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Diseases of the colon Flashcards

1
Q

area of the colon with greatest water/ion reabsorption

A

ascending colon

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2
Q

area of the colon with predominant bacterial fermentation of nonabsorbed nutrients

A

transverse colon

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3
Q

Three factors of IBD

A

genetic susceptibility, immune dysregulation, environmental triggers

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4
Q

When should you suspect IBD?

A

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

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5
Q

Gold standard of dx of IBD

A

direct visualization and biopsy

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6
Q

Differentiate Crohn’s/UC presentation

A

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

Crohn’s: nausea/vomiting, fistula sx

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

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7
Q

Crohn’s macroscopic features

A

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

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8
Q

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

A

Crohn’s

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9
Q

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

A

ulcerative colitis

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10
Q

obstruction

A

Crohn’s

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11
Q

Malabsorption

A

Crohn’s

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12
Q

Malignant potential

A

Crohn’s (with colonic involvement) and UC

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13
Q

recurrence after colectomy

A

Crohn’s

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14
Q

Toxic megacolon

A

UC

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15
Q

extraintestinal manifestations

A

mostly UC

Eye: scleritis, episcleritis

Skin: pyoderma gangrenosum, erythema nodosum

Liver: primary sclerosing cholangitis

Joints: sacroilitis, ankylosing spondylitis

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16
Q

IBD management

A

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

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17
Q

autoimmune

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

A

microscopic colitis

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18
Q

Microscopic colitis epidemiology

A

2-5/100,000

old women

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19
Q

two subtypes of microscopic colitis

A

lymphocytic, collagenous

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20
Q

prognosis of microscopic colitis

A

good. no increased cancer risk/mortality

21
Q

pathophysiology of ischemic colitis

A

triggerd by vasospasm, dehydration, hypotension, cardiopulmonary insult

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

22
Q

abrupt-onset, crampy low abd pain

urgent need to poop

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

A

ischemic colitis

23
Q

inflammatory diarrhea +/- frank blood

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

A

infectious colitis

24
Q

Hx of eating undercooked beef

A

E coli colitis

25
Q

Hx eating contaminated poultry, eggs, milk, lettuce

A

salmonella/shigella, campylobacter, yersinia colitis

26
Q

Hx antibiotic use, hospitilization

A

C. difficile colitis

27
Q

Hx anal intercourse

A

venereal proctitis

28
Q

management of microscopic colitis

A

antidiarrheals (loperamide, diphenoxylate), bismuth, topical steroids

29
Q

management of infectious colitis

A

support +/- antibiotics

30
Q

management of ischemic colitis

A

support, antibiotics, volume support

31
Q

management of drug-induced colitis

A

support, d/c offending drug

32
Q

management of radiation colitis

A

topical agents, endoscopic ablation

33
Q

associated with diverticulosis

A

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

34
Q

incidence of diverticular hemorrhage

A

5% of pts with diverticulosis

35
Q

painless, heavy frank blood, lasting 2-3 days

A

diverticular hemorrhage

36
Q

does diverticular hemorrhage occur with diverticulitis?

37
Q

LLQ pain, nausea, fever

A

acute diverticulitis

38
Q

pathophysiology of acute diverticulitis

A

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

39
Q

diverticulitis management

A

oral/IV antibiotics, abscess drainage, surgery

40
Q

Hx chronic abd pain and diarrhea, excluding other dx

41
Q

hx weight loss, new constipation, anemia

42
Q

hx sudden onset and cessation of bleeding, elderly

A

diverticulosis

43
Q

hx frank bleeding after surgery or MI

A

ischemic colitis

44
Q

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

A

infectious diarrhea

45
Q

Hx chronic, microcytic anemia

A

neoplasia or AVMs

46
Q

Hx NSAID use

A

drug-induced colitis

47
Q

Hx pelvic radiation

A

radiation proctitis

48
Q

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

A

colon obstruction

49
Q

causes of colon obstruction

A

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

GI (19 decks)

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