Gastrointestinal and Nutritional Flashcards
1
Q
What are the causes of epigastric pain?
A
PUD, gastritis, MI, pancreatitis, biliary colic, gastric volvulus, Mallory-Weiss
2
Q
What are the causes of RUQ pain?
A
cholecystitis, hepatitis, PUD, perforated ulcer, pancreatitis, liver tumors, gastritis, hepatic abscess, choledocholithiasis, cholangitis, pyelonephritis, nephrolithiasis, appendicitis (especially during pregnancy), thoracic causes (e.g, pleurisy/pneumonia), PE, pericarditis, MI (especially inferior MI)
3
Q
What are the causes of LUQ pain?
A
PUD, perforated ulcer, gastritis, splenic injury, abscess, reflux, dissecting aortic aneurysm, thoracic causes, pyelonephritis, nephrolithiasis, hiatal hernia (strangulated paraesophageal hernia), Boerhaave’s syndrome, Mallory-Weiss tear, splenic artery aneurysm, colon disease
4
Q
What are the causes of LLQ pain?
A
diverticulitis, sigmoid volvulus, perforated colon, colon cancer, urinary tract infection, small bowel obstruction, inflammatory bowel disease, nephrolithiasis, pyelonephritis, fluid accumulation from aneurysm or perforation, referred hip pain, gynecologic causes, appendicitis (rare)
5
Q
What are the causes of RLQ pain?
A
appendicitis! and same as LLQ; also mesenteric lymphadenitis, cecal diverticulitis, Meckel’s diverticulum, intussusception
6
Q
What is the presentation of acute/chronic cholecystitis?
A
45-year old woman with RUQ pain for 12 hours, fever, and leukocytosis
- 5 Fs: female, fat, forty, fertile, fair
- (+) Murphy’s sign (RUQ pain with GB palpation on inspiration)
- RUQ pain after a high-fat meal
7
Q
How is acute/chronic cholecystitis dx?
A
- ultrasound if the preferred initial imaging
- gallbladder wall > 3 mm, pericholecystic fluid, gallstone
- HIDA is the best test (gold standard)
- porcelain gallbladder = chronic cholecystitis
8
Q
What is the tx for acute/chronic cholecystitis?
A
cholecystectomy
9
Q
What is acute pancreatitis?
A
epigastric abdominal pain with radiation to the back and elevated lipase
10
Q
What is the etiology of acute pancreatitis?
A
cholelithiasis or alcohol abuse
11
Q
How is acute pancreatitis dx?
A
- clinical + elevated lipase and amylase
- CT required to differentiate from necrotic pancreatitis
12
Q
What are the signs of acute pancreatitis?
A
grey turner’s sign (flank bruising) and Cullen’s sign (bruising near umbilicus)
13
Q
What is ransoms criteria for poor prognosis of acute pancreatitis?
A
at admit: -age > 55 -leukocyte >16,000 -glucose >200 -LDH >350 -AST >250 at 48 hours: -arterial PO2 <60 -HCO3 <20 -calcium < 8.0 -BUN increased by 1.8+ -hematocrit decrease by 10% -fluid sequestration > 6 L
14
Q
What is the tx for acute pancreatitis?
A
IV fluids (best), analgesics, bowel rest
15
Q
What are the complications of acute pancreatitis?
A
pancreatic pseudocyst (a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue)
16
Q
What is chronic pancreatitis?
A
the classic triad of pancreatic calcification (plain abdominal x-ray), steatorrhea (high fecal fat), and diabetes mellitus
-alcohol abuse
17
Q
What is the tx of chronic pancreatitis?
A
no alcohol, low-fat diet
18
Q
What are the characteristics of anal fissure?
A
- small split or tear in the anal mucosa
- there may be blood on the outside of the stool or on the toilet tissue following a bowel movement
- anal fissures are extremely common in your infants but may occur at age
- studies suggest 80% of infants will have had an anal fissure by age one
- most fissures heal on their own
- vertical fissures = most common
- horizontal fissures = Crohn’s dz, HIV
19
Q
What is the tx of anal fissures?
A
stool softeners, bulk, petroleum jelly
-these measures generally heal more than 90% of anal fissures
20
Q
What is anorectal abscess?
