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aa Step 2CK: Internal & Peds > GI- Colon > Flashcards

GI- Colon Flashcards

1
Q

Define Diverticulosis

A

Characterized by sac-like mucosal projection through the muscular layer of the colon and/ or rectum.
Caused in part by a low-fiber, high fat diet.

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2
Q

Complications of Diverticulosis

A 
GI Bleed (painless)
Diverticulitis (inflammation of the diverticulum)

Diverticulitis complications:

  • Abscess formation
  • Fistula formation
  • sepsis
  • large bowel obstruction
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3
Q

Signs and symptoms of diverticulosis/ diverticulitis

A 
LLQ pain and tenderness
Diarrhea or constipation
Bleeding
Leukocytosis 
Fever

Infection symptoms indicate diverticulitis

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4
Q

Cause of diverticulitis

A

stool or other debris impacts within the outpouched mucosa, causing obstruction leading to overgrowth of bacteria and inflammation

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5
Q

Diagnosis of diverticulitis / diverticulosis

A

ITIS: Best initial and confirmation- CT scan. CT rules out complications.

OSIS: most accurate is colonoscopy

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6
Q

Tx diverticulitis

A

W/o complications: ABX - cover bowel flora (fluoquinolone or ceftriaxone + metro), bowel rest (NPO),

Perf or abscess: may need surgical resection.

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7
Q

Post diverticulitis follow up

A

Colonoscopy for cancer screening ( colon carcinoma with perf can mimic diverticulitis)
Avoid endoscopy during active diverticulitis (risk of perf)

Maintain high fiber diet.

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8
Q

Prevention of diverticulitis

A

Bran
Psyllium
Methycelulose
Increased dietary fiber

decrease rate of progression and complications

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9
Q

How is diarrhea categorized?

A
  1. Systemic
  2. Osmotic
  3. Secretory
  4. Malabsorptive
  5. Infectious
  6. Infectious
  7. Exudative
  8. Altered Intestinal transit.
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10
Q

Define osmotic diarrhea

A

Caused by non absorbable solutes that remain in the bowel, where they retain water (lactose or sugar intolerance).
When ingestions of offending substance stops, diarrhea stops.

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11
Q

What causes secretory diarrhea?

A

Results when the bowel secretes too much fluid. often due to bacterial toxins, VIPoma, or bile acids.

persists even when patient stops eating.

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12
Q

What are common causes of malabsortive diarrhea?

A

Celiacs disease
Crohns disease
Postgastroenteritis (depletion of brush boarder)

improves with bowel rest.

rare causes: tropical sprue and Whipple disease

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13
Q

Common clues to infectious diarrhea

A
  • Fever
  • WBC in stool (invasive app only)
  • Travel history
  • Hikers/stream water
  • Hx abx use (c.diff)
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14
Q

Common organisms of infectious diarrhea

A

Invasive: Shigella, Salmonella, Yersinia, Campylobacter

E.coli
Giardia
C. Diff

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15
Q

Cause of exudative dirrhea

A

Results from inflammation in the bowel mucosa that causes seepage of fluid. Usually due to IBD or cancer.

similar to infectious with fever and WBC but no organisms.

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16
Q

Common causes of diarrhea due to altered intestinal transit

A

Seen after bowel resections, in patients taking meds that interfere with bowel function and in patients with hyperthyroidism or neuropathy.

Ddx: factitious diarrhea- laxative abuse

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17
Q

presentation of malabsorption diarrhea

A

steatorrhea- oily greasy floating and foul smelling diarrhea.
Weight loss

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18
Q

Deficiencies and manifestations with malabsorption

A

Vit D- hypocalcemia, osteoporosis
Vit K- Bleeding, easy bruising
Vit A- night blindness, dry eyes, dry skin

Vit B12- megaloblastic anemia, neuropathy
(B12 need an intact abdominal wall and pancreatic enzyme)

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19
Q

What is the presentation of Whipple disease? Tx?

A 
Arthralgias
Ocular findings 
Neurological abnormalities (dementia, seizures)
Fever
Lymphadenopathy

Tx: TMP/SMX

20
Q

Signs and symptoms for celiac disease

A 
Iron Deficiency 
Dermatitis herpetiformis 
Diarrhea 
Malabsorption symptoms 
Failure to thrive 
Neuropathies

Clinically indistinguishable from tropical sprue

21
Q

Diagnosis of malabsortive diarrheas

A

Celiacs: Anti-tissue tranglutaminase (TTG)- best initial
Most accurate: small bowel biopsy that showed flattening of the villi and rules out lymphoma.

Whipple and tropical: biopsy shows organisms.

22
Q

What Abx predispose a person to C.diff

A

Clindamycin has the highest incidence but any abx can cause diarrhea.

presents several days or weeks after the start of abx.

23
Q

Best initial and most accurate test for C. Diff.

A

BIT: stool C. diff toxin

Most accurate: NAAT

24
Q

Tx C.Diff

A

Most effective: oral vancomycin. If no response switch to fidaxomicin.
Both more efficacious then oral metro.

If oral therapy cannot be used, use IV metro. IV Vanc cannot pass the bowel wall.

25
Q

What defines fulminant C. Diff? How is treatment different?

A

WBC >15,000
Metabolic acidosis
High Lactate
High Creatinine (1.5 X baseline)

Tx: both vancomycin and metro

26
Q

Diarrhea from carcinoid syndrome

Best initial test and Tx

A

Diarrhea, Flushing, cardiac abnormalities.

