colon part 1 Flashcards
IBD, bowel obs, celiac
normal bowel function
constipation defintion
3 stools per day to 3 stools per week
constipation is a decrease in stool volume and increase in stool firmness accompanied by straining
describe the bowel sounds and symptoms in an obstruction
small
large
hight pitched and comes in rushes
small: abd pain, distention, vomiting partially digested food, obstipation
large: distention and pain
sx of volvulus
cramping abdominal pain and distention(rigid), nausea, vomiting, and obstipation
maybe signs of shock
abdominal tymphany, tachycardia, fever, severe pain with ischemia
how to dx volvulus
abdominal plain film which shows colonic distention
CT with oral contrast
how to dx malabsorption
sx
72 hr fecal fat test; d-xylose test
diarrhea, bloating, abdominal discomfort;
may have wt loss, steatorrhea, edema
what if a fecal fat test if nml in malabsorption
think pancreatic insufficiency and abnormal bile salt metabolism
what is a D-xylose test for
to distinguish maldigestion(pancreatic insufficiency, bile salt deficiency) from malabsorption
nml rules out malabsorption
pt older than 50 y/o with new onset constipation
evaluate for colon cancer
constipation treatment
increase fiber to 10-20 gm/day and
fluid intake to (1.5-2L/day)
small and large bowel obstructions common causes
small: adhesion or hernias
large: neoplasm
test to look for a bowel obstruction
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
bowel obstruction tx
- initial tx
- partial obstruction
- emergency
- NPO, NG suctioning, IV fluids, monitoring
- IV hydration, NG decompression
- if a mechanical obstruction is suspected, especially large bowel
volvulus defintion
common area
twisting of bowel, commonly in sigmoid or cecal area of the bowel, emergent!
volvulus tx
endoscopic decompression
or surgery
abdominal tymphany, tachycardia, fever, severe pain with ischemia
volvulus ischemia
digestion, absorption, impaired blood or lymph flow
can cause problems with malabsorption
fistulas, abscesses, aphthous ulcers, renal stones, predisposition to colonic cancer
complications of crohns
.what is celiac disease
common where
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
.sx of celiac disease
what about in infants and children
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
.how to dx celiac disease
diagnostic: small bowel biopsy (atrophy of villi)
screen with transgluaminase IgA antibodies test of choice.
.what part of the bowel does crohns involve
population
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
.crohns vs UC onset
c: gradual; UC: gradual or sudden
.crohns vs UC distribution
C: mouth to anus, skip areas, spares rectum. UC: distal to proximal, continuous
.crohns vs UC depth of lesions
C: transmural. sometimes leading to fistulas
UC: mucosal surface
.crohns vs UC symptoms
C: diarrhea(non bloody) and pain.
UC: bloody pus filled diarrhea(more than 6 per day is severe), tenesmus
.what is tenesmus
feeling that u constantly need to pass stools even though ur bowels are empty
.crohns vs UC complications
C: fistulas common, perianal disease, iron/B12 def, granulomas
UC: toxic megacolon, primary sclerosing cholangitis, colon ca
.diarrhea in crohns and UC
crohns: no visible blook
UC: bloody diarrhea hallmark
.tx for crohns
ileocolonic
illeal and proximal colon
severe/refractory
ileocolonic: mesalamine (5-ASA) or po glucocorticoid
illeal and proximal colon: glucocorticoid
severe/refractory: azathioprine, methotrexate, anti TNF agents(infliximab)
.where does pain occur in UC
pain less common but occurs in left lower quadrant
.toxic megacolon and colon cancer in crohns vs UC
more likely in UC
scleritis, episcleritis, arthritides, sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum…
complications of UC
crohns vs UC: smoking
smoking increases disease in crohns but protective in UC
barium enema for UC ok
no, can b/c of risk of perforation. do colonoscopy or sigmoidoscopy
.tx for UC
topical or oral aminosalicylates first line
immunodulators for refractory disease
surgery: total proctocolectomy
.tests for crohns
upper GI series initial test of choice: string sign
endoscopy: cobblestoning
bx will reveal transmural inflammation, noncaseating granulomas
increased sedimentation rate, anemia, nutritional and electrolyte imbalances during what
crohns exacerbations
UC starts where
onset
starts distally, at the rectum, and progresses proximally
disease is CONTINUOUS
gradual onset but also can be abrupt
UC tests
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
avoid what tests in crohns and UC
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
.best tests for crohns and UC
crohns: upper GI series with small bowel follow through
UC: sigmoidoscopy or colonoscopy
crampy abdominal pain 4-5 minutes; vomiting typically follows pain
small bowel obstruction
leading cause of small bowel obstruction in kids and adults
kids: hernia
adults: adhesions
postprandial bloating, intermittent crampy abdominal pain, loud BS, vomiting, constipation
bowel obstruction
dehydration and metabolic alkalosis
small bowel obstruction
lactic acidosis
prognostic sign in necrotic bowel
stepladder appearance on xray
small bowel obstruction
serologic screening tests (IgA antiendomsysial[EMA] and antitissue transglutaminase antibodies)
for celiac disease
constipation
- gender
- dx how
- palpate stool where
- kind of laxatives to give
females
less than 2 BM a week
LLQ
osmotic and stimulant
abdominal tymphany
tachycardia, fever, severe pain
volvulus
.cobblestone appearance
elevated WBC
crohns
.labs: anti-Saccharomyces cerevisiae antibodies, iron/B12 def.
crohns
.string sign on upper GI series
crohns
.stovepipe or lead pipe sign
UC
.UC mild/mod/severe description
mild: 4 or less BM
moderate: over 4 loose BM
severe: 6 loose BM, severe pain, signs of toxicity
.cyclosporine, tacrolimus, -mab drugs, methotrexate, 6 mercaptopurine, azathioprine
UC and crohns meds
.diarrhea
dermatitis herpetiformis (pruritic papulovesicular rash on extensor surfaces, neck, trunk, scalp)
celiac disease
.test of choice for lactose intolerance
hydrogen breath test
.nut allergy
____ mediated
timing of exposure
IgE
wait until 3 yo
