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colon part 1 Flashcards

IBD, bowel obs, celiac

1
Q

normal bowel function

constipation defintion

A

3 stools per day to 3 stools per week

constipation is a decrease in stool volume and increase in stool firmness accompanied by straining

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2
Q

describe the bowel sounds and symptoms in an obstruction

small

large

A

hight pitched and comes in rushes

small: abd pain, distention, vomiting partially digested food, obstipation
large: distention and pain

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3
Q

sx of volvulus

A

cramping abdominal pain and distention(rigid), nausea, vomiting, and obstipation

maybe signs of shock

abdominal tymphany, tachycardia, fever, severe pain with ischemia

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4
Q

how to dx volvulus

A

abdominal plain film which shows colonic distention

CT with oral contrast

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5
Q

how to dx malabsorption

sx

A

72 hr fecal fat test; d-xylose test

diarrhea, bloating, abdominal discomfort;

may have wt loss, steatorrhea, edema

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6
Q

what if a fecal fat test if nml in malabsorption

A

think pancreatic insufficiency and abnormal bile salt metabolism

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7
Q

what is a D-xylose test for

A

to distinguish maldigestion(pancreatic insufficiency, bile salt deficiency) from malabsorption

nml rules out malabsorption

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8
Q

pt older than 50 y/o with new onset constipation

A

evaluate for colon cancer

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9
Q

constipation treatment

A

increase fiber to 10-20 gm/day and

fluid intake to (1.5-2L/day)

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10
Q

small and large bowel obstructions common causes

A

small: adhesion or hernias
large: neoplasm

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11
Q

test to look for a bowel obstruction

A

initial: upright radiograph may illustrate air-fluid levels and multiple dilated loops of bowel
definitive: CT abdomen

CBC: leukocytosis if there is ischemia or necrosis

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12
Q

bowel obstruction tx

  • initial tx
  • partial obstruction
  • emergency
A
  • NPO, NG suctioning, IV fluids, monitoring
  • IV hydration, NG decompression
  • if a mechanical obstruction is suspected, especially large bowel
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13
Q

volvulus defintion

common area

A

twisting of bowel, commonly in sigmoid or cecal area of the bowel, emergent!

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14
Q

volvulus tx

A

endoscopic decompression

or surgery

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15
Q

abdominal tymphany, tachycardia, fever, severe pain with ischemia

A

volvulus ischemia

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16
Q

digestion, absorption, impaired blood or lymph flow

A

can cause problems with malabsorption

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17
Q

fistulas, abscesses, aphthous ulcers, renal stones, predisposition to colonic cancer

A

complications of crohns

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18
Q

.what is celiac disease

common where

A

autoimmune: inflammation of the small bowel due to rxn with alpha gliadin in gluten containing foods (wheat, rye, barley)

most common in Europe and US

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19
Q

.sx of celiac disease

what about in infants and children

A

diarrhea, steatorrhea, flatulence, wt loss, weakness, abdominal distention

dermatitis herpetiformis (pruritic papulovesicular rash on extensor surfaces, neck, trunk, scalp)

kids: failure to thrive, growth delays

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20
Q

.how to dx celiac disease

A

diagnostic: small bowel biopsy (atrophy of villi)

screen with transgluaminase IgA antibodies test of choice.

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21
Q

.what part of the bowel does crohns involve

population

A

the small and large bowel, most commonly the terminal ileum and right colon. rectum is spared!!

skip areas are characteristic

smokers have signficant increased risk

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22
Q

.crohns vs UC onset

A

c: gradual; UC: gradual or sudden

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23
Q

.crohns vs UC distribution

A

C: mouth to anus, skip areas, spares rectum. UC: distal to proximal, continuous

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24
Q

.crohns vs UC depth of lesions

A

C: transmural. sometimes leading to fistulas

UC: mucosal surface

25
Q

.crohns vs UC symptoms

A

C: diarrhea(non bloody) and pain.

