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My DEMS I > Diseases of the Colon > Flashcards

Diseases of the Colon Flashcards

1
Q

Right colon func, transverse/desc/sig func

A

r: absorb ions, water
transverse/descending/sigmoid: store waste and indigestible materials

other: bacterial fermentation of nonabsorbed nutrients; elimination of waste and indig materials

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2
Q

Gold standard of IBD dx

A

Direct visualization and biopsy

when:
sx >2 wks (diarrhea, crampy abd pain, bleeding)
Neg work up for other causes
Extra-intest sx

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3
Q

IBD types

A

UC

Crohn’s

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4
Q

UC signs/sx

A

diarrhea
weight loss
fatigue

LOWER abd pain

hematochezia (bright red blood in stool)
mucus in stool
tenesmuc

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5
Q

Crohn’s signs/sx

A

diarrhea
weight loss
fatigue

Mid or lower abd pain

N/v
fistula sx

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6
Q 
Macroscopic features of Crohn's vs UC
bowel region
fistulae or abscess
strictures
distribution
A

*pics 10/19

Bowel region:
Crohn’s: entire GI tract
UC: colon

Fistulae or abscess:
Crohn’s yes
UC no

strictures:
Crohn’s: common
UC: no

Distribution:
Crohn’s: skip lesions
UC: diffuse

UC= “hamburger meat appearance”; pseudopolyps

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7
Q 
Pathologic features of Crohns vs UC
inflammation
ulcers
fibrosis
granulomas
A

Inflammation:
Crohn’s: transmural
UC: mucosa +/- SM

Ulcers:
Crohn’s: deep, linear
UC: superficial, confluent

Fibrosis:
Crohn’s: marked
UC: mild to none

Granulomas:
Crohn’s: yes ~20%
UC: no

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8
Q 
Crohn's vs UC
obstructive
malabsorption
malignant potential
recurrence after colectomy
toxic megacolon
A

Obstructive:
Crohn’s: yes
UC: no

Malabsorption:
Crohn’s: yes
UC: no

Malignant potential:
Crohn’s: with colonic involvement
UC: yes

recurrence after colectomy:
Crohn’s: common
UC: no

toxic megacolon
Crohn’s: no
UC: yes

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9
Q

Types of Crohn’s fistulas

A 
Entero-cutaneous
Entero-enteral
Entero-gastric
Entero-vesical
Entero-vaginal
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10
Q

Extraintestinal manifestations

A

mostly UC

Eye: scleritis, episcleritis

Skin: pyoderma gangrenosum, erythema nodosum

Liver: primary sclerosing cholangitis (PSC)

Joints: sacroiliitis, ankylosing spondylitis

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11
Q

IBD management

A

Corticosteroids (topical or absorbed) - flares

5-aminosalicylates, PO or PR (Sulfasalazine, olsalazine, mesalamine, balsalazide)

Immunomodulators
(6-mercaptopurine, Azathioprine, Methotrexate)

TNF-alpha antagonists (IV or SC)
(Infliximab, Adalimumab, Natalizumab)

Surgery – colectomy, partial SB resection, or stricturoplasty (Refractory disease, obstruction, fistula, HG dysplasia, or cancer)

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12
Q

Colon cancer surveillance and IBD

A
  • risk increases w/ duration
  • yearly colonoscopy after 7-8 yrs
  • bx from every segment
  • LG dysplasia is common in IBD
  • HG dysplasia or cancer–> colectomy
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13
Q

Microscopic colitis

A

2-5 per 100,000 indiv

  • 50-80y, F:M 15:1
  • autoimmune, trigger unknown
  • salt and water loss in colon

Presentation= chronic secretory diarrhea

  • watery, nonbloody
  • 4-10 per day
  • minimal nocturnal or fasting sx

2 subtypes (hist)
lymphocytic colitis
collagenous colitis

Mild assoc w/ celiac

good prognosis (no increased cancer risk, etc)

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14
Q

Dx of microscopic colitis

A

biopsy (bc colonoscopy is usually normal)

LC: lymphocytic infiltration of mucosa and SM

CC: thickened subepi collagenous band

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15
Q

Ischemic colitis

A 
90% >60 y
-most w/o vascular or GI disease
-acute compromise in colonic blood flow
-triggers:
vasospasm
dehydration, hypotension, cardiopulm insult (MI, PE)
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16
Q