A
- infection of an anal fissure, STDs, and blocked anal glands are common causes of anorectal abscesses
- deep rectal abscesses may be caused by intestinal disorders such as Crohn’s disease or diverticulitis
21
Q
What is the tx for anorectal abscess?
A
I&D, warm sitz baths, pain medication and antibiotics
22
Q
What is an anorectal fistula?
A
open tract between two epithelium-lined areas and is associated with deeper anorectal abscesses
-fistulae will produce anal discharge and pain when the tract becomes occluded
23
Q
What are the characteristics of appendicitis?
A
the first symptom is crampy or “colicky” pain around the navel (periumbilical)
- there is usually a marked reduction in or total absence of appetite, often associated with nausea, and occasionally, vomiting and low-grade fever
- as the inflammation increases, the abdominal pain tends to move downward - begins in epigastrium - umbilicus - RLQ
- right lower quadrant = “McBurney’s point”
- this “rebound tenderness” suggests inflammation has spread to the peritoneum
24
Q
What are the signs of appendicitis?
A
- Rovsing - RLQ pain with palpation of LLQ
- Obturator sign - RLQ pain with internal rotation of the hip
- Psoas sign - RLQ pain with hip extension
25
How is an appendicitis dx?
- imaging if atypical presentation - apply ultrasound or abdominal CT scan
- CBC - neutrophilic supports the diagnosis
26
What is the tx for appendicitis?
surgical appendectomy
27
What are the guidelines for bariatric surgery?
- BMI > 40 (basically 100 pounds above ideal body weight) or
- BMI > 35 with a medical problem related to morbid obesity
- individuals must have failed other non-surgical weight loss programs
- they must be psychologically stable and able to follow post-op instructions
- obesity is not caused by a medical disease such as endocrine disorders
28
How is BMI measured?
body weight in kg divided by height in meters squared
29
What are the characteristics of bowel obstruction?
colicky abdominal pain, nausea, bilious vomiting, obstipation, abdominal distention, hyperactive bowel sounds (early) or hypoactive bowel sounds (late), prior abdominal surgery
30
What are the characteristics of large bowel obstruction?
gradually increasing abdominal pain with longer intervals between episodes of pain, abdominal distention, obstipation, less vomiting (feculent), more common in the elderly
31
What should you look for in bowel obstruction?
- look for vomiting of partially digested food, severe abdominal dissensions and high pitch hyperactive bowel sounds progressing to silent bowel sounds
- KUB shows dilated loops of bowel with air-fiuid levels with little or no gas in the colon
32
What is the treatment of bowel obstruction?
bowel rest, NG tube placement, surgery as directed by underlying cause
33
What is cholangitis?
RUQ pain, jaundice, and fever
-a complications of gallstones with symptoms secondary to an infected obstruction of the common bile duct (E.coli is the #1 cause)
34
What is Charcot's triad?
RUQ tenderness, jaundice, fever
35
What is Reynold's pentad?
Charcot's triad + altered mental status and hypotension
36
What is the dx and tx for cholangitis?
ERCP is the optimal procedure both for diagnosis and for treatment
37
What is cholelithiasis and choledocholithiasis?
a precursor to cholecystitis, cholesterol stones account for >85% of gallstones in the Western world
38
What is colorectal carcinoma?
painless rectal bleeding and a change in bowel habits in patients 50-80 years of age
39
What are the characteristics of colorectal carcinoma?
- apple core lesion on barium enema, adenoma most common type
- Tumor Marker: CEA
- more likely to be malignant: sessile, >1 cm, villous
- less likely to be malignant: pedunuclated, < 1 cm, tubular
40
What is the tx of colorectal carcinoma?
resection and adjuvant chemotherapy
41
How is constipation defined?
as less than 2 bowel movements per week
42
What is obstipation?
a severe form of constipation, where a person cannot pass stool or gas
43
What are the signs and symptoms of a small bowel obstruction?
colicky abdominal pain, nausea, bilious vomiting, obstipation, abdominal distention, hyperactive bowel sounds (early) or hypoactive bowel sounds (late), prior abdominal surgery
44
What are the signs and symptoms of a large bowel obstruction?
gradually increasing abdominal pain with longer intervals between episodes of pain, abdominal distention, obstipation, less vomiting (feculent), more common in the elderly
45
What is an illeus?
