CLINICAL CARE OF THE GASTROINTESTINAL SYSTEM Flashcards
What is known as increased stool frequency?
Diarrhea
Diarrhea is usually defined as more than how many bowel movements a day?
3 bowel movements or more a day
The liquidity of feces is known as what?
Diarrhea
Diarrhea can be classified as what?
Acute or chronic
Diarrhea that is acute in onset and persisting for less than two weeks is most commonly caused by what?
- infectious agents
- bacterial toxins
(either preformed or produced in the gut)
How can infectious sources of diarrhea be transmitted and what is the usual incubation period?
- Fecal-oral contact
- food and water
- between 12-72 hours
What is the prime absorptive surface of the GI tract?
Small intestine
>90% of all water absorbed in the GI tract takes place where?
Small intestine
What part of the small intestine is the major site of water reabsorption?
Jejunum
True or False
Disorders of the small intestine results in increased amounts of diarrheal fluid with a concomitantly greater loss of water, electrolytes, and nutrients
True
What is the most common cause of acute gastroenteritis?
Infectious agents
What is a common diarrheal illness seen in the operational setting?
Acute infectious gastroenteritis
What is a diarrheal disease (three or more times per day or at least 200g of stool per day) of rapid onset that lasts less than two weeks and may be accompanied by nausea, vomiting, fever, or abdominal pain?
Acute gastroenteritis
What involves inflammation of the stomach and portions of the small intestine; both vomiting and diarrhea are usually present; however either can occur alone?
Acute gastroenteritis
What are some common findings on the physical examination of patients with acute viral gastroenteritis?
- mild diffuse abdominal tenderness on palpation
- abdomen is soft but may have voluntary guarding
True or False
Acute viral gastroenteritis is usually self-limited and is treated with supportive measures. No specific antiviral agents are necessary.
True
The agents that cause diarrhea work by several mechanisms such as what?
- adherence
- mucosal invasion
- enterotoxin production and/or cytotoxin production
The mechanisms that cause diarrhea usually result in what?
Increased fluid secretion and/or decreased absorption
True or False
Infectious gastroenteritis can be easily confused with acute gastritis
True
True or False
Infectious gastroenteritis can be easily confused with acute gastritis
True
What term is often used to describe endoscopic or radiologic characteristics of abnormal-appearing gastric mucosa, a diagnosis of this is defined as and required histopathologic evidence of inflammation?
Gastritis
True or False
Gastritis involves the same organs that gastroenteritis does
False
Gastritis ONLY involves the stomach
What are the two most common causes of gastritis?
- Chronic NSAID use
- Chronic alcohol and/or large amounts of alcohol consumption
What form of gastritis causes a decrease in prostaglandin synthesis that’s required for the maintenance of the stomach mucosal lining, making the mucosa susceptible to damage by gastric acid resulting in peptic ulcers (PUD) as well as diffuse mucosal inflammation?
Chronic NSAID use
Chronic alcohol use results in what?
Diffuse gastric mucosal inflammation
True or False
Other etiologies for gastritis can include trauma and critically ill patients that are admitted to the ICU
True
(Burn patients: Curling Ulcers)
Gastritis is usually self limiting but patients may also benefit from what?
- Proton Pump Inhibitor
- Removal of offending agent
What should be done if a patient doesn’t respond to conservative management of gastritis?
- Referral for endoscopy
- H. Pylori testing
Chronic Diarrheal illnesses may be classified as what?
- Osmotic
- Inflammatory
- Secretory
- Chronic infection: parasites: Giardia Lamblia
- Malabsorption Syndromes
- Motility disorders
What is a chronic diarrheal illness due to an increase in the osmotic load presented to the intestinal lumen, either through excessive intake or diminished absorption?
Osmotic chronic diarrheal illness
What is a chronic diarrheal illness when the mucosal lining of the intestine if inflamed?
Inflammatory chronic diarrheal illness
(IBS, Malignancy)
What are some forms of malabsorption syndromes that can cause chronic diarrheal illnesses?
