colon part 2 Flashcards
ibs, intussuseption, cancer, polyps
.IBS combination of what 3 things
-altered motility(chemical imbalance in intesting)
-visceral hypersensitivity to intestinal distention
-psychosocial distress
.differential diagnosis: lactose intolerance, cholecystitis, chr pancreatitis, intestinal obstruction, chronic peritonitis, carcinoma of the pancreas or stomach
DD for IBS
.tx for IBS
1. constipation
2. diarrhea
- prokinetics: fiber, psyllium, maybe add polyethylene glycol after fiber.
- loperamide. anticholinergics/antispasmodics
.common cause of chronic or recurrent abdominal pain in the US
IBS
.IBS
pathology
symptoms begin when
symptoms length
gender
exacerbated by what
unknown pathology/no organic cause
symptoms begin late teen/early 20s
sx more than 6 months
women mainly(2/3s)
exacerbated by menses or stress
.IBS
pain location
pain exacerbation
pain associated with what
pain can be anywhere or localized to hypogastrium or LLQ
pain worsened by food intake and relieved by defecation
pain associated with bowel distention from gas and spasm of gastric muscle. postprandial urgency is common
.IBS
PE
SX
PE: nml but may show a tender palpable sigmoid colon and hyperresonance on percussion over abdomen
sx: changes in stool frequency and character, constipation, diarrhea, dyspepsia, urinary frequency and urgency
will have alternating constipation and diarrhea
.IBS tests to order
dx of exclusion
colonoscopy and abd CT
what is intussusception
invagination of proximal segment of the bowel into the portion just distal to it
intussusception
ages, following what
physical presentation
stools
complaints
children 3 months to 6 years. following a viral infection
child holding knees to chest
currant jelly stools
complaining of a colicky abdominal pain
what if intussusception occurs in an adult
think neoplasm
currant jelly stools
intussusception secondary to ischemia in the bowel
kid with severe colicky pain. sausage like mass felt on abdominal exam
adult symptoms
intussusception
adults have a more indolent course of crampy abdominal pain
dx for intussusception
kids: barium or air contrast enema
adults: no barium enema. do a CT
**ultrasonography is the test of choice: shoes a “target sign” must be taken during painful episode
tx for intussusception
air or barium enema for kids. surgery for adults
avoid a barium enema in what
intussusception in an adult
.diverticulitis ages
60% of people older than 60 y/o and 20% become symptomatic
20% of pts with acute diverticulitis are younger than 40 years old
sudden onset of large volume hematochezia(bloody stools) which resolves spontaneously
diverticulitis
what to avoid in diverticulitits testing
avoid barium enema
diverticulitis
presentation
sudden onset abdominal pain, usually in LLQ or suprapubic region, with or without a fever
can be mild to severe infection with peritonitis
altered bowel movements as well as nausea and vomiting
diverticulitis
2 tests for dx
3 labs findings
2 tests to avoid
CT(to **dx) if pts do not respond to therapy
colonoscopy to provide definitive dx
occult blood in stool
mild to moderate leukocytosis
plain film to rule out free air
NO BARIUM ENEMA
no colonoscopy or sigmoidoscopy in acute disease
diverticulits tx
mild diverticulitis
ileus develops
surgery?
diet
low residue diet and broad spectrum antibiotics
(flagyl, FQ, 2nd or 3rd gen ceph)
NG tube for ileus
surgery in severe cases: peritonitis, large abscesses, fistulae, obstruction
high fiber diet
child holding knees to chest and vomiting
intussusception
most common cause of acute lower GI bleeding in pts over 40 y/o
diverticulits
ultrasonography shows a “target sign” and taken during painful episode
intussusception
also do a air enema
.definition of toxic megacolon
nonobstructive, colon dilation of >6cm with signs of systemic toxicity
profound bloody diarrhea, distention, pain
.etio and def: chronic mesenteric ischemia
dx
atherosclerosis;
hypoperfusion relating to EATING;
POSTPRANDIAL pain
angiography
.where does ischemic colitis occur usually
splenic flexure and rectosigmoid junction; watershed area
.dx for ischemic bowel disease
plain film radiography or CT show “thumbprinting”
**CT angiography is initial
conventional arteriography is definitive
.tx of ischemic bowel disease
surgerical revascularization. hydration is a critical factor
.what is hirschsprung’s disease
congenital aganglionosis(lack of neurons) of the colon, leading to functional obstruction in the newborn.