- hypomotility of the gastrointestinal tract in the absence of mechanical bowel obstruction
- illeus that persists for more than 3 d following surgery is termed postoperative dynamic ileum or paralytic ileus
- signs: absent bowel sounds
- CT scan with gastrografin - must exclude mechanical obstruction
46
What is gastroparesis?
- a condition that affects the stomach muscles and prevents proper stomach emptying
- MCC: diabetes
47
What is pseudomembranous colitis?
- inflammation of the colon caused by the bacteria clostridium difficile
- occurs secondary to treatment with antibiotics with broad-spectrum antibiotics - pencilling, cephalosporins, and FQ
- mild watery foul-smelling diarrhea (>3 but < 20 stools/day)
- IV metronidazole OR PO vancomycin (this is the only use for oral vancomycin)
48
What is diverticular disease?
LLQ pain, tenderness, abdominal distention, fever, and leukocytosis in older patients
- inflammation of an abnormal pouch (diverticulum) in the intestinal wall, usually found in the large intestine
- the presence of the pouches themselves is called diverticulosis
- when they become inflamed, the condition is known as diverticulitis
49
What are the characteristics of diverticular disease?
- left-sided Appy
- most common location: sigmoid colon
- fevers/chills/nausea/vomiting/left-sided abdominal pain
50
How is diverticular disease dx?
abdominal/pelvic CT scan revealing fat stranding and bowel wall thickening
-the most common cause of massive lower gastrointestinal bleedings
51
What is the tx of diverticular disease?
ciprofloxacin or augmentin/+ metronidazole (flagyl)
- recurrent attacks or presence of perforation, fistula, or abscess requires surgical removal of the involved portion of the colon
- treat by increasing the bulk in the diet with high-fiber foods and bulk additives such as Metamucil
52
What is esophageal cancer?
progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis
-squamous cell m/c worldwide and adenocarcinoma common in the US
53
What is adenocarcinoma of the esophagus?
a complication of Barrett's esophagus (screen Barrett's patients every 3-5 years with endoscopy), affects distal (lower) 1/3rd of the esophagus
54
What is squamous cell of the esophagus?
- associated with smoking and alcohol use
- affects proximal (upper) 2/3rds of the esophagus
- progressive dysphagia, weight loss, hoarseness
- diagnostic studies: endoscopy + biopsy
- treatment: resection
55
What is an esophageal strictures?
solid food dysphagia in a patient with a history of GERD
- GERD and scleroderma
- ingestion of corrosive substances
- viral or bacterial infections
56
What are the symptoms of esophageal strictures?
difficulty and painful swallowing, weight loss, regurgitation of food
57
What is esophageal achalasia?
primary esophageal motility disorder characterized by the absence of lower esophageal peristalsis
-difficulty swallowing caused by a failure of the LES to relax and poor peristaltic waves, production a motor disorder signified by initial complaints of dysphagia for solids and liquids
58
How is esophageal strictures dx?
barium swallow shows there is acute tapering at the lower esophageal sphincter and narrowing at the gastroesophageal junction, producing a "bird's beak" or "rat's tail" appearance - distal 2/3 most common
-esophageal manometry is the best test to diagnosis shows the absence of esophageal peristalsis
59
What is the tx for esophageal strictures?
EGD dilation of the esophagus or myotome is the preferred treatment
60
What is an esophageal web?
thin membranes in the mid-upper esophagus
| -may be congenital or acquired
61
What is plummer-vinson?
esophageal webs + dysphagia + iron deficiency anemia
62
What is a schatzki ring?
a diaphragm-like mucosal ring that forms at the esophagogastric junction (the B ring)
-if the lumen of this ring becomes too small, symptoms occur
63
What is gastric cancer?
presents with weight loss, abdominal fullness/pain, anemia, early satiety, melena, anorexia, guaiac positive stool
- adenocarcinoma
- the incidence is extremely high in Japan, Chile and iceland
64
What are the risk factors for gastric cancer?
- a family history of gastric cancer
- gastric ulcers
- Helicobacter pylori
- pernicious anemia
65
What are the sx of gastric cancer?
- a loss of appetite
- difficulty swallowing, particularly difficulty that increases over time
- vague abdominal fullness
- nausea and vomiting weight loss
- abdominal fullness prematurely after meals
66
How is gastric cancer dx?