- Celiac disease
- Whipple
- Crohn Disease
- Lactose intolerance
True or False
Irritable bowel syndrome is a motility disorder
True
What term for diarrhea suggests colonic involvement by invasive bacteria or parasites or by toxin production?
“inflammatory diarrhea”
Patients with what usually complain of frequent blood, small-volume stools, often associated with fever, abdominal cramps, tenesmus (feeling that you need to pass stools), and fecal urgency?
Inflammatory Diarrhea
These are all common causes of what?
- Shigella
- Salmonella
- Escherichia coli
- E coli O157:H7
Inflammatory Diarrhea
What is a common protozoal cause of inflammatory diarrhea?
Entamoeba histolytica
True or False
Community outbreaks of inflammatory diarrhea suggests a viral etiology or a common food source
True
Similar recent inflammatory diarrheal illnesses in family members suggest what kind of origin?
Infectious origin
True or False
Ingestion of improperly stored or prepared food implicates food poisoning
True
What is generally a milder form of diarrhea that is caused by viruses or toxins that affect the small intestine?
Acute Non-inflammatory diarrhea
The viruses and toxins associated with acute non-inflammatory diarrhea interfere with salt and water balance resulting in what?
Large volume watery diarrhea, often with nausea, vomiting and cramps
What are some common viral causes of acute non-inflammatory diarrhea?
- Rotavirus
- Norwalk virus
What are vibriones associated with acute non-inflammatory diarrhea?
- Vibrio cholerae
- Vibrio parahaemolyticus
Common protozoal causes of acute non-inflammatory diarrhea include what?
- Giardia lamblia
- Cryptosporidium
- Cyclospora
What term usually denotes diseases caused by toxins present in consumed foods?
“food poisoning”
True or False
When the incubation period for food poisoning is short (1-6 hours after consumption), the toxin is usually new
False
When the incubation period for acute non-inflammatory diarrhea is short (1-6 hours after consumption), the toxin is usually preformed
In food poisoning, vomiting is usually a major complaint but what is normally absent?
Fever
True or False
When the incubation period for food poisoning is longer (between 8 hours and 16 hours) the organism is present in the food and produces toxin after being ingested. Vomiting is less prominent, abdominal cramping is frequent, and fever is often absent.
True
In what percentage of patients with acute non- inflammatory diarrhea, the illness is mild and self-limited, responding within 5 days to simple rehydration therapy or antidiarrheal agents?
Over 90%
Diagnostic investigation is unnecessary
If diarrhea worsens or persists for more than 7 days, stool should be sent to the lab for what?
- fecal leukocyte
- ovum and parasite evaluation
- bacterial culture
What is indicated in the following situation?
- Signs of inflammatory diarrhea manifested by any of the following: fever (> 38.5 degree Celcius), bloody diarrhea, or abdominal pain.
- The passage of six or more unformed stools in 24 hours.
- Profuse watery diarrhea and signs or symptoms of dehydration.
Prompt medical evaluation
What kind of findings may be present in infection with C difficile or enterohemorrhagic E coli?
Peritoneal findings
These could be symptoms of what?
- Sudden onset:
a. nausea, vomiting and decreased appetite
b. crampy abdominal pain
c. loose stool
d. malaise
e. fatigue - Diffuse abdominal tenderness
- Distention
- Increased bowel sounds
- Usually afebrile
Diarrhea
What are some labs you would order for diarrhea?
- CBC Dif
- Fecal leukocyte
- Fecal O/P
- Stool Culture
- C difficile assay, if recent hospitalization or antibiotics
- Stool examination for Giardia Lamblia if Giardiasis suspected, which is an important cause of waterborne and foodborne disease, daycare center outbreaks, and illness in international travelers
True or False
Stopping diarrhea abruptly with antidiarrheal medications can prolong symptoms relief if causes are ingested bacteria, parasites, etc.
True
What is the rate of oral fluid replacement for patients with diarrhea if they have a concerning hydration status?
50-200mL/kg/24h
Should patients with diarrhea follow a strict BRAT diet and avoid irritating foods?
Yes
What antidiarrheal agents should be given to a patient with diarrhea?
