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Julie W: Module 9 - GI > GI Conditions: D/O of Small & Large Intestine - Porth, Chpt. 29 > Flashcards

GI Conditions: D/O of Small & Large Intestine - Porth, Chpt. 29 Flashcards

1
Q

How many Layers are there in the walls of the Large & Small Intestine?

A

4

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2
Q

Conditions that Cause Altered Intestinal Function

A
  • Irritable Bowel Syndrome
  • Inflammatory Bowel Disease
  • Infectious Enterocolitis
  • Diverticulosis
  • Appendicitis
  • Bowel Motility D/Os
    • Diarrhea, Constipation, Obstruction
  • Peritonitis
  • Malabsorption Syndrome
  • Colon CA
  • Rectal CA

Shit… there’s alot.

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3
Q

Irritable Bowel Syndrome

A

“Functional GI disorder w/ variable combo of chronic & recurrent intestinal symptoms not explained by structural or biochemical abnormalities”

10-20% of ppl in Western countries have this… most do not seek medical attention.

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4
Q

Irritable Bowel Syndrome

Characterized

A
  • Persistent, recurrent symptoms:
    • Abdominal Pain
    • Altered Bowel Function
    • C/O - Flatulence, Bloating, Nausea, Anorexia, Constipation, Diarrhea
      • Anxiety or Depression
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5
Q

Irritable Bowel Syndrome

Hallmark!

A
  • Abdominal Pain relieved by defecation & associated w/ change in consistency or frequency of stools
    • ​Abd pain = intermittent, crampy, lower abdomen
    • Doesn’t interfere w/ sleep
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6
Q

Irritable Bowel Syndrome

Why does this happen?

A
  • Dysregulation of intestinal motor & sensory functions modulated by CNS
    • Occurance reacts to stress
      • Exaggerated responses
      • Psych. role is uncertain
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7
Q

Irritable Bowel Syndrome

+ Women

A
  • Occurs more often in women
  • Exacerbated around premenstrual period
    • Hormonal component?!
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8
Q

Irritable Bowel Syndrome

Diagnosis

A
  • Clinically
    • Signs & Symptoms
  • Common diagnostic:
    • Continuous or Recurrent of at least 12 weeks’ duration (in past year)
    • W/ 2 of the following features:
      • Relief with defecation
      • Onset assc. w/ change in bowel frequency
      • Assc. w/ change in stool form
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9
Q

Irritable Bowel Syndrome

Other Diagnostic Criteria

A
  • Abnormal stool frequency
  • Abnormal form
  • Abnormal Passage
  • Passage of Mucus
  • Feeling of abdominal distention/Bloating
  • Consider a history of Lactose Intolerance
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10
Q

Irritable Bowel Syndrome

Acute onset of Symptoms

A
  • Be suspicious…
    • Raise likelihood of organic disease
      • As do
        • Weight loss
        • Anemia
        • Fever
        • Occult Blood in Stool….
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11
Q

Irritable Bowel Syndrome

Treatment

A
  • Stress Management!!!
    • Esp. related to symptom production
  • Reassurance.
  • Fiber intake :-)
  • Avoid offending foods: fatty, gas-producing
  • Antispasmodics, Anticholinergics
  • Alosetron = 5-HT3
    • FDA approved for IBS
    • reduces intestinal secretions, decreases nerve activity, reduces motility
    • Restricted prescribing program
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12
Q

Inflammatory Bowel Disease

A

Designates 2 related inflammatory d/os:

  1. Chron’s Disease
  2. ulcerative colitis
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13
Q

Inflammatory Bowel Disease

Chron’s & UC

What do they have in common?

A
  • Produce bowel inflammation
  • Lack evidence of causative agent
  • Familial pattern of occurace
  • & both can have Systemic Manifestations
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14
Q

Inflammatory Bowel Disease

Chron’s & UC

What do symptoms do they share?

