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Pathophysiology Term 2 > Inflammatory Bowel Disorders > Flashcards

Inflammatory Bowel Disorders Flashcards

1
Q

What is a diverticulum?

A

A pouch, pocket or sack.

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2
Q

What are risk factors for developing diverticular disease?

A
  • poor diet
  • inactivity
  • poor bowel habits (constipation)
  • ageing
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3
Q

What is the pathology of diverticular disease?

A
  • there are normal weak points that exist in GIT wall where blood vessels enter
  • an increase in intraluminal pressure causes the mucosa to herniate through the muscularis externa causing a bowel protrusion/out-pouching
  • there are multiple diverticula at multiple sites
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4
Q

Where is the most common site for a diverticulum to occur?

A

sigmoid colon

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5
Q

What is diverticulosis?

A

non-inflamed diverticula, the diverticula remain patent

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6
Q

What is diverticulitis?

A

inflamed diverticula

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7
Q

What are the manifestations of diverticulosis?

A

None - it is asymptomatic.

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8
Q

What are the manifestations of diverticulitis?

A
  • dull pain
  • nausea and vomiting
  • low grade fever
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9
Q

How is diverticular disease treated?

A

First option is to address the risk factors (ex. improve diet, increase activity).

If complications occur, treat them surgically.

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10
Q

What are two complications that can arise in diverticular disease? How are they treated?

A

1) perforation
2) obstruction

These complications are treated surgically.

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11
Q

Generally speaking, what is Irritable Bowel Syndrome?

A

a disorder of GI motility

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12
Q

Is IBS the same as IBD?

A

no

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13
Q

What causes IBS?

A
  • unclear

- linked to diet, stress, smoking, lactose intolerance?

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14
Q

What structural or functional problems are evident in IBS?

A

there are no obvious abnormalities of structure or function

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15
Q

What is the pathology of IBS?

A

unsure, some suggestions include:

1) malabsorption of fermentable carbohydrates (ex. fructose) and polyols (poly sugar alcohols ex. sorbitol), these are then processed by gut flora causing flatulence
2) alteration in CNS regulation of GI motor and sensory function
3) molecule signalling defect for serotonin (serotonin is made in GI tract and mediates perfusion, secretion, motility and pain)

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16
Q

What are the manifestations of IBS?

A
  • abdominal discomfort and/or pain
  • diarrhea and/or constipation (often in periods)
  • flatulence
  • nausea (not as common)
  • mucoid stool
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17
Q

How is IBS diagnosed?

A

No definitive test for IBS.

presentation + rule out diseases of the organs using:

  • labs (CBC, antibodies, stool samples)
  • scopes (colonoscopy, endoscopy, sigmoidoscopy)
  • radiology (barium swallow to look for any structural abnormalities)
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18
Q

How is IBS treated?

A
  • avoid offending foods
  • decrease emotional stress
  • drugs
19
Q

What drugs are used to treat IBS?

A
  • antispasmodic drugs (ex. modulon)
  • antidiarrheals
  • drugs for constipation
  • antibiotics with caution (to reduce the number of normal flora digesting fermentable carbs and causing flatulence)
20
Q

What is the peritoneum?

A

Membrane lining the abdominopelvic cavity and covering most digestive organs.

21
Q

What is peritonitis?

A

Inflammation of the peritoneum.

22
Q

What causes peritonitis?

A
  • bacteria (especially E. coli) or chemical irritation (HCl, bile)
  • event allowing injurious agent to enter the abdominal cavity, such as a perforating ulcer or ruptured appendix
  • pelvic inflammatory disease (PID)
  • other causes, iatrogenic (ex. perforation from a botched colonoscopy)
23
Q

What is the pathology of peritonitis?

A
  • injurious agent enters and impacts the peritoneum, causing inflammation
  • the injurious agent spreads rapidly because the peritoneum is a large structure
  • because the mesentery is vascular there is rapid absorption of toxins
  • a thick, sticky exudate forms, which localizes inflammation, and this also serves to seal/block the perforation
24
Q

What is the compensatory response to peritonitis?

A

SNS limits GI motility so that gut content won’t push out of the perforation into the abdominal cavity

25
Q

What does ileus mean?