- Loperamide (Imodium) 4mg, then 2mg after each loose stool with max dose of 16mg/day
- Bismuth Subsalicylate (Pepto-Bismol) 2 tabs or 30mL PO every 30-60 mins as needed, max 16 tabs or 240mL/24hrs
True or False
Empiric antibiotic therapy is indicated in patients with acute, community acquired diarrhea
False
Normally not indicated
What are the infectious bacterial diarrheas for which antibiotic treatment is recommended?
- Shigellosis
- Cholera
- Salmonellosis
- Listeriosis
- C. Difficile
What are the diarrhea causing parasitic infections that require treatment?
- Amebiasis
- Giardiasis
- Cryptosporidiosis
What is the most common digestive complaint in the United States?
Constipation
What is the most common cause of constipation?
Diminished intake of fiber associated with decreased fluid intake
Can chronic laxative abuse cause constipation?
Yes
Systemic diseases such as hypothyroidism, hyperparathyroidism, diabetes, and chronic neurologic disorders can all be causes of what?
Constipation
Medications such as CCB’s, iron, narcotic analgesics, and antipsychotics can cause what?
Constipation
True or False
Irritable bowel syndrome with predominant constipation (IBS-C) is characterized by abdominal pain with altered bowel habits
True
What labs would you order for someone with constipation?
- CBC for anemia
- Thyroid function test for suspected hypothyroidism
- Electrolyte abnormalities (hypokalemia and hypercalcemia)
What radiology studies would you order for constipation?
- Upright chest film and abdominal flat and erect films for the presence or absence of intestinal obstruction
- Abdominal films to assess stool burden
What does the first line treatment of constipation include?
- Strict diet changes
- Exercise
- Increased water intake
- Fiber supplementation (increase dose gradually over 7-10 days)
What emollient laxative is used for constipation?
Docusate sodium (Colace) 100mg daily to twice daily
What stimulant laxative would be used for constipation?
Bisacodyl (Dulcolax) 5-15mg PO daily or 10mg PR TID
What saline laxatives are used for constipation?
1.Magnesium Hydroxide (Milk of Magnesia) 15-30mL daily to twice daily
(not to be given to patients with impaired renal function)
2. Magnesium Citrate 100-300mL PO divided qd-bid
What hyperosmolar agents are used for constipation?
- Sorbitol 15-30mL PO qd-bid
- Polyethylene Glycol (MiraLAX) 1 capful PO qd-bid, with with at least 8oz of fluid and drink all at once
What does third line treatments of constipation include?
- Glycerin suppository PR qid
- Fleets enemas
Where should a patient with a complicated or chronic case of constipation be referred to?
Gastroenterologist
What is located above the dentate line and are sub epithelial cushions of the anorectum?
Internal hemorrhoids
What arises from the inferior hemorrhoidal veins, below the dentate line, covered with squamous epithelium, posses nervous innervation, and are very painful when thrombosed?
External hemorrhoids
What are normal anatomic structures of the anorectum and are universally present unless a previous intervention has taken place?
Hemorrhoidal venous cushions
Because of their rich vascular supply, highly sensitive location, and tendency to engorge and prolapse, what are common causes of anal pathology?
Hemorrhoidal venous cushions
What are subepithelial vascular cushions consisting of connective tissue, smooth muscle fibers, and ateriovenous communications between terminal branches of the superior rectal artery and rectal veins?
Internal hemorrhoids
What are the common locations that internal hemorrhoids usually occur?
- right anterior
- right posterior
- left lateral
True or False
Internal hemorrhoids have a nerve supply so are very painful when present
False
They lack a nerve supply so are not painful when present
What arises from the inferior hemorrhoidal veins located below the dentate line and are covered with squamous epithelium or the anal canal or perianal region?
External hemorrhoids
Straining with bowel movements, constipation, prolonged sitting, pregnancy, obesity, and low-fiber diets all may contribute to what?
Hemorrhoids
Thrombosis of the external hemorrhoidal plexus results in a what?
