Gastrointestinal Disorders - Inflammatory Flashcards
Here is a graphic representation of Diverticular Disease.
What is diverticular disease?
Diverticular disease is also known as Diverticulosis. It is the condition of having diverticula in the colon.
What is a diverticula?
A diverticula is an outpocketing of the colonic mucosa and submucosa through weaknesses of the muscle layers in the colon wall. They are most common in the sigmoid colon. This is likely because the sigmoid colon is a common place for increased intralumen pressure.
What percentage of the population at the age of 45 may experience diverticular disease?
5 - 10%
What percentage of the population at the age of 80 may experience diverticular disease?
80%
What is the etiology and risk factors associated with Diverticular disease?
Poor diet (low fibre), Inactivity, Poor Bowel Habits (constipation, poor motion, infrequent BM’s), Ageing.
What is the pathophysiology of diverticular disease?
Diverticula form when increased intraluminal pressue in the colon causes the mucosa and submucosa to herniate through the muscle wall. This occurs at weaken areas, typically entry points of vessels, due to the highly perfuse nature of the colon. Bowel contents can accumulate in the diverticulum causing infection and inflammation. The diverticulum can also become obstructed. Patients typically present with multiple sites, most commonly in the sigmoid colon.
What is diverticulosis?
Diverticulosis is the formation of an out-pouching, but one which remains open. They are non-inflammed out-pouchings. Typically patients will not know they have it.
What is diverticulitis?
Diverticulitis is an inflammed out-pounching. Diverticulitis can occur when a diverticulum becomes obstructed then inflammed. If the obstruction continues the weakened colon wall can perforate causing irritability and spasticity.
What are 2 complications of Diverticular disease?
Perferation. Obstruction of lumen.
What are the manifestations of diverticulosis?
Diverticulosis is typically asymptomatic
What are the manifestations of diverticulitis?
Diverticulitis often clinically manifests with dull pain, nausea, vomiting, and low grade fever. The pain is typically felt in the lower left quadrant. Leukocytosis (elevated WBC count) may also occure due to acute infection.
What is the treatment for diverticular disease?
Address the etiology and risks with high-fibre, low-fat diet.
What is the treatment for diverticular disease if there is a bowel obstruction or perforation?
Surgery may be required.
What is Irritable Bowel Syndrome (IBS)?
IBS is a gastrointestinal motility disorder. IBS has a wide range of various manifestations and a spectrum of symptoms. It is important to note that IBS has no obvious abnormality of GI structure or function.
What is peristalsis?
Peristalsis is a series of wave-like muscle contractions that moves food to different processing stations in the digestive tract. It begins in the esophagus when a bolus of food is swallowed.
What is the etiology of Irritable Bowel Syndrome? Is IBS linked to any conditions/factors?
The etiology of IBS is unclear. However, it is linked to life-style factors such as diet, stress and smoking. There is also a link between IBS and lactose intolerance.
What is the major problem of Irritable Bowel Syndrome?
The major problem of IBS is a motility problem.
What is the Pathophysiology of IBS?
IBS is thought to be one of three potential pathological issues: 1. Malabsorption of fermentable carbohydrates (CHO) and polyols which when processed by the gut flora lead to flatulance. 2. Alteration of the central nervous system (CNS) regulation of GI motor and sensory function. 3. Molecular signalling defect for serotonin because serotonin is produced in the gut mucosa.
Why is it believed that serotonin plays a role in IBS?
Serotonin is produced in the gut mucosa. It has many different roles: perfusion, secretion, motility and pain. All of these actions (which serotonin is responsible for conductiong with-in the body) are actions goverend by serotonin. These actions also are all the typical IBS manifestations.
What are some of the most common manifestations of IBS?
Abdominal discomfort and pain, Diarrhea and/or constipation, Flatulence, Nausea, Mucoid Stool.
What is Mucoid Stool? Why is the prescence of mucoid stool important in IBS?
Mucoid stool is the presence of mucus in the stool. In IBS the gut increases production of mucus. It is important in the diagnosis of IBS.
What are the two most common IBS manifestations? Explain the alteration of these manifestations.
The two most common manifestations are diarrhea and or constipation. Often, those suffering from IBS will experience periods of constipation follwed by periods of intense diarrhea. This is related to the problems of motility during IBS.
How is IBS diagnosed?
There are no diagnostic tests for IBS. Diagnosis is based on the exclusion of organ diseases and the patient presentation.
What tests might be conducted on an patient with suspected IBS to rule out other diesease?
CBC, Stool Sample, Labs, Various Scopes (endoscopy, colonoscopy, sigmoidoscopy).
What is an endoscopy?
A diagnostic test which inserts a tube with a camera on it into the mouth. It is used to look at the esophagus, stomach, and as far as the duodeum. The upper GI tract. Usually done under sedation.
What is a colonoscopy?
A diagnostic test which insert a camera into the anus to inspect the lower GI tract. Sedation is usually used during the test.
What is a sigmoidoscopy?
A diagnostic test which can be conducted in the Dr office which looks at the colon
How is Irritable Bowel Syndrom treated?
Treatment is based on the severity and type. It is important that triggers are identified, and compications are there-by avoided. Avoid offending food. Reduce stress levels. Pharmacological treatment, drugs.