EGD (esophagogastroduodenoscopy) and biopsy showing gastric cancer
- a CBC showing microcytic/hypochromic anemia
- postive guaiac
67
What is the tx for gastric cancer?
radiation therapy and chemotherapy can be beneficial but the prognosis is poor
68
What is heartburn and dyspepsia?
dyspepsia and abdominal pain are common indications of gastritis
69
What are the causes of heartburn and dyspepsia?
- autoimmune or hypersensitivity reaction (e.g pernicious anemia)
- infection - H. pylori (most common)
- inflammation of the stomach lining (NSAIDs and alcohol)
70
What are the characteristics of autoimmune or hypersensitivity reaction?
- location: body of the fundus
| - pernicious anemia + schilling test + decrease intrinsic factor and parietal cell antibodies
71
What are the characteristics of infection - H. pylori?
- location: antrum and body
- studies: urea breath test or fecal antigen
- treatment: PPI (ie. omeprazole) + clarithromycin + amoxicillin +/- metronidazole
72
What are the characteristics of the inflammation of the stomach lining?
- NSAIDs: cause gastric injury by diminishing oral prostaglandin production in the stomach and duodenum
- alcohol: a leading cause of gastritis
73
What is the etiology of peptic ulcer disease?
H. pylori (most common), NSAID use, Zollinger-Ellison syndrome (refractory PUD) - gastrin-secreting tumor
- duodenal ulcer - pain improved with food
- gastric ulcer - pain worsen with food
74
How is peptic ulcer disease dx?
endoscopy with biopsy is the gold standard for diagnosis
75
What is the tx for peptic ulcer disease?
- H. pylori infection: triple therapy PPI (omeprazole) + clarithromycin + amoxicillin +/- metronidazole
- NSAIDs use: discontinue use
- Zollinger-Ellison syndrome: PPI and resect the tumor
76
What are the signs and symptoms of peptic ulcer disease?
hematemesis, abdominal discomfort, dull pain
77
What are the signs and symptoms of esophageal varices?
hematemesis, bleeding, difficulty swallowing
78
What are the signs and symptoms of alcohol abuse?
physical dependence, craving, vomiting
79
What are the signs and symptoms of Mallory-Weiss syndrome?
a tear in the lining of the stomach just above the esophagus caused by violent retching or vomiting
80
What are the signs and symptoms of coagulation disorders?
characterized by a decreased ability to form a clot
81
What are the signs and symptoms of esophageal cancer?
progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis
82
What are the signs and symptoms of Gastrointestinal System Neoplasms?
abdominal pain and unexplained weight loss are most common symptoms along with reduced appetite, anorexia, dyspepsia, early satiety, nausea and vomiting, anemia, melena, guaiac-positive stool
83
What is an hemorrhoid?
very common especially during pregnancy and after childbirth
- constipation, prolonged sitting during bowel movements
- bright red blood in the stool
- anal itching
84
What is the tx for a hemorrhoid?
stool softness, corticosteroid, sitz baths
| -internal hemorrhoids = rubber band ligation
85
What is hepatic carcinoma?
abdominal pain, weight loss, right upper quadrant mass
86
What is the etiology of hepatic carcinoma?
cirrhosis, hepatitis B, hepatitis C, hepatitis D, aflatoxin from aspergillus
-tumor marker: increase alpha-fetoprotein and abnormal liver imaging
87
What is the tx for hepatic carcinoma?
resection, transplant - poor prognosis
88
What is an indirect inguinal hernia?
(most common): passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrotum
-often congenital and will present before age one
89
What is a direct inguinal hernia?
passage of intestine through the external inguinal ring at Hesselbach's triangle, rarely enters the scrotum
90
What is a ventral hernia?
often from previous abdominal surgery, obesity
| -abdominal mass noted at the site of previous incision
91
What is an umbilical hernia?
very common, generally is congenital and appears at birth
- many umbilical hernias resolved on their own and rarely require intervention
- refer to surgery if an umbilical hernia persists >2 years of life
92
What is a strangulated hernia?
hernia becomes strangulated when the blood supply of its contents is seriously impaired
93
What is an obstructed hernia?
this is an irreducible hernia containing intestine that is obstructed from without or within, but there is no interference to the blood supply to the bowel
94
What is an incarcerated hernia?
hernia so occluded that it cannot be returned by manipulation, it may or may not become strangulated
95
What is a hiatal hernia?
diaphragmatic: involves protrusion of the stomach through the diaphragm via the esophageal hiatus
- it can cause symptoms of GERD
96
What is the tx for a hiatal hernia?
acid reduction may suffice, although surgical repair can be used for more serious cases
97
What is Crohn's disease?
any part of the GI tract from the mouth to the anus
98
What are the characteristics of Crohn's disease?
