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Clin med GI > Disease of the intestines > Flashcards

Disease of the intestines Flashcards

1
Q

When does IBD typically present

A

30
*crohns more common than UC

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2
Q

Where in the world is IBD more common

A

Developed countries
*northern climates

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3
Q

What is dysbiosis

A

alterations in normal flora of the gut

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4
Q

What doubles the risk for crohns disease

A

Cigarette smoking

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5
Q

Where in the body does Crohns effect

A

Anywhere from mouth to anus

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6
Q

What type of disease are skip lesions associated with

A

Crohns

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7
Q

What are the common presentations of crohns disease

A

Dependent on location involved and disease severity

RUQ pain and diarrhea

+/- extra intestinal manifestations

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8
Q

What is the mainstay diagnosis for crohns disease

A

colonoscopy with biopsy

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9
Q

What lowers the risk of UC

A

smoking

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10
Q

How is the inflammation different between crohns and UC

A

UC inflammation is confined to the mucosa

Crohns inflammation involves the entire bowel wall

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11
Q

Where is UC found in the body

A

confined to the colon

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12
Q

What is the difference in stool presentation with crohns vs UC

A

UC generally has bloody diarrhea

Crohns generally has normal diarrhea

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13
Q

What may be seen on xray with UC

A

Thumbprinting
lead-pipe colon
colonic dilation

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14
Q

What is the mainstay of diagnosis for UC

A

Colonoscopy with biopsy

Will have contiguous inflammation

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15
Q

When is a colonoscopy with biopsy contraindicated with UC

Why?

A

During acute disease

Risk for bowel perf

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16
Q

Where is the pain usually located with UC

A

LLQ

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17
Q

What are the treatment options for crohns and UC

A

Aminosalicylates (sulfasalazine) oral or topical

Steroids for acute tx (IV, Oral, Topical)

Immunomodulators (Methotrexate)

biologics

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18
Q

Which immunomodulators increase risk for non-hodgkin lymphoma

A

Mercaptopurine
azathioprine

Monitor with CBC

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19
Q

If a patient is prescribed methotrexate, what needs to be given as adjunct therapy

A

Folic Acid

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20
Q

What biologics can be given for UC and Crohns

A

TNF inhibitors (inflixumab)
Anti-integrins (natalizumab)
Anti-IL antibody agents (Usetkinumab)

only used once they have failed all other therapy

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21
Q

What is the first pharmacological option in the tx of Crohns disease

A

mesalamine

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22
Q

What is the maintenance therapy for crohns disease

A

azathioprine or mercaptopurine + inflixumab

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23
Q

If someone has a UC acute attack what drugs should they be given and what should be avoided

A

Topical mesalamine (suppository/enema)
-move to oral if topical fails

avoid antidiarrheals (loperamide)

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24
Q

What is the greatest risk with fulminant UC

A

toxic megacolon

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25
Q

How do you r/o toxic megacolon

A

KUB

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26
Q

What is the maintenance therapy for UC

A

First line is to continue 5-ASA

oral is better if there is more proximal involvment

steroids are added if there is no improvement in 4-8 weeks

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27
Q

When is surgery done for UC and crohns

What type of surgery

A

Refractory disease
bowel resection

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28
Q

What is the first line steroid for treatment of crohns

A

budesonide

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29
Q

What is celiacs disease

A

Immunologic response to gluten

Different from gluten intolerance

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30
Q

What is the gene mutation with celiac

A

HLA-DQ2

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31
Q

What are the classic symptoms for celiac disease

A

Chronic diarrhea
dyspepsia
flatulence
steatorrhea

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32
Q

What symptoms are seen in kiddos with celiac

A

weight loss
abdominal distention
weakness
muscle wasting
delayed growth

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33
Q

What atypical symptoms may appear with celiac disease

A

dermatitis herpetiformis

Pruritic papulovesicules on extensor surfaces

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34
Q

What is the first line diagnostic test for celiac

What specific test

A

Serology

IgA levels are more sensitive and specific

35
Q

What is the definitive diagnosis for celiac

A

Mucosal bx

36
Q

What is the primary treatment for celiac

A

lifestyle modification
*true gluten free diet

37
Q

What should be avoided until the celiac is under control

A

Dairy

38
Q

What is the difference between diverticulitis and diverticulosis

A

Diverticulosis is the presence of diverticula (asymptomatic)