Perianal Hematoma
What condition is characterized by the relatively acute onset of an exquisitely painful, tense and bluish perianal nodule covered with skin that may be up to several centimeters in size?
Hemorrhoids
True or False
Pain with hemorrhoids is most severe within the first few hours but gradually eases over 2-3 days as edema subsides
True
The principal problems attributable to internal hemorrhoids are usually what?
- Painless bleeding
- Prolapse
- Mucoid discharge
True or False
Bleeding associated with hemorrhoids is often severe enough to cause anemia
False
Rarely is bleeding severe enough to result in anemia
True or False
Pain is unusual with internal hemorrhoids, occurring only when there is extensive inflammation and thrombosis of irreducible tissue or with thrombosis of an external hemorrhoid
True
What is stage one of an internal hemorrhoid?
Confined to the anal canal
What stage of internal hemorrhoids is this?
Over time the internal hemorrhoids may gradually enlarge and protrude from the anal opening. Mucosal prolapse occurs during straining and reduces spontaneously
Stage 2
Prolapsed hemorrhoids that may require manual reduction after bowel movements is what stage of hemorrhoids?
Stage 3
Prolapsed hemorrhoids that remain chronically protruding and are unresponsive to manual reduction is what stage of internal hemorrhoids?
Stage 4
True or False
Chronically prolapsed hemorrhoids may result in a sense of fullness or discomfort and mucoid perianal discharge, resulting in irritation and soiling of underclothes
True
True or False
Non-prolapsed internal hemorrhoids are not visible but may protrude through the anus with gentle straining
True
What are visible as protuberant purple nodules covered by mucosa?
Prolapsed hemorrhoids
True or False
During a digital rectal exam, uncomplicated internal hemorrhoids are palpable and painful
False
They are neither palpable nor painful
Small volume rectal bleeding not caused by hemorrhoids may be caused by what instead?
- Anal fissure or fistula
- Neoplasms of the distal colon or rectum
- Ulcerative colitis or Crohn disease
- Infectious proctitis
- Rectal ulcers
True or False
Colonoscopy should be performed in all patients with hematochezia to exclude disease in the rectum or sigmoid colon that could be misinterpreted in the presence of hemorrhoidal bleeding
True
Treatment for thrombosed external hemorrhoids includes what?
- warm sitz bath
- analgesics and ointments
- if seen in the first 24-48 hours, removal of the clot may hasten symptomatic relief
Most patients with early, Stage 1 and Stage 2, disease can be managed with what?
Conservative treatment
For edematous, prolapsed hemorrhoids, gentle manual reduction may be supplemented by what?
- suppositories
- Topical pads containing witch hazel
- Warm sitz baths
What is reserved for 5-10% of patients with chronic severe bleeding due to stage 3 or stage 4 hemorrhoids or patients with acute thrombosed stage 4 hemorrhoids?
Surgical Excision (hemorrhoidectomy)
What are linear or rocket shaped ulcers that are usually <5mm in length?
Anal Fissures
Anal fissures most commonly occur in the posterior midline, but what percentage occur anteriorly?
10%
Fissure that occur off the midline could be symptomatic of what?
- More serious disease process
- Sexual assault
Where do most anal fissures come from?
Trauma to the anal canal during defecation
A patient with what may complain of severe, tearing pain during defecation followed by throbbing discomfort that may lead to constipation due to fear of recurrent pain?
Anal fissure
What do acute anal fissures look like?
Cracks in the epithelium
Chronic fissures result in what?
Fibrosis and the development of a skin tag at the outermost edge
What is an important portion for the management of anal fissures?
Promoting effortless, painless bowel movements
What are some additional treatments for anal fissures?
- Fiber supplements
- Topical anesthetics (5% viscous lidocaine; 2.5% lidocaine w/ 2.5% procaine)
- Oral analgesics (Tylenol or NSAIDS)
With conservative management, healing of anal fissures usually occurs within 2 months in up to what percentage of patients?
45%
True or False
Chronic Fissures should be referred
True
Can anal fissures be treated with topical nitroglycerin 0.2-0.4% or Diltiazem 2%?