- "skip areas" with transmural (full-thickness)
- young adults (20-40) 2 to 3 times more common in jews
- Pathology: antibodies against intestinal epithelia cells
- appearance leading to the typical "cobblestone"
99
What are the sxs of Crohn's disease?
cramping, tenderness, flatulence, N/V/D, F/C, mild bleeding or may be massive, diarrhea (4 to 6 times/day), RLQ pain, steatorrhea, marked weight loss
- obstruction, fistulas, abscesses, and perforation
- malabsorption of B12, megaloblastic anemia
100
How is Crohn's dx?
barium "string sign" (segments of stricture separated by normal bowel) BX
101
What is the tx for Crohn's?
maintenance meds: sulfasalazine (azulfidine)
- mesalamine
- prednisone during flare-up
- restrict fiber in the diet
102
What is ulcerative colitis?
- acute inflammation of the large bowel rectosigmoid area
- increase risk of colorectal CA
- pathology: cause is unknown, antibodies that cross-react with intestinal epithelial cells and certain serotypes of E. coli, food allergy to proteins
- mucosal surface shows superficial ulcerations area is greatly thickened and rigid "lead pipe"
- backwash iritis can be seen in UC versus ileitis which is seen in Crohn's
103
What are the sxs of ulcerative colitis?
bloody diarrhea containing pus and mucus
- n/v, abdominal pain, spastic rectum, anus
- anemia (Fe++ deficiency)
- coagulation defects dur to Vit K deficiency
- erythema nodosum, uveitis, toxic megacolon
104
How is ulcerative colitis dx?
sigmoidoscopy and bx
105
How is the tx for ulcerative colitis?
maintenance meds: sulfasalazine
- mesalamine, NSAIDs
- prednisone during flare-ups
- antispasmodics only used for patients with frequent and troublesome diarrhea may precipitate toxic megacolon
106
What is the serum bilirubin for jaundice?
>2.5 mg/dl
107
What are the causes of postoperative jaundice?
- prehepatic
- hepatic
- posthepatic
108
What are the causes of prehapatic jaundice?
hemolysis (prosthetic valve), resolving hematoma, transfusion reaction, post cardiopulmonary bypass, blood transfusions (decreased RBC compliance leading to cell rupture)
109
What are the causes for hepatic jaundice?
drugs, hypotension, hypoxia, sepsis, hepatitis, "sympathetic" hepatic inflammation from adjacent right lower lobe infarction of the lung or pneumonia, preexisting cirrhosis, right-sided heart failure, hepatic abscess, pyelphlebitis (thrombosis of portal vein), Gilbert syndrome, Crigler-Najjar syndrome, Dubin-Johnons syndrome, fatty infiltrate from TPN
110
What are the causes for posthepatic jaundice?
choledocholithiasis, stricture, cholangitis, cholecystitis, biliary-duct injury, pancreatitis, sclerosing cholangitis, tumors (e.g cholangiocarcinoma, pancreatic cancer, gallbladder, metastases), biliary stasis (e.g ceftriazone)
111
What is melena?
black tarry stool - upper GI bleed
112
What are the causes of melena?
gastric cancer, duodenal ulcers, right-sided colon cancer, portal hypertension with esophageal varices, severe erosive esophagitis, Mallory-Weiss syndrome
113
What is hematochezia?
bright red blood per rectum (BRBPR) - lower GI bleed
114
What are the causes of hematochezia?
hemorrhoids, anal fissure, polyps, proctitis, rectal ulcers, and colorectal cancer
-diverticulosis is generally an incidental finding, since diverticular bleeding is usually of greater volume
115
What is postoperative nausea and vomiting?
an unpleasant complication affecting 30 percent of children and adults after anesthesia
-vomiting or retching can result in wound dehiscence, esophageal rupture, aspiration, dehydration, increased intracranial pressure, and pneumothorax
116
What is the cause of nausea?
can have causes that aren't due to underlying disease
- examples include motion such as a car and plane, taking pill on an empty stomach, eating too much or too little, or drinking too much alcohol
- gastroenteritis
- common cold
- migraine headache
- food poisoning
- influenza virus
- pyloric stenosis
- peptic ulcer disease
- hiatal hernia
117
What is pancreatic carcinoma?
an elderly man with large nontender palpable gallbladder (Courvoisier's sign)
-painless jaundice is pathognomonic
118
What are the characteristics of pancreatic carcinoma?
