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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
**Inflammatory Bowel Disease** Chron's Disease *Characteristic Features*
* Sharply demarcated, granulomatous lesions * Surrounded by normal-appearing tissue
26
**Inflammatory Bowel Disease** Chron's Disease *Skip Lesions*
* Multiple Lesions * Interspersed btwn Normal Bowel Segments * All layers of the bowel are involved, w/ _submucosal layer_ affected most
27
**Inflammatory Bowel Disease** Chron's Disease *Skip Lesions*
* Multiple Lesions * Interspersed btwn Normal Bowel Segments
28
**Inflammatory Bowel Disease** Chron's Disease *"Cobblestone Appearance"*
* Surface of inflamed bowel * Fissures & Crevices * surround by regions of submucosal edema
29
**Inflammatory Bowel Disease** Chron's Disease *Appearance over time....*
* Wall over time becomes _thickened & inflexible_ * "lead pipe", "rubber hose" * mesentery inflamed * regional lymphs & channels enlarged
30
**Inflammatory Bowel Disease** Chron's Disease *Clinical Course*
* Variable * Periods of Exacerbations & Remissions * Symptoms related to location of lesions
31
**Inflammatory Bowel Disease** Chron's Disease *Symptoms*
* Symptoms: * Intermittent Diarrhea * Ulceration of perianal skin can occur * Colicky Pain (LRQ) * Weight Loss * Fluid & Electrolyte D/Os * Malaise * Low Grade Fevers
32
**Inflammatory Bowel Disease** Chron's Disease *Why is there less bloody diarrhea in Chron's than UC?*
* B/c Chron's affects the submucosal layer more than the mucosal layer
33
**Inflammatory Bowel Disease** Chron's Disease *Disrupted Absorptive Surfaces*
* Nutritional Deficiencies may occur * In childhood: * Retardation of growth & physical development ​
34
**Inflammatory Bowel Disease** Chron's Disease *Complications*
* **Fistula Formation** * Abdominal abscess formation * Intestinal obstruction
35
**Inflammatory Bowel Disease** Chron's Disease *Complications*
* Nutritional Deficiencies may occur * In childhood: * Retardation of growth & physical development ​
36
**Inflammatory Bowel Disease** Chron's Disease *Fistulas*
* 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
**Inflammatory Bowel Disease** Chron's Disease *Diagnosis*
* 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
**Inflammatory Bowel Disease** Chron's Disease *Treatment - Basics*
* 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
**Inflammatory Bowel Disease** Chron's Disease *Treatment - Medications*
* 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
**Inflammatory Bowel Disease** Ulcerative Colitis
Non-specific Inflammatory Condition *More common in US & Western Countries* Occurs at any age; peak in 3rd decade
41
**Inflammatory Bowel Disease** Ulcerative Colitis *Confined to:*
Rectum & Colon * Begins in Rectum & spreads proximally* * affects mucosal layer (sometimes submucosal)*
42
**Inflammatory Bowel Disease** Ulcerative Colitis *May involve*
* Rectum alone: *Ulcerative Proctitis* * Rectum & Sigmoid Colon: *Proctosigmoiditis* * Entire Colon: *Pancolitis*
43
**Inflammatory Bowel Disease** Ulcerative Colitis *Does it have _Skip lesions_?*
Nope!! Ulcerative Colitis confluent & continuous vs. Skipping areas like Chron's
44
**Inflammatory Bowel Disease** Ulcerative Colitis *Characteristics*
* 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
**Inflammatory Bowel Disease** Ulcerative Colitis *Characteristics - Mucosal Layer may develop \_\_\_\_\_*
Pseudopolyps * Due to inflammatory process * 'tounge-like projections'
46
**Inflammatory Bowel Disease** Ulcerative Colitis *Presentation*
* 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
**Inflammatory Bowel Disease** Ulcerative Colitis *Severity & Extent*
* 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
**Inflammatory Bowel Disease** Ulcerative Colitis *Severity: Fulminant*
* Fulminant Disease: * w/ all its horrible things (bleeding, fever, distention, need for transfusions) leads to * Toxic Megacolon risk! * Colon dilation & systemic toxicity
49
**Inflammatory Bowel Disease** Ulcerative Colitis *Feared Complications of Ulcerative Colitis*
**Cancer of the Colon** * Regular annual or biannual surveilence colonoscopies w/ multiple biopsies * Beginning 8-10 years after diagnosis
50
**Inflammatory Bowel Disease** Ulcerative Colitis *Diagnosis*
* Hx and PE * Confirmed by: * Sigmoidoscopy * Colonscopy * Biopsy * Negative Stool exams (for infectious)
51
**Inflammatory Bowel Disease** Ulcerative Colitis *Who should you NOT perform a Colonscopy on?*
* Ppl w/ SEVERE DISEASE * b/c danger of perforation
52
**Inflammatory Bowel Disease** Ulcerative Colitis *Treatment*
* 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
**Inflammatory Bowel Disease** Ulcerative Colitis *Medications*
* 5-ASA compounds * Salfasalazine * Mesalamine * Corticosteroids * use selectively * decrease acute inflammatory response * Immunomodulating & anti-TNF therapies can also be used * in severe cases
54
**Infectious Enterocolitis**
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Julie W: Module 9 - GI (8 decks)

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