A

stoppage of peristalsis

26
Q

What are the manifestations of peritonitis?

A
  • fluid shifts (ileus forms, fluid and air are retained, some exudate moves into the gut, causes irritation, causing increased fluid secretion/secretion of mucous, this increases intraluminal pressure
  • altered perfusion as blood is shunted to the site of inflammation
  • dyspnea (breathing moves the peritoneum, which hurts)
27
Q

How is peritonitis treated?

A
  • IV antibiotics
  • fluids/electrolytes
  • anti-inflammatory drugs
  • pain medication
  • surgery if indicated
28
Q

What is appendicitis?

A

inflammation of the appendix wall

29
Q

Who is affected by appendicitis?

A

People of any age can get appendicitis but it is most common between 5-30 years old.

30
Q

What is the etiology of appendicitis?

A
  • idiopathic

may be caused by:

  • fecalith obstruction of the cecum
  • twisting of appendix or bowel
31
Q

What is the pathology of appendicitis?

A
  • appendix lumen is obstructed causing drainage into the cecum to be blocked
  • this irritates the appendix and causes an increase in mucous secretion
  • this increases intraluminal pressure
  • when intraluminal pressure exceeds venous pressure it will cause venous stasis
  • this causes ischemia, leading to necrosis
  • necrotic areas allow bacteria to invade the appendix wall
32
Q

What is a serious complication of appendicitis?

A

perforation, which can lead to peritonitis

33
Q

What are the manifestations of appendicitis?

A
  • acute epigastric or periumbilical pain
  • pain increases
  • pain changes from dull to colicky/spasmodic over 12h
  • pain then becomes localized to LRQ at McBurney’s point (midline point between umbilicus and iliac crest), the pain is guarded pain and there is rebound pain
  • nausea
  • increased temperature and WBC
34
Q

How is appendicitis diagnosed?

A
  • history and presentation
  • ultrasound
  • CT scan
35
Q

How is appendicitis treated?

A
  • IV fluids
  • antibiotics
  • appendectomy within 24-48 hrs (if delayed, risk perforation & peritonitis)
36
Q

What two chronic conditions fall under the category of Inflammatory Bowel Disease?

A
  • ulcerative colitis

- Crohn’s disease

37
Q

What causes IBD?

A

It is multifactoral/complex trait; there is a genetic susceptibility and an environmental trigger (often bacterial infection) that ultimately cause the loss of tolerance to normal gut flora. The immune system then attacks the gut flora, which resides in the gut lining and the gut lining is damaged in the process.

38
Q

What is the pathology of Crohn’s disease?

A
  • primarily affects terminal ileum (other areas can be affected)
  • primarily affects the submucosa (all layers can be affected)
  • granulomatous skip lesions
  • slow, non-aggressive progression
39
Q

What are the manifestations of Crohn’s disease?

A
  • diarrhea
  • intermittent abdominal pain (pain with peristalsis/passage of content through the gut)
  • weight loss (decreased absorptive surface in the small intestine leads to nutritional deficit)
  • lesions have cobble stone pattern
40
Q

What is the pathology of ulcerative colitis?

A
  • primarily involves mucosa of colon and rectum
  • proximal spread from the rectum
  • continuous lesions that are: bleeding ulcers, thickened and inflamed, cause edema and congestion in the gut
41
Q

What are the manifestations of ulcerative colitis?

A
  • bloody diarrhea
  • abdominal cramping
  • weight loss (smaller amount over more time, but due to 1) decreased intake from pain and 2) some affect on the small intestine)
42
Q

How is IBD diagnosed?

A
  • history and presentation
  • exclude a GI infection
  • sigmoidoscopy and colonoscopy and biopsies
43
Q

How is IBD treated?

A
  • may be able to modify diet if very mild
  • anti-inflammatory drugs, often sulfasalazine (plus antibiotics to prevent an infection since the gut wall is compromised)
  • steroids if non-responsive
  • immuno-modulatory drug methotrexate used to decrease the immune targeting of gut flora and thus prevent disease progression
  • surgery if needed

Pathophysiology Term 2 (65 decks)

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