Yes
Can anal fissures be treated with an injection of botulinum toxin into the internal anal sphincter?
Yes
The mechanism of what involves obstruction of an anal gland that opens in the base of an anal crypt which normally drains into the anal canal?
Anorectal Abscess
True or False
Anorectal disorders range from simple to complex, may be varied and multiple, and at times can manifest signs and symptoms of underlying serious local or systemic disorders that may be life threatening.
True
Where are anorectal abscesses frequently encountered?
Perianal and perirectal region
What do almost all anorectal abscesses begin with involvement of?
Anal crypt and its gland
When obstruction of an anal gland occurs, the gland orifice is blocked, resulting in what?
Infection and abscess formation
What are these spaces?
- Perianal space
- Interphincteric space
- Ischiorectal space
- Deep postanal space
- Supralevator or pelvirectal space
Spaces in which an anorectal abscess can form
What is a common sequela that can form from an anorectal abscess?
Fistula
In what group are anorectal abscesses more common?
Young middle-aged males
What would you suspect if a patient presents to you with a dull, aching, or throbbing pain that becomes worse immediately before defecation, is lessened after defecation, but persists between bowel movements?
Anorectal abscess
True or False
Perianal abscesses, easily palpable, are usually accompanied by fever, leukocytosis, and sepsis in the immunocompetent patient
False
Usually not accompanied by fever, leukocytosis, and sepsis in the immunocompetent patient
True or False
Other anorectal abscesses (ischiorectal, intersphincteric, supralevator, etc) are painful but may express fewer outward signs upon examination. The patient often appears markedly
uncomfortable and may be febrile. Leukocytosis may be present.
True
Could you perform an ultrasound for a deep anorectal abscess?
Yes
What is the treatment for an anorectal abscess?
Surgery
Should be performed as soon as the diagnosis is made, before it becomes fluctuant
True or False
Drainage for anorectal abscesses should be both early and extensive
True
Should all perirectal abscesses (supralevator, intersphincteric, and complicated ischiorectal) be drained in the operating room?
YES
Can isolated, simple, fluctuant perianal abscesses that are NOT associated with the presence of any deeper abscesses be drained in the ED or outpatient setting using local anesthetics?
Yes
If a simple, linear drainage incision is made for the drainage of an anorectal abscess, the abscess is more likely to recur because of the premature closing of the skin edges, what additional care should be given to this patient with this form of drainage incision?
- Abscess cavity must be packed initially with strips of gauze for at least 24hrs
- These patients require closer follow up care
To ensure adequate drainage, a ___or ___incision can be made over the fluctuant part of the abscess. Trimming the flaps of these incision is suggested to prevent closure
- cruciate
- elliptical
Is packing required in a drainage using a cruciate or elliptical incision?
No packing is not required, but if it is used it should be done lightly and removed in 24 hours
Are antibiotics necessary after an abscess have been adequately drained?
No
What broad-spectrum antibiotics should be used in patients with fever, leukocytosis, valvular heart disease, or those with cellulitis, in the management of a patient with an anorectal abscess?
- Cephalexin (Keflex) 250mg four times daily (QID)
- Doxycycline 100mg BID for 7 days
- Clindamycin 300mg PO q 6hrs for 7 days
- Dicloxacillin 125-500mg PO q 6 hours
What is a chronic manifestation of the acute perirectal process that forms an anal abscess; When the abscess ruptures or is drained, and epithelialized track can form that connects the abscess in the anus or rectum with the perirectal skin?
Anorectal Fistula
These are symptoms of what?
- “non-healing” anorectal abscess following drainage
- Chronic purulent drainage and a pustule-like lesion in the perianal or buttock area
- Intermittent rectal pain, particularly during defecation, but also with sitting
- intermittent and malodorous perianal drainage and pruritus
Anorectal Fistula
True or False
Patients presenting with an anal fistula require higher echelons of care due to the proximity of the involved area
True
Should you MEDEVAC and unstable patient with an anorectal fistula?