A
  • Remissions & Exacerbations of:
    • Weight Loss
    • Fecal urgency,
    • Diarrhea
      • Intestinal Obstructions may occur during flares
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15
Q

Inflammatory Bowel Disease

Chron’s & UC

Location Differences

A
  • Chron’s
    • Distal Small Intestine
    • Proximal Colon
    • & can affect any area of GI Tract
  • Ulcerative Colitis, confined to:
    • Colon
    • Rectum
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16
Q

Inflammatory Bowel Disease

Chron’s & UC

What makes these guys act up?

A
  • Result of activation of inflammatory cells w/ elaboration of inflammatory mediators
    • causes non-specific tissue damage
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17
Q

Inflammatory Bowel Disease

Chron’s & UC

Systemic Manifestations

A
  • Axial arthritis
    • spine & sacroiliac joints
  • Oligoarticular arthritis
    • large joints of arms & legs
  • Uveitis
  • Skin lesions
    • Erythema nodosum
  • Stomatitis
  • Blood D/Os
  • Inflammation of Bile Duct
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18
Q

Inflammatory Bowel Disease

Table 29-1: Differentiating CD vs. UC

Chron’s

A
  • Granulomatous inflammation
  • Submucosal layer involved
  • Skip lesions = extent of involvement
  • Primarly ileum & colon involved
  • Diarrhea common
  • Rectal Bleeding rare
  • Fistulas, Strictures, Perianal Absesses = common
  • Cancer development? Rare
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19
Q

Inflammatory Bowel Disease

Table 29-1: Differentiating CD vs. UC

Ulcerative Colitis

A
  • Ulcerative & Exudative inflammation
  • Mucosal layer involved
  • Continous involvement
  • Rectum & Left Colon involved
  • Diarrhea & Rectal Bleeding common
  • Fistulas, Strictures, Perianal Absesses = rare
  • Cancer development? Common!
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20
Q

Inflammatory Bowel Disease

Chron’s & UC

Etiology & Pathogenesis

A
  • Causes = uncertain
  • Growing evidence of:
    • Genetic Factors predispose to an immune response
    • Possible triggered by:
      • Dietary antigen, or
      • Microbial agent
  • Evidence of intestinal microorganisms contribution…but still uncertain!
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21
Q

Inflammatory Bowel Disease

Chron’s & UC

Tobacco Smoking:

Good for one, Bad for the other…

A

Smoking Tobacco:

  • Predisposes to Chron’s
  • Reduced incidence of Ulcerative Colitis
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22
Q

Inflammatory Bowel Disease

Chron’s & UC

Genetic Basis

A
  • Greater risk if affected family member
  • Family hx more common in Chron’s vs. UC
  • Linked to:
    • Major Histocompatibility class II alleles
    • Chomosome 16 and 5 in Chron’s
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23
Q

Inflammatory Bowel Disease

Chron’s Disease

A
  • Recurrent, granulomatous type of inflammatory response
    • Affects ANY area of GI Tract
  • Slowly progressive, Relentless, Disabling!!
  • Strikes around age 20-30’s; MC in women
24
Q

Inflammatory Bowel Disease

Chron’s Disease

A
  • Recurrent, granulomatous type of inflammatory response
    • Affects ANY area of GI Tract
  • Slowly progressive, Relentless, Disabling!!
  • Strikes around age 20-30’s; MC in women
25
Q

Inflammatory Bowel Disease

Chron’s Disease

Characteristic Features

A
  • Sharply demarcated, granulomatous lesions
    • Surrounded by normal-appearing tissue
26
Q

Inflammatory Bowel Disease

Chron’s Disease

Skip Lesions

A
  • Multiple Lesions
    • Interspersed btwn Normal Bowel Segments
  • All layers of the bowel are involved, w/ submucosal layer affected most
27
Q

Inflammatory Bowel Disease

Chron’s Disease

Skip Lesions

A
  • Multiple Lesions
    • Interspersed btwn Normal Bowel Segments
28
Q

Inflammatory Bowel Disease

Chron’s Disease

“Cobblestone Appearance”

A
  • Surface of inflamed bowel
    • Fissures & Crevices
    • surround by regions of submucosal edema
29
Q

Inflammatory Bowel Disease

Chron’s Disease

Appearance over time….

