Diseases of the colon

Question 1

area of the colon with greatest water/ion reabsorption

Answer 1

ascending colon

Question 2

area of the colon with predominant bacterial fermentation of nonabsorbed nutrients

Answer 2

transverse colon

Question 3

Three factors of IBD

Answer 3

genetic susceptibility, immune dysregulation, environmental triggers

Question 4

When should you suspect IBD?

Answer 4

suggestive sx (diarrhea, crampy abd, pain, bleeding) > 2 weeks; exclusion of other causes of colitis; extra-intestinal sx

Question 5

Gold standard of dx of IBD

Answer 5

direct visualization and biopsy

Question 6

Differentiate Crohn’s/UC presentation

Answer 6

UC: frank blood, mucus in stool; urge to poop

Crohn’s: nausea/vomiting, fistula sx

Both: diarrhea, weight loss, fatigue, low abd pain

Question 7

Crohn’s macroscopic features

Answer 7

entire GI tract, fistulas/abscesses, strictures are common, “skip lesions”

Question 8

Pathology: transmural inflammation; deep, linear ulcers; marked fibrosis; granulomas

Answer 8

Crohn’s

Question 9

Pathology: mucosal +/- submucosal inflammation; superficial, confluent ulcers; mild/no fibrosis; no granulomas

Answer 9

ulcerative colitis

Question 10

obstruction

Answer 10

Crohn’s

Question 11

Malabsorption

Answer 11

Crohn’s

Question 12

Malignant potential

Answer 12

Crohn’s (with colonic involvement) and UC

Question 13

recurrence after colectomy

Answer 13

Crohn’s

Question 14

Toxic megacolon

Answer 14

UC

Question 15

extraintestinal manifestations

Answer 15

mostly UC

Eye: scleritis, episcleritis

Skin: pyoderma gangrenosum, erythema nodosum

Liver: primary sclerosing cholangitis

Joints: sacroilitis, ankylosing spondylitis

Question 16

IBD management

Answer 16

corticosteroids, 5-aminosalicylates (sulfasalazine, olsalazine, mesalamine, balsalazide), immunomodulators (6-mercaptopurine, azathioprine, methotrexate), TNF-alpha antagonists (infliximab, adalimumab, natalizumab), surgery (colectomy, partial SB resection, stricturoplasty)

Question 17

autoimmune

chronic secretory diarrhea: watery, non-bloody, 4-10x/day, minimal nocturnal or fasting sx

Answer 17

microscopic colitis

Question 18

Microscopic colitis epidemiology

Answer 18

2-5/100,000

old women

Question 19

two subtypes of microscopic colitis

Answer 19

lymphocytic, collagenous

Question 20

prognosis of microscopic colitis

Answer 20

good. no increased cancer risk/mortality

Question 21

pathophysiology of ischemic colitis

Answer 21

triggerd by vasospasm, dehydration, hypotension, cardiopulmonary insult

ischemic colitis in watershed vascular areas (splenic flexure, rectosigmoid)

Question 22

abrupt-onset, crampy low abd pain

urgent need to poop

endoscopy: edema, ulceration, +/- bleeding confined to a vascular region

Answer 22

ischemic colitis

Question 23

inflammatory diarrhea +/- frank blood

Hx: short duration, travel, ill contacts, antibiotic use

Answer 23

infectious colitis

Question 24

Hx of eating undercooked beef

Answer 24

E coli colitis

Question 25

Hx eating contaminated poultry, eggs, milk, lettuce

Answer 25

salmonella/shigella, campylobacter, yersinia colitis

Question 26

Hx antibiotic use, hospitilization

Answer 26

C. difficile colitis

Question 27

Hx anal intercourse

Answer 27

venereal proctitis

Question 28

management of microscopic colitis

Answer 28

antidiarrheals (loperamide, diphenoxylate), bismuth, topical steroids

Question 29

management of infectious colitis

Answer 29

support +/- antibiotics

Question 30

management of ischemic colitis

Answer 30

support, antibiotics, volume support

Question 31

management of drug-induced colitis

Answer 31

support, d/c offending drug

Question 32

management of radiation colitis

Answer 32

topical agents, endoscopic ablation

Question 33

associated with diverticulosis

Answer 33

Western countries, increased intra-colonic pressure, low fiber diet, elderly

Question 34

incidence of diverticular hemorrhage

Answer 34

5% of pts with diverticulosis

Question 35

painless, heavy frank blood, lasting 2-3 days

Answer 35

diverticular hemorrhage

Question 36

does diverticular hemorrhage occur with diverticulitis?

Answer 36

no

Question 37

LLQ pain, nausea, fever

Answer 37

acute diverticulitis

Question 38

pathophysiology of acute diverticulitis

Answer 38

fecolith obstructs a diverticulum --> distension from bacterial gas and neutrophils; microperforation, abscess; macroperforation with peritonitis

Question 39

diverticulitis management

Answer 39

oral/IV antibiotics, abscess drainage, surgery

Question 40

Hx chronic abd pain and diarrhea, excluding other dx

Answer 40

IBD

Question 41

hx weight loss, new constipation, anemia

Answer 41

neoplasia

Question 42

hx sudden onset and cessation of bleeding, elderly

Answer 42

diverticulosis

Question 43

hx frank bleeding after surgery or MI

Answer 43

ischemic colitis

Question 44

hx acute dysentary, travel, ill contacts, or antibiotic use

Answer 44

infectious diarrhea

Question 45

Hx chronic, microcytic anemia

Answer 45

neoplasia or AVMs

Question 46

Hx NSAID use

Answer 46

drug-induced colitis

Question 47

Hx pelvic radiation

Answer 47

radiation proctitis

Question 48

nausea/vomiting, abd distention, constipation or obstipation (severe/complete constipation)

Answer 48

colon obstruction

Question 49

causes of colon obstruction

Answer 49

malignancy, benign (adhesions, strictures, volvulus (twisting)), foreign body