UC: bloody pus filled diarrhea(more than 6 per day is severe), tenesmus

26
Q

.what is tenesmus

A

feeling that u constantly need to pass stools even though ur bowels are empty

27
Q

.crohns vs UC complications

A

C: fistulas common, perianal disease, iron/B12 def, granulomas

UC: toxic megacolon, primary sclerosing cholangitis, colon ca

28
Q

.diarrhea in crohns and UC

A

crohns: no visible blook

UC: bloody diarrhea hallmark

29
Q

.tx for crohns

ileocolonic

illeal and proximal colon

severe/refractory

A

ileocolonic: mesalamine (5-ASA) or po glucocorticoid

illeal and proximal colon: glucocorticoid

severe/refractory: azathioprine, methotrexate, anti TNF agents(infliximab)

30
Q

.where does pain occur in UC

A

pain less common but occurs in left lower quadrant

31
Q

.toxic megacolon and colon cancer in crohns vs UC

A

more likely in UC

32
Q

scleritis, episcleritis, arthritides, sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum…

A

complications of UC

33
Q

crohns vs UC: smoking

A

smoking increases disease in crohns but protective in UC

34
Q

barium enema for UC ok

A

no, can b/c of risk of perforation. do colonoscopy or sigmoidoscopy

35
Q

.tx for UC

A

topical or oral aminosalicylates first line

immunodulators for refractory disease

surgery: total proctocolectomy

36
Q

.tests for crohns

A

upper GI series initial test of choice: string sign

endoscopy: cobblestoning

bx will reveal transmural inflammation, noncaseating granulomas

37
Q

increased sedimentation rate, anemia, nutritional and electrolyte imbalances during what

A

crohns exacerbations

38
Q

UC starts where

onset

A

starts distally, at the rectum, and progresses proximally

disease is CONTINUOUS

gradual onset but also can be abrupt

39
Q

UC tests

A

anemia, increased ESR, decreased serum albumin

abdominal plan film xray may show colonic dilation

**sigmoidoscopy or colonoscopy best method for dx

avoid colonoscopy and barium edema in acute disease because of risk of perforation and toxic megacolon

40
Q

avoid what tests in crohns and UC

A

Crohns: avoid contrast studies and endoscopic procedures because of possibility of inducing toxic megacolon or perforation

UC: avoid colonoscopy and barium edema in acute disease because of risk of perforation and toxic megacolon

41
Q

.best tests for crohns and UC

A

crohns: upper GI series with small bowel follow through

UC: sigmoidoscopy or colonoscopy

42
Q

crampy abdominal pain 4-5 minutes; vomiting typically follows pain

A

small bowel obstruction

43
Q

leading cause of small bowel obstruction in kids and adults

A

kids: hernia
adults: adhesions

44
Q

postprandial bloating, intermittent crampy abdominal pain, loud BS, vomiting, constipation

A

bowel obstruction

45
Q

dehydration and metabolic alkalosis

A

small bowel obstruction

46
Q

lactic acidosis

A

prognostic sign in necrotic bowel

47
Q

stepladder appearance on xray

A

small bowel obstruction

48
Q

serologic screening tests (IgA antiendomsysial[EMA] and antitissue transglutaminase antibodies)

A

for celiac disease

49
Q

constipation

  • gender
  • dx how
  • palpate stool where
  • kind of laxatives to give
A

females

less than 2 BM a week

LLQ

osmotic and stimulant

50
Q

abdominal tymphany

tachycardia, fever, severe pain

A

volvulus

51
Q

.cobblestone appearance

elevated WBC

A

crohns

52
Q

.labs: anti-Saccharomyces cerevisiae antibodies, iron/B12 def.

A

crohns

53
Q

.string sign on upper GI series

A

crohns

54
Q

.stovepipe or lead pipe sign

A

UC

55
Q

.UC mild/mod/severe description

A

mild: 4 or less BM
moderate: over 4 loose BM
severe: 6 loose BM, severe pain, signs of toxicity

56
Q

.cyclosporine, tacrolimus, -mab drugs, methotrexate, 6 mercaptopurine, azathioprine

A

UC and crohns meds

57
Q

.diarrhea

dermatitis herpetiformis (pruritic papulovesicular rash on extensor surfaces, neck, trunk, scalp)

A

celiac disease

58
Q

.test of choice for lactose intolerance

A

hydrogen breath test

59
Q

.nut allergy
____ mediated
timing of exposure

A

IgE

wait until 3 yo

GI (14 decks)

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