A
  • Wall over time becomes thickened & inflexible
    • “lead pipe”, “rubber hose”
  • mesentery inflamed
  • regional lymphs & channels enlarged
30
Q

Inflammatory Bowel Disease

Chron’s Disease

Clinical Course

A
  • Variable
    • Periods of Exacerbations & Remissions
    • Symptoms related to location of lesions
31
Q

Inflammatory Bowel Disease

Chron’s Disease

Symptoms

A
  • Symptoms:
    • Intermittent Diarrhea
      • Ulceration of perianal skin can occur
    • Colicky Pain (LRQ)
    • Weight Loss
    • Fluid & Electrolyte D/Os
    • Malaise
    • Low Grade Fevers
32
Q

Inflammatory Bowel Disease

Chron’s Disease

Why is there less bloody diarrhea in Chron’s than UC?

A
  • B/c Chron’s affects the submucosal layer more than the mucosal layer
33
Q

Inflammatory Bowel Disease

Chron’s Disease

Disrupted Absorptive Surfaces

A
  • Nutritional Deficiencies may occur
  • In childhood:
    • Retardation of growth & physical development
      ​
34
Q

Inflammatory Bowel Disease

Chron’s Disease

Complications

A
  • Fistula Formation
  • Abdominal abscess formation
  • Intestinal obstruction
35
Q

Inflammatory Bowel Disease

Chron’s Disease

Complications

A
  • Nutritional Deficiencies may occur
  • In childhood:
    • Retardation of growth & physical development
      ​
36
Q

Inflammatory Bowel Disease

Chron’s Disease

Fistulas

A
  • Tubelike passages forming connections btwn different sites in the GI Tract
  • May develop in other sites
  • Perineal fistulas originate in the ileum (common)
  • Lead to:
    • Malabsorption
    • Syndromes of bacterial overgrowth
    • Diarrhea
    • can also get infected & form abscesses
37
Q

Inflammatory Bowel Disease

Chron’s Disease

Diagnosis

A
  • Hx and PE
  • sigmoidoscopy for direct visualization of affected areas & Biopsy
  • Stool cultures
    • r/o infectious agents
  • Radiographic contrast studies
    • Determine extent of involvement & spot fistulas
38
Q

Inflammatory Bowel Disease

Chron’s Disease

Treatment - Basics

A
  • Terminating the inflammtory response, promote healing, maintain adequate nutrition, prevent complications
  • Nutritious diet
    • Elemental!
      • Balanced, residue & bulk free
  • Medications (see next flashcard)

If necessary: Surgical resection, drainage of abscesses, fistula repair

39
Q

Inflammatory Bowel Disease

Chron’s Disease

Treatment - Medications

A
  • 5-aminosalicylic acid (5-ASA) agents
    • Pentsa
      • act locally
      • first line
  • corticosteroids
    • suppress acute clinical symptoms
  • antibiotics
    • Metronidazole - treats bacterial overgrowth
  • immunosuppresent drugs
    • Azithioprine
    • Methotrexate
      • used if no respose to other therapies
  • anti-TNF
    • infliximab
    • adalimumab
40
Q

Inflammatory Bowel Disease

Ulcerative Colitis

A

Non-specific Inflammatory Condition

More common in US & Western Countries

Occurs at any age; peak in 3rd decade

41
Q

Inflammatory Bowel Disease

Ulcerative Colitis

Confined to:

A

Rectum & Colon

  • Begins in Rectum & spreads proximally*
  • affects mucosal layer (sometimes submucosal)*
42
Q

Inflammatory Bowel Disease

Ulcerative Colitis

May involve

A
  • Rectum alone: Ulcerative Proctitis
  • Rectum & Sigmoid Colon: Proctosigmoiditis
  • Entire Colon: Pancolitis
43
Q

Inflammatory Bowel Disease

Ulcerative Colitis

Does it have Skip lesions?