PUNT PUNT PUNT
What is a malfunction which describes a spectrum of clinical presentations, ranging from asymptomatic hair-containing cysts and sinuses to large symptomatic abscesses of the sacrococcygeal region that have some tendency to recur?
Pilonidal disease
Can pilonidal abscesses occur from Staph aureus after it invades the openings caused by ingrown hairs?
Yes
Pilonidal sinuses are formed by the penetration of the skin by an ingrowing hair, which causes a what?
a foreign body granuloma reaction
When does pilonidal disease most commonly occur?
Before the 4th decade of life
True or False
An abscessed pilonidal cyst is always located in the midline (there may however be secondary fistula openings on either side of the midline) and does not communicate with the anorectum.
True
What are some common complaints of patients with pilonidal cysts?
Swelling, pain, and persistent discharge
What is the most common exam finding for patients with pilonidal cysts?
A single opening from which hair is protruding
Examination of a patient with a possible pilonidal cyst generally reveals what?
an area of inflammation in the midline of the gluteal crease with one or more sinus openings
True or False
IF the patient gives a history of recurrent infection at the base of the spine, this in itself may be considered diagnostic
True
True or False
When concerning pilonidal disease or cysts, a patient will usually present when an abscess has formed that can no longer drain
True
Should you consider a CBC in a patient with a pilonidal cyst?
Yes, if the patient demonstrates systemic symptoms (fever, chills, etc.)
What is the treatment of choice for a pilonidal cyst?
Surgical treatment
Are recurrences of pilonidal cysts common?
Yes
True or False
A simple I&D performed in the clinical setting often does not completely resolve the pilonidal disease due to reoccurrence and the presence of hair follicles within the sinus tracts that were not debrided. Thus the definitive treatment for persistent or complicated pilonidal abscesses is surgical excision performed in the operating room.
True af
What antibiotic therapy is considered for patients after I&D of a pilonidal cyst or if surrounding cellulitis is present?
- Cephalexin(Keflex) 500mg PO three times daily (TID)
- Doxycycline 100mg BID for 7 days
If a patient with a pilonidal cyst remains uncomplicated you may retain them onboard, but should ultimately be referred to who for a more definitive management?
General Surgery
Should you MEDEVAC complicated cases of patients with pilonidal cysts?
Yes
True or False
Depending on your Physician Supervisor’s preferences MEDADVICE may be required for patients with pilonidal cysts
True
The term “inflammatory bowel disease” includes what ?
- Ulcerative Colitis
- Crohn’s Disease
True or False
In several studies, genetic factors appeared to have no influence of the risk of inflammatory bowel disease (IBD)
False
In several studies, genetic factors appeared to influence the risk of inflammatory bowel disease (IBD).
The immune response disrupts the intestinal mucosa and leads to a chronic inflammatory process in what?
Inflammatory bowel disease
In what disease process can you have pseudo-polyps and inflammation that is limited to the colonic mucosa?
Ulcerative Colitis (UC)
What is an island of normal colonic mucosa which only appears raised because it is surrounded by atrophic tissue?
Pseudo-polyp
What disease process can affect ANY segment of the GI tract from the mouth to the anus?
Crohn’s Disease
What can also be seen in Crohn’s disease?
- “skip lesions”
- Transmural inflammation
Crohn’s disease and ulcerative colitis may be associated in what percentage of patients with a number of extra-intestinal manifestations? ESPECIALLY CROHN’S
50%
What are some extra-intestinal manifestations in Crohn’s AND Ulcerative Colitis?
- Erythema nodosum
- Pyoderma Gangrenosum
- Thromboembolic events
What are some extra-intestinal manifestations just from Crohn’s?
- oral ulcers
- anorectal disease
What are some extra-intestinal manifestations for just Ulcerative Colitis?
- Peripheral Arthritis
- Spondylitis or Sacroiliitis
- Episcleritis or Uveitis
- Hepatitis
- Sclerosing Cholangitis
What kind of inflammation only involves the mucosal layer of the bowel wall
Mucosal Inflammation
What is mucosal inflammation characteristic of?
Ulcerative Colitis
What kind of inflammation shows inflammatory changes/ulceration of all layers of the bowel wall?