BIT: 5 HIAA
Tx: octreotide

27
Q

How to recognize IBS?

A

Patients are anxious, hx of diarrhea aggravates by stress, bloating, and pain relieved by dedication, mucus in stool. psychosocial stressors.

Normal physical and Labs. Diagnosis of exclusion.

MOST LIKE DIAGNOSIS if: no positive findings, young adult, female (F:M 3:1)

28
Q

TX IBS

A
  • Fiber in diet
  • Antispasmodic agents (dicyclomine, peppermint oil, hyoscyamine)
  • TCA

Diarrhea prominent: rifaximine, aldosterone, eluxadoline, probiotics.

Constipation prominent: Fiber, polyethylene glycol, lubiprostone (CC activator), linaclotide (guanylate cyclase agonist)

29
Q

Characteristics of IBD Crohns:

  • Place of origin
  • pathology thickness
  • progression
  • location
  • classic lesions
A
  • Origin: distal ileum
  • Thickness: transmural
  • Progression: irregular (skip- lesions)
  • Location: mouth to anus
  • Classic lesions: Cobblestone, string sign on barium xray
30
Q

Characteristics 2 of IBD Crohns:

  • Bowel Habit changes
  • complications
  • colon cancer risk
  • surgery
A
  • Bowel: obstruction, abdominal pain
  • Complications: Fistula, abscesses, perianal disease
  • Cancer: slightly increase risk
  • Surgery: NO (may make worse) only if obstruction
31
Q

Characteristics of IBD Ulcerative colitis :

  • Place of origin
  • pathology thickness
  • progression
  • location
  • classic lesions
A
  • Origin: rectum
  • Thickness: mucosa/ submucosa only
  • Progression: proximal, continuous from rectum
  • Location: Colon only, rarely extends to ileum
  • Classic lesions: pseudopolyps, lead pipe on barium x-ray
32
Q

Characteristics 2 of IBD Ulcerative colitis:

  • Bowel Habit changes
  • complications
  • colon cancer risk
  • surgery
  • associated disease
A
  • Bowel: Bloody diarrhea
  • Complications: toxic mega colon
  • Cancer: markedly increased risk
  • Surgery: colectomy is curative
  • Association: primary sclerosis cholangitis
33
Q

Extraintestinal manifestations of IBD

A
  • Uveitis
  • Arthritis/ Arthalgias
  • Ankylosing Spondylitis
  • Skin manifestations: (Erythema Nodosum, Erythema Multiforme, pyoderma gangrenous)
  • Anemia
  • Failure to thrive.
34
Q

Which IBD is related to:
antineutrophil cytoplasmic antibody (ANCA)
anti-saccharomyces cervusuae antibody (ASCA)

A

ANCA- UC

ASCA- Crohns

35
Q

How is IBD treated?

A

Steroids for exacerbations (budesonide, prednisone)
5- aminosalicylic acid (5-asa) derivatives- mesalamine
ABX: cipro and metro
Calcium and vit D
Anti-TNF or Anti IL12/23 for fistula and severe disease.

if very refectory: a-intergin inhibitor (vedolizumab)

36
Q

What drugs are Anti-TNF? Anti- IL12/23?

A

Anti-TNF: infliximab, cetrolizumab, golimumab, certolizumab

Anti-IL 12/23: ustekinumab

37
Q

What causes toxic mega colon? presentation?

A

Classically seen with IBD (UC) and infectious colitis (C.diff).

patients have: 
high fever
leukocytosis 
abd pain
rebound tenderness
dilated segment of colon
38
Q

Tx toxic mega colon

A 
MEDICAL EMERGENCY: 
Discontinue all antidiarrheals
NPO/ NGT
IV fluids. 
ABX: ceftriaxone +metro 
Steroids
Surgery if perforation
39
Q

Signs and symptoms of short bowel syndrome

A 
Diarrhea
dehydration
Malnutrition 
Weight Loss
Steatorrhea 
Nutrient deficiency( vit A,D,E,K, calcium, mag, iron, zinc)

Hx: Small bowel resection surgery

40
Q

Tx short bowel syndrome

A

IV hyperalimentation
loperamide (slow bowel)
Teduglutide (GLP agonist- slows bowel)
Vitamin Supplementation

41
Q

What causes small intestine bacterial overgrowth?

A

SIBO results from progressive dilation of the small bowel as the body adapts to resection. ileoccal valve loss lets bacteria in.

42
Q

Presentation and Tx of SIBO

A

Flatulence, bloating, diarrhea, steatorrhea, positive small bowel aspirate cultures.

Tx: ABX (rifaximin)

43
Q

Define and cause of microscopic colitis

A

Normal tissue with inflammation on biopsy. Colitis that is only seen under microscope.

Cause by chronic, non bloody, watery diarrhea. Autoimmune Hx.

44
Q

Tx of microscopic colitis

A

all varieties (lymphocytic, collagenous, mastocytic) respond to steroids.

45
Q

Anorectal abscesses

A

anal crypt gland obstruction allowing bacterial overgrowth

46
Q

Management of anorectal abscess

A

Prompt I&D.

Abx therapy consideration

47
Q

Whan ins systemic abx therapy indicated for an anorectal abscess

A

Systemic illness (fever)
Cellulitis
Pts risk of severe infection (DM, immunocompromised)

Abx decreases risk of fistula formation

aa Step 2CK: Internal & Peds (71 decks)

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