Diseases of the Colon

Question 1

What are the similarities between Crohn’s disease and ulcerative colitis?

Answer 1

• IBD: chronic, dysregulated inflammation of small/large intestine
• chronic diarrhea
• Weight loss
• Fatigue

Question 2

What are the differences between Crohn’s disease and ulcerative colitis?

Answer 2

UC

• Lower abd pain
• Hematochezia
• Mucus in stool
• Tenesmus
• Localized to colon
• No fistulae, abscesses, or strictures
• Diffuse distribution
• Mucosal/submucosal inflammation
• superficial/confluent ulcers
• mild to no fibrosis
• no granulomas
• malignant potential

Crohn’s

• Mid or lower abd pain
• N/V
• Steatorrhea
• Fistula symptoms
• “Tongue to bum” - entire GI tract
• Strictures are common
• “Skip lesions” distribution
• Transmural inflammation
• Deep, linear ulcers
• Marked fibrosis
• ~20% have granulomas
• Obstruction and malabsorption
• Can recur after colectomy

Question 3

What are the complications of diverticular disease and their presentation?

Answer 3

Complications:

• Hemorrhage
• Acute diverticulitis

Presentation:

• 80% are asymptomatic
• > 50% are elderly
• Hemorrhage: painless hematochezia often heavy and stops w/in 2-3 days
• Diverticulitis: lower abd pain, nausea, fever

Question 4

What are the causes of lower GI bleed?

Answer 4

• Diverticulosis
• Arteriovenous malformations
• Colitis (IBD usually)
• Neoplasia
• Post-polypectomy or biopsy

Misc

• Internal hemorrhoids
• Solitary rectal ulcer
• Anal fissure
• Dieulafoy’s lesions

Question 5

What is the presentation of lower GI bleeding?

Answer 5

Presentation varies based on cause. Determining the stuff below helps you figure out the cause

• Chronic vs acute vs no pain
• Diarrhea?
• Wt loss?
• NSAIDs?
• H/o radiation?
• Heavy vs light bleeding
• Travel history?
• Dysentery?
• Antibiotic use?
• Recent surgery

You get the idea. Go look at his “historical clues” slide — he said test questions would be based on it

Question 6

What are the causes of colonic obstruction?

Answer 6

• Malignancy
• Benign (adhesions, strictures, volvulus)
• Foreign body

Question 7

What is the presentation of colonic obstruction?

Answer 7

• N/V
• Abd distension
• Constipation
• Obstipation

Question 8

What are the causes of colitis?

Answer 8

Microscopic

Ischemic

• Vasculitis
• Substance abuse (cocaine, meth)
• Rx
• Mesenteric thrombosis
• Rare: marathon running, extreme dehydration

Infectious

Radiation

Question 9

How can you differentiate colitis from diverticulitis?

Answer 9

a