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DEMS 1 > Colon > Flashcards

Colon Flashcards

1
Q

Colon (length and fxn)

A

5 ft long, absorption of water and ions, storage of waste and indigestibles

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2
Q

Colon (blood supply)

A

Superior mesenteric a. –> right colon
Inf mesenteric a. –> distal transverse and left colon
Rectal and hemorroidal a. –> splenic flexure and rectum (rectosigmoid) (both prone to ischemia)

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3
Q

IBD (info/causes)

A

immune disorder of small and large intestine
F>M, presents in teens/early 20s, then second peak in 80s
Crohn’s, UC, or BOTH (20%)

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4
Q

IBD (diagnx/treat)

A

Gold standard: direct visualization and biopsy (crypt architectural distortion)
Treat: steroids acute ONLY, immunomodulators, TNF-a antags, surgery, vitamin supplements, COLON CANCER SCREENING (annual after 7-8 years of dz)

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5
Q

IBD (extraintestinal symptoms)

A

More common in UC but you get them in both:

eye, skin, liver, joints, bones

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6
Q

IBD (Crohn’s sx)

A

Diarrhea/weight/loss fatigue
Can be ANYWHERE (from mouth to anus) but USUALLY TERMINAL ILEUM & RIGHT COLON
Periumbilical/mid abd pain
Nausea/vomiting
Fistulae and sinuses
Strictures from transmural inflammation
“skip lesions” (does not unifomrlay involve the bowel - it skips around) –> obstructions

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7
Q

IBD (Crohn’s info)

A

can progress to colon cancer (related to duration/extent,/family hx/extraintestinal manifestations)
T-helper TYPE 1 mediated response
NOD2 polymorphism (intracellular receptor for microbes)
SMOKING AGGRAVATES CROHN’S (NOT UC)

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8
Q

IBD (Crohn’s Diagnx)

A

Transmural damage with deep, linear, fissuring ulcerations
Marked fibrosis –> THICKENED wall and strictures
Fistulas
GRANULOMAS (~20-35%) –> DIAGNOSTIC OF CROHN’S (not in UC)

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9
Q

IBD (UC info)

A 
can progress to colon cancer (related to duration/extent,/family hx/extraintestinal manifestations)
T-helper TYPE 2 mediated response
ECM2 polymorphism (ECM protein)
Smoking AMELIORATES (so UC is uncommon is smokers - if they smoke its most likely Crohn's)
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10
Q

IBD (UC sx)

A

Diarrhea/weight loss/fatigue
LIMITED TO COLON (usually rectosigmoid - surgery potentially curative)
Lower abd pain (LLQ)
Hematochezia and/or mucus in stool
Tenesmus (sense of incomplete evac)
Diffuses from rectum more proximally (SO YOU ALWAYS GET RECTAL INVOLVEMENT but NOT ANAL, unlike Crohn’s - spares rectum but hits the anus)
UC generally spares the ileum
Toxic megacolon
Usually PRIMARY SCLEROSING CHOLANGITIS (liver) (extreintestinal)

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11
Q

IBD (UC diagnx)

A

PSEUDOPOLYPS (area spared from ulceration form polyps)
Loss of haustra
No fistulas or strictures
Superficial (restricted to mucosa) –> THINNED walls

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12
Q

Microscopic Colitis (info)

A

50-80, F:M, 15:1
Autoimmune
Salt and water loss in colon
Mild assoc with Celiac, NSAIDs implicated, no major cancer risk
Two subtypes: lymphocytic & collagenous

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13
Q

Microscopic Colitis (pres/diagnx/treat)

A

Chronic mild secretory diarhhea (non-bloody)
ONLY seen on histology (lymphocytic infiltration of mucosa), thickened subepithelial collagenous band
Treat with antidiarrheals (and lots of others)

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14
Q

Ischemic Colitis (info & triggers)

A

90% >60 yo
Triggers: vasospasm, dehydrations, hypotension, MI, PEE
Usually in spenic flexure, rectosigmoid (watershed areas)

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15
Q

Ischemic Colitis (pres)

A

Abrupt onset, crampy lower abd pain, urgent need to poop, no peristalitc sounds with MILD diarhhea
(if severe or bleeding then another diagnx likely)

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16
Q

Ischemic Colitis (diagnx/treat)

A

Hx, X-ray “thumb print” bowel wall thickening
Colonscopy = gold standard
Muscosal necrosis
Treat the trigger, give IV fluids and Abx (complete recovery in 1-2 weeks)

17
Q

Other kinds of NON-IBD colitis

A

Bacterial Infx Colitis but MOST are viral

See later

18
Q

DiverticuLOSIS (not diverticuLITIS)

