Colonic Obstruction Flashcards by Josh Sap

What are the two main types of Inflammatory Bowel Disease (IBD)?

Ulcerative Colitis and Crohn’s Disease

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What is a common presentation of IBD?

A young patient with diarrhea for more than 6 weeks (with or without blood)

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Which non-invasive test is used to indicate intestinal inflammation in IBD?

Fecal Calprotectin (>150 µg/g suggests IBD over IBS)

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What are characteristic endoscopic findings in IBD?

Loss of vascular pattern, erythema, friability, erosions, ulcers, exudates, aphthoid ulcers, cobblestoning, pseudopolyps

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How does Ulcerative Colitis (UC) differ from Crohn’s Disease (CD) in terms of inflammation?

UC: Continuous mucosal inflammation; CD: Discontinuous transmural inflammation

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What part of the GI tract is affected in UC vs. CD?

UC: Colon and rectum (left > right); CD: Whole GI tract (right > left, often involves ileum)

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Which imaging modality is preferred for detecting Crohn’s Disease inflammation?

Magnetic Resonance Enterography (MRE)

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What is the main goal of IBD treatment?

To control bowel inflammation and provide symptomatic relief

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What is the first-line medication for IBD treatment?

5-Aminosalicylic Acid (5-ASA)

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When are corticosteroids used in IBD management?

For short-term relief of symptoms

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Which drugs are used for maintaining remission in IBD?

Immunomodulators (Azathioprine, Mercaptopurine)

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Which biologic agent is used in severe or refractory IBD?

Infliximab (anti-TNF-alpha monoclonal antibody)

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What is toxic megacolon, and what is the diagnostic criterion?

Severe colonic dilation (>5.5 cm) due to inflammation

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What are the emergent indications for colectomy in UC?

Colonic perforation, acute hemorrhage, toxic megacolon

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Why is surgery not curative in Crohn’s Disease?

Because the disease can recur in other areas of the GI tract

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What are the main risk factors for diverticular disease?

Low fiber diet, NSAID use, smoking, alcohol, chronic constipation

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What imaging is contraindicated in acute diverticulitis and why?

Colonoscopy and Barium Enema (risk of perforation)

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What is the mainstay of treatment for uncomplicated diverticular disease?

Bowel rest and antibiotics (Ciprofloxacin + Metronidazole)

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What is the Hinchey classification used for?

Staging complicated diverticulitis

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Which stage of Hinchey classification requires surgery?

Stage 3 (purulent peritonitis) and Stage 4 (fecal peritonitis)

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What is the most common cause of lower GI bleeding (LGIB)?

Diverticulosis

What is the best initial test for stable LGIB patients?

Colonoscopy

What is the Shock Index, and how is it calculated?

HR / SBP (used to assess hemodynamic stability in GI bleeding)

Which imaging modality has the highest sensitivity for GI bleeding?

Nuclear imaging (Technetium-99m)

What is the treatment for persistent GI bleeding detected via angiography?

Superselective transcatheter embolization

What is volvulus, and which part of the colon is most commonly affected?

Twisting of the gut on its mesentery; Sigmoid colon is most affected

What are the classic radiographic signs of volvulus?

Coffee bean sign (Sigmoid volvulus) and Bird’s beak sign (Cecal volvulus)

What is the initial treatment for sigmoid volvulus without strangulation?

Endoscopic detorsion with rectal tube placement

What is the recurrence rate of sigmoid volvulus after endoscopic detorsion?

40%-90%

Why should gangrenous bowel not be untwisted before resection?

It can release bacteria and mediators, leading to hypotension and organ failure

What law explains why the cecum is most prone to perforation in large bowel obstruction?

Laplace’s Law (Tension = Pressure x Radius)

What is Ogilvie’s Syndrome?

Colonic pseudo-obstruction without mechanical cause

What is the most effective pharmacologic treatment for Ogilvie’s Syndrome?

Neostigmine (acetylcholinesterase inhibitor)

What is the primary cause of colonic pseudo-obstruction?

Autonomic dysfunction

Which medications should be discontinued in Ogilvie’s Syndrome?

Narcotics, anticholinergics, tricyclic antidepressants, calcium channel blockers

What is the definitive treatment for persistent Ogilvie’s Syndrome despite conservative management?

Colonoscopic decompression

What are common complications of lower GI bleeding?

Hemodynamic instability, shock, anemia

What is the preferred imaging for hemodynamically unstable LGIB patients?

CT Angiography

What is the most common cause of massive LGIB in the elderly?

Angiodysplasia

What is the classic triad of symptoms in colonic obstruction?

Abdominal pain, distention, constipation

What is the management of choice for cecal volvulus?

Right hemicolectomy

What is the primary mechanism of ischemic injury in colonic obstruction?

Increased intraluminal pressure → vascular compromise → necrosis

What is the first-line treatment for uncomplicated sigmoid volvulus?

Sigmoidoscopy with rectal tube placement

Which artery supplies the sigmoid colon and is often involved in volvulus?

Inferior Mesenteric Artery (IMA)

What is the preferred surgical procedure for recurrent sigmoid volvulus?

Elective sigmoidectomy

What is the mortality rate for total/subtotal colectomy in GI bleeding?

0.17

What is the threshold for considering blood transfusion in LGIB?

Hematocrit <30%

What are the indications for emergent laparotomy in GI bleeding?

Failure to localize bleeding after multiple interventions

What is the most effective endoscopic treatment for diverticular bleeding?

Band ligation

What imaging technique detects the lowest rates of GI bleeding?

Nuclear imaging (0.1-0.5 mL/min)