Transmural Inflammation
What is transmural inflammation characteristic of?
Crohn’s Disease
What is transmural inflammation characteristic of?
Crohn’s Disease
What disease has segmental involvement of the alimentary tract (mouth to anus) by a nonspecific inflammatory process (transmural inflammation)?
Crohn’s Disease
What is the most common portion of the GI tract that Crohn’s affects?
Terminal Ilium
When Crohn’s involves the terminal ilium it can result in what?
Malabsorption of digested foods
(B12, Bile salts, Calcium)
What is a chronic and recurrent disease, which can affect any segment of the GI tract from the mouth to the anus and involves “skip lesions”?
Crohn’s Disease
True or False
Because of the variable location of involvement and severity of inflammation, Crohn’s disease may present with a variety of symptoms and signs
True
What is the most common presentation of symptoms with Crohn’s Disease?
Ileitis or Ileo-colitis
Can you develop a low grade fever with Crohn’s?
Yes
What is a possible complication of Crohn’s disease?
Small Bowel Obstruction (SBO)
Due to the transmural nature of the inflammation characteristic of Crohn’s disease patients may develop what?
Possible penetrating disease and fistulae formation
One third of patients with Crohn’s disease with either large or small bowel involvement develop what?
Perianal Disease
(skin tags, anal fissures, perianal abscesses, peri-anal fistulas)
What is a common oral presentation of Crohn’s?
Oral aphthous lesions
True or False
Patients with Crohn’s have and increased prevalence of cholelithiasis (cholesterol gallstones)
True
Perianal disease with abscesses and fistulas are common following exacerbations of what?
Crohn’s disease
You would see radiographic evidence of ulceration, stricturing, or fistulas of the small intestine or colon in what?
Crohn’s Disease
1/3 of cases of what disease involves the small bowel only, usually the terminal ileum (ileitis)?
Crohn’s Disease
Half of all cases of what disease involve the small bowel and colon, usually the terminal ileum and adjacent proximal ascending colon (ileocolitis)?
Crohn’s disease
What is strongly associated with the development of Crohn’s disease, resistance to medical therapy, and early disease relapse?
Cigarette smoking
True or False
A CBC and Serum Albuming should be obtained in all patients with Crohn’s disease to assess immune response and nutritional status respectively
True
True or False
Anemia in patients with Crohn’s Disease may reflect chronic inflammation, (anemia of chronic disease), mucosal blood loss, iron deficiency, or vitamin B12 malabsorption secondary to terminal ileum inflammation or resection
True
Are endoscopies recommended during acute Crohn’s exacerbations?
No
During acute exacerbations or worsening of symptoms of Crohn’s disease a what of the abdomen should be done to assess for abscess/fistula formation or even perforation?
CT Scan of the abdomen
What is a chronic lifelong illness characterized by exacerbations and periods of remission?
Crohn’s disease
What are some available therapies for Crohn’s disease?
- 5-aminosalicylic acid derivatives (5-ASA)
- Corticosteriods
- Immuno-modulating and biologic agents
a. monoclonal antibodies
b. methotrexate
Complications of Crohn’s Disease
Tender abdominal mass with fever and leukocytosis suggests a what?
An emergent CT of the abdomen is needed to confirm this diagnosis.
Intra-abdominal Abscess
Treatment: broad spectrum antibiotics
What may develop secondary to active inflammation or chronic structure/adhesion formation in Crohn’s Disease?
Small bowel obstruction
What is the treatment for a small bowel obstruction in Crohn’s disease?
NG tube to decompress the GI tract, MEDEVAC
Patients with Crohn’s Disease are how much more likely to develop colon cancer than the general population?
20 times more likely
True or False
UC has a higher risk of development of carcinoma than that of Crohn’s Disease
True
True or False
Ulcerative Colitis (UC) is limited to the stomach
False
UC is limited to the colonic mucosa
What is thought to be caused by abnormal activation of the immune system resulting in diffuse inflammation of the colonic mucosa (mucosa of the large intestine)?
UC