A

> 50% in elderly
Outpouching of colon (usually sigmoid)
Thought to be due to low fiber diet (inc intra-colonic pressure)

19
Q

DiverticuLOSIS (pres/diagnx/treat)

A

80% asymptomatic, 20% hemorrhage (bleeding of vasa recta, painless bloody shit, heavy, stops 2-3 days)
Diagnx: CT/MRI, NO infl cells
Treat with high fiber diet

20
Q

Acute DiverticuLITIS (cause/pres/complications)

A

Fecolith obstructions of a diverticulum
Most common in sigmoid
ACUTE onset LLQ pain, nausea, fever, NO diarhhea
Complications: obstruction, perforation, absess, bleeding –> risk of septic shock

21
Q

Hematochezia vs Melena

A

Red vs Black blood in stool

22
Q

Acute DiverticuLITIS (diagnx/treat)

A

CT/MRI, infl cells

Treat: ABX, drain abscess, surgery

23
Q

Lower GI bleed (Ddx)

A

Hematochezia more common than melena
+ abd pain or diarrhea: ischemia colitis/IBD
+ weight loss, anemai, constip: cancer
+ sudden onset bleeding, elderly: diverticulosis
+ acute dysentry, tavel, ABX use: infx diarrha
+ microcytic anemia: neoplasm or AVM
+ NSAIDS: drug induced inschemia

24
Q

Lower GI Bleed (LGIB) (Diagnx/Treat)

A

Colonoscopy, tagged RBC scan, angiography

Treat: supportive fluids, surgical resection, endoscopic on angiographic therapy

25
Q

Colonic Obstruction (cause)

A

Cause: malignancy, foreign body, benign (adhesions, strictures, volvulus)
Diagnx: see on xray, confirm with CT

26
Q

TAKE HOME POINTS

A

see notes

27
Q

Colonic Obstruction (pres/treat)

A

Nausea, vomiting (emesis may be feculent - has feces in it), distended abd, constipation or obstipation

28
Q

Giardia

A

parasitic enterocolitis DUODENUM not COLON

cysts are RESISTANT to chlorine so it doesn’t help

29
Q

Campylobacter Spp

A

watery diarrhea, contaminated meat
C. jejuni
C. fetus (immunosuppressed)

30
Q

Salmonella

A

Typhoid, bloody diarrhea in 2nd week (abd pain, headache, fever, abd rash, leukopenia
Non-typhoid, milder - endoscopy: musosal redness, ulneration, exudates

31
Q

E. coli

A

O157:H7
Non-invasive, toxin-producing, contaminated hamburgers
Bloody diarrhea, severe cramps, mild or no fever, sometimes renal failure (HUS)
On endoscopy: edema, erosions, ulcers, hemorrhage (right colon mostly)
Deadly outbreaks

32
Q

Pseudomembranous Colitis

A

C. DIFF
After ABX therapy (3rd gen cephs)
Fever, leukocytosis, abd pain, cramps, watery diarrhea
Disrupts normal colonic flora
Pseudomembreanes on histol (layer of infl cells)

33
Q

Viral Infx

A

Cytomegalovirus: (mouth - anus)
Herpesvirus (esophagus and anorectum)
Entericviruses: Rotavirus (most common childhood diarrhea)
6-24 months, DEHYDRATION from watery diarrhea, you can die from it, there are 2 vaccines

34
Q

Parasitic Infx

A

Protozoa: tropical/subtropical
Entamoeba histolytica (cecum but can disseminate to liver, flask shaped ulcers)
Diagnx by looking at stool samples

35
Q

Parasitic Infx (Helminths)

A

Most common, poor santitation
Ingested from soil contaminated with feces
Obstruction, perforation, growth retardation
Worms can grow to 20cm
Ascaris lumbricoides (roundworm)

36
Q

UC vs Crohn’s overlaps

A

more common in women than men, Ashkenazi Jews, neither are autoimmune (but is immune dysregulation dz)

37
Q

UC & Crohn’s (combo of defects)

A

Results from:

  • host interactions with intestinal microbiota
  • intestinal epithial dysfxn
  • aberrant muscosal immune responses
38
Q

Appendicitis (info/pres)

A

7% lifetime risk, M>F
Luminal obstruction by fecalith–> ischemic injury –>inflammatory response
POSITIVE McBurney’s Sign, periumbilical pain that radiates to TLQ

39
Q

Appendicitis (diagnx/treat)

A

Mucosal ulceration/transmural infl
High fever, high WBC, sever pain suggest perforation
Treat: appendectomy

DEMS 1 (16 decks)

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