Clinical Approach - Colon & IBD

Question 1

How can constipation be recognized?

Answer 1

caused by colonic inertia or outlet obstruction

radio-opaque marker ingestion: scattered indicates inertia, pile up indicates obstruction

Question 2

How can peudo-obstruction (Ogilvie’s syndrome) be recognized?

Answer 2

colonic dilation w signs and symptoms of obstruction but no lesion present
rule out obstruction by enema
lots of causes

Question 3

What is obstipation?

Answer 3

intractable constipation in which pt unable to pass luminal contents
present w colonic obstruction

Question 4

Why do patients w an obstruction that isn’t relieved experience nausea and vomiting?

Answer 4

retrograde peristalsis of small bowel

Question 5

What are distinguishing features of UC?

Answer 5

blood, small volume diarrhea

Question 6

What are the most dreaded complications of UC?

Answer 6

toxic megacolon, cholangiocarcinoma, PSC, colon cancer

Question 7

What are distinguishing features of Crohns?

Answer 7

small bowel involved, string sign on imaging

Question 8

How can IBS be diagnosed?

Answer 8

pain, bloating, diarrhea or constipation
no structural cause present
abnormalities in function?
no positive tests for diagnosis
can cause severe pain!