IBS & IBD Flashcards
What are some risk factors for colon CA?
> 51 yo, UC/Crohn’s, family Hx, Hx, familial syndromes, Hx of breast/ovarian CA, high fat/red meat diet, obese, EtOH, tobacco use, sedentary lifestyle
A pt presents with rectal bleeding, anemia, vague abdominal pain, changes in his bowel habits, and a 15 lb unintentional weight loss in the past 6 mo. What is the best diagnostic test for this pt?
Colonoscopy!
What are the ACS guidelines for colonoscopies?
Low risk: Q 10 yrs starting at 50 yo
High risk: Q 5 yrs starting at 40 yo or 10-15 years before 1st FHx
How do you test for polyps & CA?
Sigmoidoscopy Q 5 yrs
Colonoscopy Q 10 yrs
Double-contrast Ba enema Q 5 yrs
CT colonography Q 5 yrs
How do you test for CA?
Fecal occult blood test Q yr
Fecal immunochemical test Q yr
Stool DNA test
What is the biggest drawback to flex sigmoidoscopy?
Doesn’t look at whole colon
What are some measures to prevent colon CA?
Colonoscopy
High Ca & Fiber, low meat diet
Avoid tobacco, limit EtOH
Weight loss & increased activity
A pt presents with rectal bleeding, vague abdominal pain, thin/snake-like stools, and unintentional weight loss. Colonoscopy shows cancerous polyps. What is the best treatment?
Endoscopic removal if possible
Surgical removal
Chemo/Radiation based on stage
Stent
A 34 yo female presents with bloating and gas which are worse after eating. She has hard, lumpy stool most of the time, but occasionally has loose, watery stool. What disease does she have? Which subtype?
IBS-C
think IBS-constipation
A 29 yo female presents with bloating and abdominal discomfort. She has loose, mushy stool most of the time but occasionally has hard, lumpy stool. What disease does she have? Which subtype?
IBS-D
think IBS-diarrhea
A 39 yo female presents with abdominal discomfort. She complains of feeling bloated and gassy after she eats. She reports having hard, lumpy stool or watery, mushy stool most of the time. What disease does she have? Which subtype?
IBS-M
think IBS-mixed
How does IBS present? What are the criteria?
Recurrent abdominal pain or discomfort 3 day per month of the past 3 months with symptoms starting 6 months ago and 2 of the following:
- relieved w/ defecation
- change in stool frequency
- change in stool form
A pt presents with sx of IBS. She has loose watery stool most of the time. What treatment do you recommend?
IBS-D Fiber, probiotics Anti-diarrheals, anti-spasmotics TCAs, SSRIs Lotrenox Broad-spectrum Abx Align
A pt presents with abdominal pain 5 days per month for the past 3 mos. She has had bloating and gassiness for the past 6 mos. Most of the time she has hard, lumpy stool. What treatment do you recommend?
IBS-C Laxatives (Miralax, Senna, Bisacodyl) Stool softeners Enemas/suppositories SSRIs Amitiza
A pt presents with post-prandial bloating. She meets the description of IBS. She reports having hard, lumpy stool equally often as having soft, mushy stool. What treatment do you recommend?
IBS-M Anti-diarrheals, stool softeners PRN Stress management SSRIs Fiber
What can cause IBS?
Motility d/o Visceral hypersensitivity Stress response Post-infection Bacterial overgrowth (SIBO)
A pt presents with crampy, LLQ pain, bloating, and gas. You R/O IBS with stool testing. What is your diagnosis and what treatment do you recommend?
High fiber diet
Probiotics
A pt presents with LLQ abdominal pain. She said she started to notice the pain last weak but it was a 1/10. Yesterday, the pain started getting worse and is now a 7/10. She has a fever and diarrhea. What do you suspect? What test should you do?
Acute diverticulitis CT Scan (97% sensitive)
A pt presents with acute LLQ pain and fever. He is on NSAIDs and when you ask you find he has a low fiber diet. CT shows inflammation of diverticula. What treatment do you recommend if he has no sx of complicated Dz?
Acute Diverticulitis
Bowel rest (few d clear liquid diet)
Abx 7-10d (Cipro & Metronidazole, Augmentin)
F/U colonoscopy in 6-8 wks
A pt presents with acute LLQ pain and a fever. CT shows inflamed diverticuli an abscess. What treatment do you recommend for this pt?
Complicated Acute Diverticulitis
In-pt IV Abx, drain abscess
Surgical intervention if necessary
F/U colonoscopy in 6-8 wks
A pt presents to the ER with painless, bright red blood in his stools. He has some cramping and reports that there has been a large volume of blood in his stool in the past few hours. What do you suspect? What should you do to confirm?
Diverticular bleeding
CBC
Colonoscopy
Bleeding scan, angiography
A pt presents with painless, maroon stools and abdominal cramping. His scan shows an uncontrolled diverticular bleed. What treatment do you recommend?
Surgery (uncontrolled bleed) Transfuse PRN Correct coagulopathy Colonoscopy 70-75% spontaneously resolve
What are the different categories of IBD Tx?
Anti-TNF agents Steroids Abx Methotrexate (rare) Cyclosporin (salvage therapy)
What Anti-TNF agents are used to treat IBD?
Infliximab (IV)
Adalimumab (SQ)
Certolizumab (SQ)
Anti-TNF + AZA/6MP
What steroids are used to treat IBD?
Prednisone
IV steroids (methylprednisone)
Proctofoam/Cortenemas/Anusol
How do you diagnose fistulizing Dz?
Barium enema
A 8 yo presents with weight loss and failure to thrive. His mother mentions that he’s been having diarrhea recently. What diagnostics should you perform based on this Hx?
Crohn’s
Colonoscopy
WBC count
A pt presents with severe abdominal pain, cramps, and diarrhea. She appears malnourished, but says her stomach hurts too much and she doesn’t want to eat. Colonoscopy shows transmural right-sided colon inflammation, strictures, and a fistula. What treatment do you recommend?
Crohn’s
AZA & 6MP
Smoking cessation
Surgical management: segmental removal of strictured/stenosed areas
A pt presents with bloody diarrhea. He complains of cramping abdominal pain. Colonoscopy shows left colon mucosal inflammation. What treatmen do you recommend?
UC
5-ASAs
Fecal transplantation (do NOT recommend)
Surgical management: total colectomy, ileostomy vs. reconnection vs. J-pouch
A 66 yo female presents with chronic, water, non-bloody diarrhea that resolves and returns without any apparent aggravating or alleviating factors. What diagnostics should you perform based on her Hx?
Microscopic Colitis
Endoscopic biopsy
Stool studies
Guaiac negative
A 58 yo female presents with chronic, watery, non-bloody diarrhea that constantly resolves and comes back. Endoscopic biopsy indicates microscopic colitis. What treatment do you recommend?
Anti-diarrheals (high-dose)
Self-resolve
2nd line Tx - steroids, mesalamines or other 5-ASAs, probiotics
A pt presents with acute LLQ pain, hematochezia, and diarrhea. She mentions that she is on OCPs and has a 5 yr pack Hx/ What diagnostics should you run?
Ischemic colitis
CT
Confirm w/ endoscopy & Bx
A pt presents with acute LLQ pain and hematochezia. CT shows ischemic colitis, endocopy & biopsy results are pending. What treatment do you recommend?
Self-limiting
What are some causes of proctocolitis?
Radiation
Medication, Abx, infection
Colonoscopy prep