.how does toxic megacolon occur in an adult
as a complication of UC, crohns, pseudomembranous colitis and specific infectious causes(c diff, campylobacter, shigella, amebiasis)
.what to get dx toxic megacolon
abdominal plain film xray to show colonic dilation
.what should be careful with when treating toxic megacolon
fluid and electrolyte imbalance
.3 ways to dx colonic polyps
most of what come from polyps
barium enema, flexible sigmoidoscopy, colonoscopy
95% of adenocarcinoma come from polyps
.acute mesenteric ischemia
s/s
dx
complication
*SEVERE pain out of proportion
CT angiogram!
lactic acidosis/gangrene
AMI emergent. Mortality remains high despite treatment
.AMI etiology
arterial embolus or thrombosis (atherosclerosis) (Afib MC)
shock/hypoperfusion
venous thrombosis(hypercoagulable state)
.sudden onset severe abdominal pain out of proportion, later will have involuntary guarding, rebound, and heme positive stool may develop
AMI
.ischemic colitis s/s
LLQ crampy abd pain with ttp, bloody diarrhea
.abdominal angina, pain occuring 10-30 min after eating, relieved by squatting or lying down. PE nml
CMI
.risk factors:
age over 60
hx of a fib
vasculitis
hypercoagulable
use of vasoconstrictors(vasopressin, cocaine)
bowel ischemia
survival rate in ischemic colitis
if diagnosed within 24 hours
survival rate is 50%
.toxic megacolon presentation
fever, prostration(severe weakness), severe cramps, abdominal distention
rigid abdomen, localized diffuse rebound abdominal tenderness
.fever, prostration(severe weakness), severe cramps, abdominal distention
rigid abdomen, localized diffuse rebound abdominal tenderness
toxic megacolon
*emergency
.most common neoplastic polyp
highest risk of becoming cancerous
low risk for malignancy/most common non-neoplastic polyp
adenomatous
villous adenoma
hyperplastic
how often should you evaluate family members of those with familial polyposis syndrome
every 1-2 years beginning 11 years old
discuss elective colectomy for an option for high risk individuals
polyps symptoms
usually asymptomatic
although constipation, flatulence, and rectal bleeding may occur
bleeding polyps can cause iron deficiency anemia
surgical resection of polyps
pts with history of polypectomy should follow up when
yes for lesions 2-3 cm
pts with history of polypectomy should follow up…
every 5-10 years with mild disease(up to 2 polyps less than 1cm)
every 3 years for moderate disease (3-10 small polyps or one greater than 1 cm)
every 1-2 years if more than 10 polyps are removed
sausage shaped abdominal mass
intussusception
stepladder appearance on abdominal xray
bowel perforation
.Familial adenomatous polyposis screening
initiate screening at age 10-12 years with flex sig annually
dx of colorectal cancer
occult blood in stool; flexible colonoscopy
** colonoscopy is the gold standard
.what can u do to monitor but not detect colorectal cancer
carcinoembryonic antigen (not specific)
.tx for colorectal cancer
surgical resection for local
chemotherapy for mets
.3rd leading cause of cancer death in the world
2nd in US
colorectal cancer
.colorectal cancer incidence and age
risk factor
race
90% cases occur in people older than 50 years old
hereditary non polyposis colorectal cancer leads to an extremely high risk of colon cancer (autosomal dominant)
pts with familial polyposis have a virtually 100% risk of developing the disease
hx of crohns or UC(worse)
african americans at an increased risk
.dx for colorectal cancer
colonoscopy with bx dx test of choice
barium enema: apple core
lab: anemai poss
tumor marker: CEA
.colorectal cancer
prognosis
good in early disease
its slow growing and symptoms appear late in the disease
.colorectal cancer
screening
occult blood in stool can be an early marker and used in screen in adults older than 40 y/o
colonoscopy recommended for adults older than 50 years old or 10 before the earliest dx of colon cancer in a first degree relative
carcinoembryonic antigen be used to monitor, not detect the cancer
.colorectal symptoms depending on locations
right side
left side
rectum
right sided lesions typically cause chronic blood loss and fatigue, iron defiency anemia. obstruction is uncommon
left sided lesions are often circumferential, causing change in bowel habits, abdominal pain, constipation/diarrhea, bloody stools, and obstructive symptoms. “apple core”
if lesion is found in the rectum: tenesmus, bright red blood, hematochezia
.”apple coring” filling defect on descending colon on barium enema
colon cancer
.which side of the colon is larger
right side
.iron defiency anema in an elderly pt
indicates colorectal cancer until proven otherwise
.iron defiency anema in an elderly pt
indicates colorectal cancer until proven otherwise
.strep bovis (example in endocarditis) has a strong association with what
colon cancer
.toxic megacolon due to UC, tx?
corticosteroids, manage underlying casue
.toxic megacolon dx s/s
3 or more: fever >38 degrees, pulse >120, neutrophilic leukocytosis >10,500, anemia
1 of the following: hypotension, dehydration, electrolyte abn, altered mental status
.antibx for toxic megacolon
flagyl plus ceftriaxone
.thumbprint sign on CT abdomen
ischemic colitis
.for medical decompression of colon, for pts at risk for perforation
netostigmine
.how to dx IBS
ROME IV criteria