Diverticulitis is infection/inflammation of the diverticula

39
Q

What is one of the most common intestinal disorder

A

Diverticulitis

increasing prevelance with age

Men m/c until 50y/o then women m/c

40
Q

What helps decrease the risk of diverticulitis

A

high fiber diet
<4 servings of red meat/week
physical activity

nuts and seeds can contribute to inflammation

41
Q

What are the symptoms of diverticulitis

A

LLQ / suprapubic pain
abdominal tenderness
N/V/F
change in bowel habits

42
Q

What are some complications with diverticulitis

A

abscess formation
ruptured diverticulum
fistula
hemorrhage

43
Q

How do you treat moderate diverticulitis

A

NPO + oral abx
- cipro is preferred

44
Q

What is the most common cause of acute surgical abdomen

A

appendicitis

45
Q

If appendicitis is left untreated for 24-36 hours, what happens

A

perforation
gangrene
abscess

46
Q

What is the patient presentation with appendicitis

A

peritoneal signs, fever, tachycardia
+/- other signs of sepsis

47
Q

What is Rovsings sign and what is it used for

A

Appendicitis
palpate LLQ and have rebound tenderness on opposite side

48
Q

What may be seen on US with appendicitis

A

target sign

49
Q

What is the imaging of choice in adults with appendicitis

A

CT

50
Q

What is the preferred tx of appendicitis

A

laparoscopic appendectomy

51
Q

Where are obstructions most common

A

small bowel

can be mechanical or movement issue

if movement issue = paralytic ileus

52
Q

What are signs of a bowel obstruction

A

Crampy w/ intermittent abdominal pain

no BM or flatus

abdominal distention

53
Q

What is the most common cause of SBO

A

Surgery
hernia

54
Q

What is the most common cause of LBO

A

History of cancer

#1 is carcinoma

55
Q

What will be seen on physical exam with a bowel obstruction

A

Tympanic to percussion
decreased BS
high pitched BS

56
Q

What is the workup like for a bowel obstruction

imaging specific

A

KUB first (2 view)
TOC = abdominal CT

57
Q

What pathology is indicative of an apple core lesion on an abdominal film

A

colonic carcinoma

58
Q

What is the initial tx for a bowel obstruction

Definitive tx?

A

NGT

definitive is to treat underlying cause and decompress the bowel

59
Q

What is a volulus

Where is it most common

A

bowel twists on itself, causing strangulation

1. signmoid colon m/c, then cecum, in kids-> small intestine

60
Q

what is the patient presentation of a volvulus

What about if there is a perf

A

Acute onset
hematochezia
abdominal pain / distention

abdominal tenderness, rigidity, guarding

61
Q

What is the first line tx for a volvulus

What would be seen with a BE

A

Abdominal Xray
*coffee bean appearance”

Birds beak appearance

62
Q

What type of test can be diagnostic and therapuetic for a volvulus

A

Flexible signmoidoscopy

63
Q

What is the initial treatment for a volvulus

What about if refractory?

A

Sigmoidoscopy

Surgical management

64
Q

What is the most common cause of bowel obstruction in young kiddos

What age

A

Intussesception

most cases before age 2
*if over 4y/o its typically boys

65
Q

If a child is over 6 with an intussusception, what should be a big differential

A

Lymphoma

66
Q

When in the year does intussusception generally occur

A

Viral enteritis season

67
Q

What is the presentation of an intussusception

A

sudden onset of colicky abd pain
vomiting
bloody stool (currant jelly color)
lethargy
palpable abd mass (sausage shape)

68
Q

What is the test of choice to dx intussusception

A

US is test of choice
*target sign is seen

BE is diagnostic and therapeutic

69
Q

What is the treatment of choice for an intussusception

A

Air or barium enema

if unsuccessful -> surgical reduction

70
Q

Which patients have an increased risk of ischemic colitis

A

IBS or COPD

71
Q

What is the patho behind ischemic colitis

A

Hypoperfusion through the IMA

72
Q

When might ischemic colitis present

A

post op from aortic procedures

females more common
generally >65

73
Q

What is the presentation of ischemic colitis

A

LLQ pain / tenderness/cramping
bloody diarrhea
low grade fever

74
Q

What is first line imaging for ischemic colitits

What can confirm dx

A

CT

colonoscopy

75
Q

When is surgery needed with ischemic colitis

A

When full thickness necrosis is present

76
Q

What is overt vs. occult

A

Overt: symptomatic w/ obvious presentation

occult: asymptomatic, no visible blood

77
Q

Where do GI bleeds typically occur

Which patients have a higher mortality rate

A

usually UGI

over 65 and hospitalized

78
Q

What are the common causes of UGI bleed

how about LGI bleed

A

Gastric
esophageal

colonic, anal

79
Q

What is a different presenting symptoms between UGI and LGI bleeds

A

UGI will have hematemesis

80
Q

How do you treat a GI bleed if its a secondary cause from liver disease

A

octreotide

81
Q

How do you treat a GI bleed

A

embo
surgical mngmnt
TIPS if variceal

82
Q

What are common causes of occult bleeding

A

Neaoplasms
PUD
IBD

83
Q

What is the diagnostic test of choice of occult GI bleed

if positive?, if less than 60?, if greater than 60?

A

Fecal occult blood test (FOBT)

Colonoscopy & EGD
check small bowel is less than 60
over 60 + neg = iron

Clin med GI (9 decks)

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