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GI Exam 3 > Bernadino > Flashcards

Bernadino Flashcards

1
Q

IBD Epidemiology

A
  • Equal men and women (jews>non)
  • Bimodal distribution
  • 1st peak is 15-25 y.o.
  • 2nd peak is +60 y.o.
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2
Q

Symptoms of UC

A

bloody diarrhea and tenesmus

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3
Q

Symptoms of CD

A

nonbloody diarrhea, ab pain, weight loss, anorexia

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4
Q

Infectious mimics of IBD

A

Shigella, E. Coli, Campylobacter, Salmonella, C. diff, Vibrio, CMV

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5
Q

UC

A

inflammatory disease affecting mucosa of rectum and parts of colon (continous)
- chronic and relapsing
- neutrophilic crypt abscess
pANCA (+)

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6
Q

CD

A 
pan-enteric transmural inflammatory disease (mouth to sigmoid --> spares rectum) 
- skip lesions (usually terminal ileum)
- granulomas!!!
- painful diarrhea, anemia
ASCA (+)
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7
Q

IBD Extraintestinal manifestations

A

Musculoskeletal –> arthritis, ankylosing spondylitis, osteoporosis, sacroilitis
Skin and Mouth –> erythema nodosum, apthous ulcers, vitiligo, psoriasis, amyloidosis, pyoderma gangrenosum
Ocular –> uveitis, iritis, episcleritis
Hepatobiliary –> primary sclerosing cholangitis, cholangiocarcinoma, hepatitis

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8
Q

Complications of UC

A

toxic megacolon, hemorrhage, stricture, CRC

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9
Q

Complications of CD

A

abscess, perforation, obstruction, hemorrhage, CRCV

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10
Q

CRC in IBD

A

increased risk at 10 and 30 years
- increased risk with proximal disease, long duration, fmaily history
5-ASA is protective

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11
Q

Pathogenesis of IBD

A

abnormal function of gut mucosal barrier –> chronic inflammation

  • there is genetic suceptibility
  • dysregulation of mucosal inflammatory immunity (Th1)
  • decreased Treg cells
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12
Q

Environmental Influences

A

“Clean Kid hypothesis”

- more common in cold climates, industrialized areas,

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13
Q

Expectations of IBD treatment

A
  • induce clinical remission
  • maintain remission
  • improve quality of life
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14
Q

Induction therapy

A 
5-ASA
Steroids
Infliximab
Cyclosporine
Surgery
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15
Q

Maintenance therapy

A

5-ASA
Immunomodulators
Infliximab

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16
Q

Causes of Lower GI bleeding

A

Upper GI - 10%
Small Bowel - 5%
Colon - 85%

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17
Q

Upper GI bleeds

A

peptic ulcer
esophageal varices
erosive
mallory-weiss

18
Q

Lower GI bleeds

A 
angioectasia
ulcer
IBD
infections
fistula
hemorrhage
Meckel's
19
Q

Colon GI bleeds

A 
Diverticular hemorrhage
angiodysplasia
ischemia
neoplasm
IBD
infection
radiation
20
Q

Acute Colonic Diverticulitis

A

symptoms occur in about 20% of patients that have them
- pain, diarrhea, fever, ab tenderness, hemorrhage (rare)
Complications
- abscess, rupture, fistula
Diagnosis by CT (not endoscopy)

21
Q

Treatment of diverticulitis

A

Mild -> oral hydration, liquid diet, antibiotics
Severe -> hospitalize, IV antibiotics, NPO, CT scan
Peritonitis -> surgical intervention

22
Q

Acute Diverticular Hemorrhage

A

accounts for 50% of acute lower GI bleeds
- massive - 5%
- self-limiting 80%
Tx -> resuscitation, reverse anticoagulation, transfuse, observe, colonoscopy

23
Q

Angioectasia

A

Angiodysplasia
tortuous, dilated submucosal capillaries/veins lacking smooth muscle
- spider-like, can occur anywhere
- presents as hemorrhage or anemia
- associated with aortic stenosis, renal failure, and old age
Tx -> colonoscopy with ablation

24
Q

Colitis

A

inflammatory -> Crohn’s, UC, NSAIDs
infectious -> salmonella, shigella, campylobacter, E. Coli
ischemia

25
Q

Infectious Colitis

A

Tx -> usually self-limiting

  • hospitalize if elderly, immunocompromised, dehydrated
    • IV hydration and antibiotics
26
Q

Ischemic Colitis

A

Non-occlusive -> hypoperfusion, drugs, heart disease, exercise
Occlusive –> embolic, A fib, thrombosis, vascular procedure, vasculitis, hypercoaguable state
Diagnosis –> history, CT, colonoscopy

27
Q

Neoplasm

A

Location-dependent symptoms (R-anemia, L-obstruction)

  • occult, slow bleed –> rarely hematochezia
  • treat with surgical resection
28
Q

Radiation Proctitis

A

acute radiation proctitis -> during radiation treatment
chronic radiation proctitis -> delayed for months-years
Tx -> endoscopic ablation

29
Q

Ano-rectal disorders

A

fissures
hemorrhoids
solitary rectal ulcers

30
Q

Anal Fissure

A

acute or chronic tear in anal canal

  • internal sphincter spasm
  • pain and bright red blood with stool passage
  • associated with constipation, diabetes, Crohn’s
31
Q

Hemorrhoids

A

dilated plexus of submucosal middle and superior hemorrhoidal veins

  • symptoms = bleeding, pruritis, pain
  • associated wtih age, diarrhea, pregnancy, straining
32
Q

Solitary Rectal Ulcer

A

varying appearance –> erythema, nodularity, ulcer

  • etiology from rectal prolapse, puborectalis muscle, constipation, 4th decade
  • Symptoms -> bright blood, straining, pelvic fullness, constipation
  • Treatment -> stool bulking, softeners
33
Q

Gilbert’s Syndrome

A

autosomal dominant inborn error of metabolism

- benign unconjugated hyperbilirubinemia

34
Q

Physical evidence of chronic liver disease

A

spider hemangiomas, ascites, edema, palmar erythema, caput medusa, jaundice, asterixis, xanthelasma, Dupuytren’s contractures

35
Q

Hyperbilirubinemia

A

Unconjugated –> hemolysis, Gilbert’s, medication

Conjugated –> intrinsic liver disease, meds, biliary tract obstruction

36
Q

Gallstones

A

cholesterol (90%) –> bile composition and biliary stasis
pigment (10%) –> cirrhosis, hemolytic anemia
- most often mixed composition
RISKS - 4 F’s
female, fat, fertile, forty

37
Q

Transabdominal ultrasound

A

study of choice for gallstones and cholecystitis

- 95% sens, 98% spec

38
Q

Biliary Pain

A

colic –> rapid crescendo, slower decrescendo

  • spasm of GB in setting of obstruction, postprandial
  • RUQ pain, radiates to interscapular region
39
Q

Acute Cholecystitis

A 
ab pain (murphy sign), fever, leukocytosis
Acalculous cholecystitis --> no stone (after surgery, trauma, burn)
40
Q

Choledocholithiasis

A

stone/stones in common bile duct –> has exited the gallbladder
- secondary –> migrate from GB
- primary –> form in CBD
Charcot’s Triad –> fever, pain, jaundice

41
Q

Cholangitis

A

infection/inflammation of gallbladder

- most caused by gallstones, can be infectious, cancer, strictures

GI Exam 3 (10 decks)

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