7. Dzs of the Colon

Question 1

LO1: Crohn (4) vs UC (4) clinical features, shared

Answer 1

Crohn

1) Mid or lower abd pn
2) n/v
3) steatorrhea
4) fistula

UC

1) Lower abd pn
2) hematochezia
3) mucus in stool
4) tenesmus

Shared

1) chronic diarrhea
2) fatigue
3) wt loss

Question 2

LO1: Crohn vs UC pathology: inflamm, ulcers, fibrosis, granulomas

Answer 2

Crohn

1) Transmural inflamm
2) deep linear ulcers
3) marked fibrosis
4) Granulomas

UC

1) Mucosa +/- SM inflamm
2) Superficial, confluent inflamm
3) mild or no fibrosis
4) no granulomas

Question 3

LO1: Crohn vs. UC endoscopy: affected region, fistula or abscess, strictures, distribution

Answer 3

Crohn
1) All GI
2) Fistula and abscesses
3) common strictures
4) skip lesions
UC
1) colon only
2) no fistula or abscess
3) no stricture
4) diffuse

Question 4

LO2: Dx diverticulosis lower GI bleed (1)

Answer 4

1) painless hematochezia in o/w healthy elderly

Question 5

LO2: Dx diverticulitis (2)

Answer 5

1) CT or MRI

2) lower abd pn, nausea, fever

Question 6

LO3: Dx colonic obstruction, Hx, PE, x-ray

Answer 6

Clinical
1) n/v
2) abd distension
3) constipation
Dx - tentative=x-ray
Definitive = CT

Question 7

LO4: Extra-intestinal manifestations of IBD: eye(2), skin (2), Liver/bile duct (2), Joints (2)

Answer 7

Eye
1) scleritis 2) episcleritis
Skin
1) pyoderma gangrenosum
2) erythema nodosum
Liver/bile duct
1) PSC
2) cholangiocarcinoma
Joints
1) sacroilitis
2) ankylosing spondylitis

Question 8

LO5: Ischemic colitis features vs. other colitis (5)

Answer 8

1) hematochezia after major surgery or MI
2) Abrupt, crampy, lower abd pn
3) urgency to defecate
4) mild diarrhea and/or hematochezia
5) endoscopy - edema, ulceration, +/- bleed confined to vasc region

Question 9

LO6: Microscopic colitis (5)

Answer 9

1) F>M
2) Autoimmune
3) Salt and H2O loss in colon
4) mild, chronic, secretory diarrhea
5) colonoscopy NL

Question 10

LO6: diverticulitis (3)

Answer 10

1) fecolith obstruction
2) Lower abd pn, nausea, fever
3) bx gas and neutrophils -> distension

Question 11

LO7: colitis Tx

Microscopic (4), ischemic (2), infxs (1)

Answer 11

Microscopic colitis 1) loperamide, 2) diphenoxylate, 3) bismuth, 4) topical steroids
Ischemic - 1) antibio, 2) volume support
Infxs -
1) Support +/- antibio

Question 12

LO7: Tx diverticular dz (2)

Answer 12

1) oral or IV antibio
2) abscess drainage
3) surgery

Question 13

LO7: Tx GI bleed (2)

Answer 13

1) 90% cease w/ intervention

2) endoscopic or surgical tx

Question 14

LO7: Tx colonic obstruction (5)

Answer 14

1) Hospital admit -NPO
2) colonoscopy
3) NGT tube decompression
4) surgical resection -standar
5) metal stent