Diseases of the colon

Question 1

I. Differentiate ulcerative colitis, and Crohn’s disease

Answer 1

UC- Chronic diarrhea, wt loss, fatigue,

• lower abd pain
• hematochezia, mucous in stool, tenesmus
• colon, no fistula, no stricture, diffuse
• no obstruction, no malabsorption, yes malignant potential, no recurrence after colectomy, yes toxic megacolon

-mucosa +/- SM, superficial, confluent, mild to no fibrosis, no granulomas

Crohns- chronic diarrhea, wt loss, fatigue

• mid or lower abd pain
• nausea/vomiting, steatorrhea, fistula symptoms

-entire gi tract, yes fistula, common strictures, skip lesions

• Transmural, deep linear, marked fibrosis, 20% granulomas
• obstruction yes, malabsorption yes, malignant pot-in colon, recurrence after colectomy, yes, toxic megacolon-no

Question 2

II. State the complications of diverticular disease and their presentation

Answer 2

Hemmorhage- 5%, right colon, vasa recta, painless hematochezia

Diverticulitis- 10-15%, fecolith obstructs a diverticulum
symptoms- lower abd pain, nausea, fever
–> perforations and absesses

Question 3

III. Recognize and differentiate the different causes of lower GI bleeding

Answer 3

Diverticulosis- painless heavy bleeding

AVM- chronic mycrocytic anemia

Colitis- chronic abd pain, diarrhea

Neoplasia- wt loss, anemia, new constipation

Post-polypectomy

Miscellaneous- internal hemmorhoids

Question 4

IV. Describe the presentation and different causes of colonic obstruction

Answer 4

Causes: malignancy, adhesions, strictures, volvulus- twaiting of the colon, foreign objects
Presntation- abd. distention, constipation, obstipation, nausea vomiting
Dx- plain film xray, confirmed and defined with CT
Tx- Surgery

Question 5

V. Recognize the extra-colonic manifestations of inflammatory bowel disease

Answer 5

UC-
-eye-scleritis, episcleritis
-skin pyoderma gangrenosum
erythema nodosum

either-

• liver/bile duct- primary sclerosing changitis, and cholangiocarcinoma
• Joints- Sacroilitis, Ankylosing Spondilitis

Question 6

who gets microscpoic collitis?

Answer 6

elderly females, mild watery diarrhea, 4-10 stools per day

tx with meds

Question 7

how do u Dx microscopic collitis?

Answer 7

biopsy

Question 8

ischemic colitis

Answer 8

elderly, insult to blood flow
acute onset crampy abd pain, urgent need to defecate–> mild diarrhea or hematochezia
scope–> isolated focal edema and ulceration

Question 9

infectious colitis

Answer 9

acute diarrhea +/- hematochezia, hx of traveling or exposure or abx use

Question 10

travelers diarrhea
undercooked beef
contaminated poultry eggs milk lettuce
abx use
anal intercourse

Answer 10

GNR
E.Coli
Salmonella, campylobacter
C diff
Syph, Gonnorhea, HSV

Question 11

presentation of diverticulosis

Answer 11

elderly, low fiber diet, western, 80% non symptomatic, 20% diverticulitis/hemmorhage

Question 12

how do we Dx diverticulitis

Answer 12

imaging

Question 13

lower abd pain + hematochezia

Answer 13

colitis (scope them)