Most common areas of ischemic colitis

A

Watershed vascular areas:
splenic flexure
rectosigmoid

17
Q

Presentation of ischemic colitis

A

Abrupt-onset, crampy, lower abdominal pain
Urgent need to defecate
Mild diarrhea and/or hematochezia
(Severe diarrhea or bleeding– diff dx)

Endoscopic findings - edema, ulceration, +/- bleeding confined to a vascular region

Complete recovery usually in 1-2 weeks

Less common causes:
Vasculitis – Lupus (SLE), Polyarteritis Nodosa (PAN), Henoch-Schonlein
Substance abuse - cocaine, amphetamines
Medications - estrogens, migraine medications
Mesenteric thrombosis - Protein C/S deficiency, Factor V Leiden def., etc.
Rare: Marathon running, extreme dehydration

18
Q

Infectious colitis

A

-inflammatory diarrhea +/- hematochezia (mucosal invasion; toxin related injury)

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

Ex: pseudomembranes seen w/ C. diff

Undercooked beef: E. coli
Poultry, eggs, milk, lettuce: salmonella/shigella, campylobacter, yersinia
Abx use/hosp: C. diff
Anal intercourse: venereal proctitis

19
Q

Non IBD colitis management

A

Microscopic colitis – antidiarrheals (loperamide, diphenoxylate), Bismuth, topical steroids

Infectious colitis – support, +/- antibiotics

Ischemic colitis – support, antibiotics, volume support

Drug-induced – support, d/c offending drug

Radiation colitis – topical agents, endoscopic ablation

Surgery – rare; severe/refractory cases

20
Q

Diverticulosis

A

> 50% in the elderly

Western >developing (increased intracolonic, pressure, low fiber)

80% asymptomatic

20% diverticulitis, hemorrhage

(endoscopy shows large “holes”)

21
Q

Diverticular hemorrhage

A

5% of patients with diverticulosis

Usually from RIGHT colon

Vasa recta within the dome of diverticulum

Painless hematochezia, often heavy, typically stops w/in 2-3 days

Does NOT occur with diverticulitis

22
Q

Acute diverticulitis

A

10-15% of patients w/ diverticula

Fecolith obstructs diverticulum:
Distension from bacterial gas and neutrophils
Microperforation, abscess
Macroperforation with peritonitis

Sx: LLQ pain, nausea, fever

23
Q

Management of diverticulitis

A

Diagnosis: CT or MRI
Tx: oral or IV abx; abscess drainage; surgery

Strictures may require dilation or resection

24
Q

Lower GI bleeding

A

Bleeding distal to ligament of Treitz

colonic bleeding&raquo_space;> SB bleeding

Usually hematochezia, less commonly melena

Mort: 1-2%
(UGI bleed higher)

Ceases w/o intervention in most

Recurs freq w/o cause ID

25
Q

Lower GI Bleeding etiologies

A 
Diverticulosis
AVM
Colitis
Neoplasm
Radiation colitis
Post-polypectomy or biopsy
Miscellaneous:
Internal hemorrhoids
Solitary rectal ulcer
Anal fissure
Dieulafoy’s lesions
26
Q

Chronic abdominal pain and diarrhea

A

IBD

27
Q

weight loss, new constipation, anemia

A

neoplasia

28
Q

Sudden onset & cessation of bleeding, elderly patient

A

diverticulosis

29
Q

Hematochezia after surgery or MI

A

ischemic colitis

30
Q

Acute dysentery, travel, ill contacts, or antibiotic use

A

infectious diarrhea

31
Q

Chronic, microcytic anemia

A

neoplasia or AVMs

32
Q

NSAIDs

A

drug induced colitis

33
Q

History of pelvic radiation

A

Radiation proctitis

34
Q

Dx/tx lower GI bleeding

A

Diagnosis
Colonoscopy
Tagged rbc scan
Angiography

Treatment
Support
Endoscopic therapy
Angiographic therapy
Surgical resection:
-Refractory bleeding
-Recurrent bleeding
35
Q

Colon obstruction

A 
N/V, abd. distension, constipation or obstipation
Diagnosis
Tentative - plain x-ray
Confirmed and defined with CT
Causes
Malignancy
Benign – adhesions, strictures, volvulus
Foreign body – inserted or ingested
Tx:
Admission to hospital, NPO
NGT tube decompression
Colonoscopy if suspected cancer or volvulus
Surgical resection is standard 
Metal stent for select patients

My DEMS I (26 decks)

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