Diseases of the Colon Flashcards
True or false: there are villi in the colon.
False.
What symptoms are suggestive of IBD?
Diarrhea Cramps Pain Bleeding Extra-intestinal symptoms (scleritis, episcleritis, erythema nodosum, pyoderma gangrenosum)
__________ can be helpful in diagnosing IBD, but _____________ is the gold standard.
Imaging; endoscopy
Inflammatory bowel disease encompasses which two disorders?
Ulcerative colitis and Crohn’s
What are the similarities and differences between ulcerative colitis and Crohn’s?
Similarities: chronic diarrhea, weight loss, and fatigue
UC:
- lower abdominal pain
- hematochezia
- mucus in stool
- tenesmus
Crohn’s:
- mid abdominal pain
- nausea/vomiting
- fistulas
- steatorrhea
- skip lesions
__________ can occur throughout the GI tract.
Crohn’s
Which IBD disorder has fistulas?
Cronh’s
Which IBD disorder has transmural inflammation?
Crohn’s
True or false: only UC has ulcers.
False. Crohn’s and UC can have ulcers.
Deep, linear ulcers are characteristic of __________, while superficial, confluent ulcers are characteristic of _____________.
Crohn’s; ulcerative colitis
Malabsorption is a feature of _______________.
Crohn’s
What are the basic categories of treatment options for IBD?
- corticosteroids for flares
- surgery for extreme cases or very young patients
- immunomodulators
- 5-aminosalicylates
- TNF-alpha antagonists
It is recommended that those with IBD should have yearly colonoscopies after _______ years with the disease (with biopsies for dysplasia).
seven
The colitis that is more common in elderly females demonstrates thickened ____________ on histologic exam.
collagenous band in submucosa (this being microscopic colitis); this is not noticeable on colonoscopy –hence the “microscopic”
Ischemic colitis is often triggered by ________________.
vasospasm, dehydration, hypotension, or cardiac insult (essentially anything that limits colonic blood flow); think of this in someone who was previously asymptomatic, such as a patient who was admitted to the hospital without GI symptoms and then later developed bloody diarrhea
Causes of ischemic colitis include ______________.
- vasculitis (PAN, HSP, lupus)
- cocaine/amphetamine use
- estrogen or migraine medications
- dehydration (marathon running)
- thrombosis
_________ proctitis is diagnosable by the clinical history.
Radiation
Diverticulosis risk increases with ________________.
age and fat intake
True or false: diverticulosis needs to be aggressively managed.
False. Most are asymptomatic.
Hemorrhage occurs in about ____ percent of those with diverticulosis and is usually in the __________ colon.
5; right (ascending)
What is diverticulitis?
In patients with diverticula, fecoliths can obstruct the outflow and induce abdominal distension, bowel perforation, abdominal pain, and peritonitis.
True or false: diverticulitis needs to be surgically managed.
False. It can be surgically managed –in severe cases – but antibiotics most often cure it.
Topical GI steroids are those that ________________.
do not get absorbed (such as budesonide) and thus coat the GI tract
What does fermentation of chyme contents in the colon produce? What function does this serve?
Fermentation produces trophic factors that lead to growth and maintenance of the mucosal lining as well as increased motility.
What is indeterminant colitis?
A form of IBD with both UC and Crohn’s features (15% of all IBD cases)
Crohn’s occurs most commonly in the ______________.
terminal ileum and ascending colon
Why are strictures seen in Crohn’s?
Because the chronic inflammation leads to fibrosis
True or false: all people with Crohn’s present with granulomas.
False. Only 20%
How does the diarrhea from Crohn’s and UC present?
It is usually small-volume and roughly six times per day.
Extra-intestinal features are more common in _____.
UC
True or false: bad extra-intestinal manifestations typically indicate worsening GI function.
False. Extra-intestinal manifestations do not correlate with GI status.
What is the guideline for colon-cancer screening in IBD?
Those with IBD are at increased risk of colon cancer. Yearly colonoscopies are recommended, and if dysplasia is present, then colectomy is indicated.
How is microscopic colitis treated?
- anti-diarrheals
- bismuth
- topical steroids
- bile-acid binders (cholestyramine)
- aminosalicylates
It is mildly associated with Crohn’s.
What is tenesmus?
Sudden urgency to defecate
How should you treat ischemic colitis?
Treat the underlying cause:
- If the cause is dehydration, give fluids.
- If the cause is decreased cardiac output, give ionotropic agents.
- If the cause is hypoperfusion, treat with vasopressors.
- If the cause is a thrombus, treat with thrombolytics.
Diverticuli are surrounded only by ___________.
serosa, not muscularis propria
Lower-GI bleeding is usually from the ____________.
colon
The causes of lower-GI bleed, in order of decreasing prevalence, are ________________.
diverticulosis, AVM, neoplasia, colitis, and iatrogenic
Volvulus usually occurs in the ____________.
elderly
