Gastro 10 - Large Intestine Part 3

Question 1

What is diverticulum? What is the plural word for it?

Answer 1

It is a blind pouch. If more than one, it is called Diverticula.

Question 2

What is a true Diverticulum? A False diverticula? Which one is the most common?

Answer 2

A true diverticula has all 3 layers of the gut wall are in the blind pouch. A false diverticula only has mucosa and submucosa.

Question 3

Where do diverticula most commonly form?

Answer 3

In the sigmoid colon.

Question 4

What are the symptoms of diverticulitis?

Answer 4

LLQ pain. Fever. Increased WBC count. Rectal bleeding.

Question 5

What is the treatment for Diverticulitis?

Answer 5

Metronidazole (because there are lots of anaerobic bacteria) plus fluoroquinolones (lots of G(-); levo or ciprofloxacin) or TMP-SMX.

Question 6

What are the traits of Crohn’s disease?

Answer 6

Transmural inflammation. Anywhere in the GI tract, can cause skip lesions (mouth to anus but spares the rectum).

Question 7

What would we see in barium swallow in someone w/ Crohn’s?

Answer 7

A string sign: there is a narrowing of lumen amongst normal lumen.

Question 8

What are the symptoms of Crohn’s disease?

Answer 8

Stricturing. Diarrhea. Malabsorption. Weight loss. Increased risk of colon cancer. Fissures and fistulas. Arthritis, joint problems. Immunologic and dermatological problems. Noncasiating granulomas in lesions.

Question 9

What treatments are available for managing Crohns?

Answer 9

5-ASA (mesalamine, sulfasalazine). Azathioprine, mercaptopurine or methotrexate. Anti-TNF (infliximab, adalimumab). Steroids +/- antibiotics for acute exacerbations.

Question 10

What are the traits of Ulcerative Colitis?

Answer 10

Limited to the colon (inflammation also limited to mucosa and submucosa). It is continuous and always affects rectum.

Question 11

What would we see in a barium swallow of someone with Ulcerative Colitis?

Answer 11

The haustras of the colon are gone, causing a lead pipe appearance of the colon.

Question 12

What do we find in biopsy of lesion of ulcerative colitis?

Answer 12

Crypt abscesses and ulceration.

Question 13

What are the symptoms of Ulcerative Colitis?

Answer 13

Bloody diarrhea. Malnutrition. Increased risk of colon cancer (more than Crohn’s). Primary sclerotic cholangitis (PSC). Pyoderma gangrenosum. Sacroiliitis and uveitis.

Question 14

What is the cure for ulcerative colitis?

Answer 14

Colectomy.

Question 15

What problem is most Common cause of acute RLQ pain?

Answer 15

Appendicitis.

Question 16

What problem is most common cause of acute LLQ pain?

Answer 16

Diverticulitis.

Question 17

What problem is most common cause of RUQ pain?

Answer 17

Cholecystitis.

Question 18

Colonoscopy reveals very friable mucosa extending from rectum to the distal transverse colon. What problem is it?

Answer 18

Ulcerative colitis.

Question 19

RFF: Most common site of colonic diverticula.

Answer 19

Sigmoid.

Question 20

RFF: “String sign” on contrast X-ray.

Answer 20

Crohn disease.

Question 21

RFF: “Lead pipe” appearance of colon on contrast X-ray.

Answer 21

Ulcerative colitis.