
Abd pain
Bloody diarrhea
Tenesmus
Fecal incontinence
Fever
Weight loss
Most common extraintestinal CF of IBD
Inflammatory arthritis
(When treated with NSAIDS further worsens IBD)
Crohn Dx area involved
Mouth (ulcers ) to anus (mostly ileum and colon)
Perianal Dx with rectal sparing
Skip lesions
Crohn dx microscopy
Non caseating granulomas
Crohn Dx Gross finding on colonoscopy
Transmural inf
Linear mucosal ulcers
Skip lesions
Cobblestoning , creeping fat
Crohn dx complications
Fistulae
Abscesses
Strictures (bowel obstruction)
CF of crohns
Age 15-40
Abd pain (often RLQ)
Watery diarrhea (bloody if colitis )
Ttt of CD
Corticosteroids
Biologic agents (infliximab)
Microscopic Colitis CF
🧿Watery nonbloody diarrhea
Secretory diarrhea that happens during fasting and at night
🧿Fecal urgency
🧿Fecal incontinence
🧿Abd pain fatigue weight loss
arthralgias
Microscopic colitis Triggers
Smoking
Medicines (NSAIDS , PPIs , SSRIs)
Dx of MC
Colonoscopic biopsy with lymphocytic infiltration of lamina propria
🔪 collagenous: thick subepithelial collagen band
🔪 lymphocytic : high levels of intraepithelial lymphocytes
Normal CRP, Hb , negative fecal occult blood
Ttt of Microscopic Colitis
Remove triggers eg smoking
Antidiarrheal medicines and budesonide
MC Risk factors
NSAIDS PPIs SSRIs
Smoking
Autoimmune dx
Women >60 are disproportionately affected
IBS definition
Abd pain >_1days /week X >-3months and >-2 of the following
Link with defecation
Change in stool freq
Change in stool form
Lack of alarm features
Chronic mesenteric ischemia Etiology
Atherosclerosis (smoking , dyslipidemia)
Chronic mesenteric ischemia CF and dx
Crampy , PP epigastric pain
Food aversion and weight loss
Early satiety , diarrrhea
Occurs within first hours of eating
Slowly resolves over next 2hrs
Dx:
Signs of malnutrition , abd bruit
CT angio(preferred) ,
doppler USG
Ttt of CMI
Risk reduction( smoking cessation)
Endovascular or open surgical revascularization
