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GI block > GI goljan vascular disorders, sigmoid diverticular, IBS > Flashcards

GI goljan vascular disorders, sigmoid diverticular, IBS Flashcards

1
Q

which part of bowel is more likely to have ischemic damage?

A

small bowel

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2
Q

What areas are supplied by SMA?

A

most of small bowel;
ascending and transverse colon;
overlap w/ IMA at splenic flexure

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3
Q

Where is a watershed area?

A

splenic flexure

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4
Q

What are the types of infarctions assoc w/ vascular disorders?

A

transmural;

mural and mucosal infarctions

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5
Q

Define transmural bowel infarction. what is the most common cause?

A

full thickness hemorrhagic infarction usually involving all or part of small bowel due to OCCLUSION OF SMA

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6
Q

When is mural and mucosal infarctions likely to occur?

A

hypoperfusion states (shock)

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7
Q

What are causes of acute ischemia involving small bowel?

A

acute mesenteric ischemia (50%);
nonocclusive ischemia (25%);
mesenteric vein thrombosis (25%)

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8
Q

What is the mechanism of acute mesenteric ischemia?

A

embolism from L side of heart to SMA;

thrombosis of SMA

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9
Q

Embolism from left heart to SMA causes what?

A

atrial fibrillation is most common predisposing arrhythmia

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10
Q

What are characteristics of nonocclusive ischemia?

A

Hypotension secondary to heart failure (common);
Hypovolemic shock;
patient taking digitalis (possible vasospasm)

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11
Q

What does mesenteric vein thrombosis lead to?

A

thrombosis states => polycythemia vera; anti-phospholipid syndrome;
extension of renal cell carcinoma into vena cava

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12
Q

What are clinical findings of small bowel infarction

A 
sudden onset of diffuse abdominal pain;
bowel distention;
bloody diarrhea; 
absent bowel sounds (ileus);
No rebound tenderness (peritonitis) early in infarction
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13
Q

What are micro and physical exam findings?

A

profound neutrophilic leukocytosis

positive stool guaiac

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14
Q

Radiographic findings in small bowel infarction

A

“thumbprint sign” due to edema in bowel wall;
bowel distention w/ air-fluid levels similar to bowel obstruction;
abdominal CT is 90% sensitive

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15
Q

Tx for small bowel infarction

A 
surgery for embolic disease; 
thrombotic disease (anticoag and surgery)
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16
Q

What does ischemic colitis involve?

A

splenic flexure of large bowel => watershed area

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17
Q

What has occurred when severe pain occurring in splenic flexure shortly after eating?

A

ischemic colitis => atherosclerotic narrowing of SMA causing mesenteric angina

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18
Q

What are clinical findings in ischemic colitis?

A

Hx compatible w/ mesenteric angina;
pain localized to splenic flexure;
barium study shows “thumb-printing” of colonic mucosa (edema of mucosa)

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19
Q

What accompanies pain localized to splenic flexure in ischemic colitis?

A

bloody diarrhea due to mucosal or mural infarction

20
Q

What may ischemic colitis lead to and why?

A

normal repair of infarction results in fibrosis => ischemic strictures and obstruction

21
Q

Define angiodysplasia

A

dilation of mucosal and submucosal venules in cecum and right colon;
increased wall stress in cecum stretches venules

22
Q

Who is most at risk for angiodysplasia?

A

elderly => vascular ectasias in cecum increases w/ age

23
Q

clinical findings of angiodysplasia

A

hematochezia;

association w/ vWf disease and calcific aortic stenosis

24
Q

how is angiodysplasia Dx?

A

colonoscopy and angiography

25
Q

Tx for angiodysplasia

A

colonoscopy;
angiography localizes disease;
Right hemicolectomy;
correction of aortic stenosis

26
Q

Epidemiology of sigmoid colon diverticular disease

A

incidence in general public is 35-50%;
incidence increases w/ age;
common site for diverticula is entire GI tract

27
Q

Pathogenesis of sigmoid colon diverticular disease

A

low-fiber diet w/ increased constipation;

area of weakness is where vasa recta penetrate muscular propria

28
Q

most common site for sigmoid colon diverticular disease

A

sigmoid colon

29
Q

where does diverticulum in sigmoid colon diverticular disease occur?

A

juxtaposed to a blood vessel

30
Q

what are some associations w/ sigmoid colon diverticular disease?

A

Marfan syndrome;
Ehlers-Danlos syndrome;
adult polycystic kidney disease

31
Q

Define 2 outcomes of sigmoid colon diverticular disease

A

diverticulitis (most common)=> fecalith in diverticulum sac produces ulceration and ischemia

diverticulosis=> painless bleeding and often massive (hematochezia)

32
Q

Clinical findings w/ diverticulitis

A

fever;
diarrhea initially followed by constipation;
left lower quandrant pain (“L sided appendicitis”);
tender mass can be easily palpated

33
Q

How is diverticulitis Dx?

A

CT scan or water-soluble barium study

34
Q

what is risk in diverticulitis?

A

increased risk for perforation and abscess formation

35
Q

Will hematochezia be a problem in healed diverticulitis?

A

No=> scarring will prevent bleeding

36
Q

What is the most common cause of fistulas of the bowel? (connection bw hollow structures)

A

sigmoid colon diverticular disease

37
Q

What is a common fistula in GI tract? what is it associated with?

A

colovesical fistula;

associated w/ pneumaturia (air in urine) and recurrent UTI

38
Q

Nonpharm and pharm Tx of sigmoid colon diverticular disease

A

increase fiber in diet to prevent constipation;

ABx for acute disease

39
Q

When is colonic resection necessary in sigmoid colon diverticular disease?

A

repeated episodes of diverticulitis and bleeding that does not stop;
abscess and fistula formation;
obstruction

40
Q

Irritable bowel syndrome is caused by what? what are mechanisms of this loss?

A

intrinsic colonic motility disorder;
possible loss of tolerance to GI flora;
possible genetic factors;
environmental triggers

41
Q

Who is most likely to have IBS? How common is IBS?

A

females > males;

most common functional bowel disorder

42
Q

Risk factors for IBS

A

Hx of childhood sexual abuse;
domestic abuse in women;
increased stress, depression, personality disorder

43
Q

How does IBS typically present?

A

alternating bouts of diarrhea and constipation

44
Q

What are 3 characteristics of alternating bouts of diarrhea and constipation in IBS?

A

abdominal pain and bloating relieved by defecation;
stools accompanied by mucus;
abnormal defecation=> strain, sense of incomplete evacuation

45
Q

How is IBS diagnosed?

A

normal flexible sigmoidoscopy or colonoscopy

46
Q

Nonpharm Tx of IBS

A

mainstay is adequate fiber intake;

eliminate foods that aggravate (coffee, fatty foods, diary)

47
Q

pharm Tx of IBS

A

antispasmodics-anticholinergics (dicylomine);
Loperamide effective for diarrhea (serotonin type 3 receptor antagonist);
Lubiprostone (Cl-channel activator) effective for constipation;
Rifaximin is effective if small bowel bacterial overgrowth

GI block (11 decks)

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