A

Nope!!

Ulcerative Colitis confluent & continuous

vs. Skipping areas like Chron’s

44
Q

Inflammatory Bowel Disease

Ulcerative Colitis

Characteristics

A
  • Lesions that form in crypts of Lieberkühn (Bieber-kuhn?)
  • Inflammatory process leads to:
    • pinpoint mucosal hemorrhages
      • turn into: crypt abscesses
    • May become necrotic & ulcerate
      • _​_ulcers can grow large!
  • Bowel wall thickens
45
Q

Inflammatory Bowel Disease

Ulcerative Colitis

Characteristics - Mucosal Layer may develop _____

A

Pseudopolyps

  • Due to inflammatory process
  • ‘tounge-like projections’
46
Q

Inflammatory Bowel Disease

Ulcerative Colitis

Presentation

A
  • Relapsing Disorder
    • w/ Diarrhea attacks
      • May persist days-weeks-months!
        • then subside…
  • Stools contain Blood & Mucus!
    • b/c affects mucosal layer! vs. Chron’s
  • Nocturnal diarrhea esp if day diarrhea
  • Mild abdominal cramping
  • Fecal incontinence
  • Anorexia, weakness, fatigability = common
47
Q

Inflammatory Bowel Disease

Ulcerative Colitis

Severity & Extent

A
  • Severity:
    • Mild =
      • most common; <4 stools/day, +/- blood, no toxicity, normal ESR
    • Moderate =
      • >4 stools/day, minimal toxicity
    • Severe =
      • >6 stools/day, bloody, toxicity signs, elevated ESR
    • Fulminant
      • >10 stools/day, bloody, toxcitiy, dilatation, transfusions… (bad stuff)
48
Q

Inflammatory Bowel Disease

Ulcerative Colitis

Severity: Fulminant

A
  • Fulminant Disease:
    • w/ all its horrible things (bleeding, fever, distention, need for transfusions) leads to
      • Toxic Megacolon risk!
        • Colon dilation & systemic toxicity
49
Q

Inflammatory Bowel Disease

Ulcerative Colitis

Feared Complications of Ulcerative Colitis

A

Cancer of the Colon

  • Regular annual or biannual surveilence colonoscopies w/ multiple biopsies
    • Beginning 8-10 years after diagnosis
50
Q

Inflammatory Bowel Disease

Ulcerative Colitis

Diagnosis

A
  • Hx and PE
  • Confirmed by:
    • Sigmoidoscopy
    • Colonscopy
    • Biopsy
    • Negative Stool exams (for infectious)
51
Q

Inflammatory Bowel Disease

Ulcerative Colitis

Who should you NOT perform a Colonscopy on?

A
  • Ppl w/ SEVERE DISEASE
    • b/c danger of perforation
52
Q

Inflammatory Bowel Disease

Ulcerative Colitis

Treatment

A
  • Extent of disease & severity of symptoms
    • Control acute manifestations
    • Prevent recurance
  • May be as easy as avoiding:
    • caffeine
    • lactose
    • spicy foods
    • gas-forming foods
  • FIber supplements
  • Medications (see next card)
  • Surgical Treatment (if unresponsive to conservative tmt)
    • Take it all out & ileostomy or ileoanal anastomosis
53
Q

Inflammatory Bowel Disease

Ulcerative Colitis

Medications

A
  • 5-ASA compounds
    • Salfasalazine
    • Mesalamine
  • Corticosteroids
    • use selectively
    • decrease acute inflammatory response
  • Immunomodulating & anti-TNF therapies can also be used
    • in severe cases
54
Q

Infectious Enterocolitis

Julie W: Module 9 - GI (8 decks)

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