- the 4th leading cause of death form cancer in the U.S.
- the disease is slightly more common in men than in women and risk increases with age
- the cause is unknown, but the incidence is greater in smokers
- almost one-third of cases of pancreatic carcinoma can be attributed to cigarette smoking and ETOH abuse
- most commonly ductal adenocarcinoma located at the pancreatic head
119
What is the presentation of pancreatic carcinoma?
- weight loss/epigastric pain, clay-colored stools
- jaundice + palpable non-tender gallbladder (Courvoisier's sign)
- virchow's node (or signal node) is a lymph node in the left suprclavicular fossa (the area above the left clavicle) that is associated with pancreatic cancer
120
How is pancreatic carcinoma dx?
- ERCP
- abdominal CT scan: 75% show tumor at the head of the pancreas, 25% at the tail
- pancreatic bx
- abdominal MRI
- elevated serum bilirubin
- abnormal liver function tests
- CA 19-9 is present in about 80% of patients who have pancreatic cancer
121
What is the tx of pancreatic carcinoma?
- at the time of diagnosis, only about 20% of pancreatic tumors can be removed by the standard procedure is called a pancreaticoduodenectomy (Whipple procedure)
- when the tumor is confined to the pancreas but cannot be removed, a combination of radiation therapy and chemotherapy may be recommended
122
What is pancreatic pseudocyst?
pancreatitis and a palpable epigastric mass
- cystic collection of tissue, fluid, and necrotic debris surrounding the pancreas
- classically occur 2-3 weeks after acute pancreatitis
- presents with abdominal pain and a palpable epigastric mass
- CT scan is the study of choice
123
What is the tx for pancreatic pseudocyst?
if pseudocyst persists for 4-6 weeks or continues to enlarge
- surgical decompression (pancreaticogastrostomy)
- percutaneous drainage
- can become infected and lead to peritonitis
124
What is peptic ulcer disease?
duodenal ulcer (food classically relieves pain think duodenum = decease with food)
- ct scan is the study of choice
- gastric ulcer (food classically causes pain)
125
What is pyloric stenosis?
an infant with projectile vomiting
- palpable epigastric olive-shaped mass (is pathognomonic for the disorder)
- on ultrasound, you will see a "double-track"
- barium studies will reveal a "string sign" or "shoulder sign"
126
What is the treatment for pyloric stenosis?
by pyloromyotomy - known as Ramstedt procedure
127
What is small bowel carcinoma?
the most common presenting symptom of small bowel tumor is abdominal pain-typically intermittent and cramps in nature
128
What are the characteristics of small bowel carcinoma?
- adenocarcinomas represent from 25 to 40 percent of small bowel cancers - highest in the duodenum
- Crohn's disease predisposes to adenocarcinoma within the involved area of the small intestine
129
How is small bowel carcinoma dx?
radiographic (computed tomography [CT] scan, small bowel series, enteroclysis ) or endoscopic (wireless capsule endoscopy, push enteroscopy, double-balloon endoscopy)
130
What is the tx for small bowel carcinoma?
surgery - localized adenocarcinomas of the small bowel are best managed with wide segmental surgical reaction
-adjuvant chemotherapy to patients with lymph node-positive
131
What is toxic megacolon?
a 24-year old man with ulcerative colitis receives Lomotil for excessive diarrhea and develops fever, abdominal pain and tenderness, and a massively dilated colon on abdominal x-ray
- toxic patient: sepsis, febrile, abdominal pain
- megacolon: acutely and massively distended colon
- can occur with IBD (UC>Crohn's)
132
What is the tx for toxic megacolon?
decompression of the colon is required
| -In some cases, colostomy or even complete clonic resection may be required
