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Study Notes - Gastroenterology > *Intestinal Problems (lecture 5 and 6) > Flashcards

*Intestinal Problems (lecture 5 and 6) Flashcards

1
Q

What is GI diverticulum?

A

Mucosal herniation through muscle coat

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2
Q

What is the difference between diverticulum, diverticular disease, and diverticulitis?

A

Diverticulum means they are present
Divertiular disease means they are symptomatic
Diverticulitis means they are inflamed

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3
Q

Where do diverticulum most often occur?

A

Sigmoid colon

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4
Q

Do patients who develop diverticular disease tend to have a low or high fibre diet?

A

Low fibre intake

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5
Q

How are diverticulum diagnosed?

A

Barium enema

Sigmoidoscopy

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6
Q

Symptoms of diverticular disease?

A

Altered bowel habit
Left sided colic relieved by deification
Flatulence
Nausea

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7
Q

Symptoms of diverticulitis?

A

LIF pain/ tenderness
Septic
Altered bowel habit

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8
Q

Complications of diverticular disease? (5)

A 
Pericolic abscess
Perforation
Haemorrhage (if it ruptures through a blood vessel)
Fistula
Stricture
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9
Q

Treatment of uncomplicated (bacterial infection with possible sepsis) diverticulitis?

A

Pain relief
Management in the community
Oral antibiotics

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10
Q

Treatment of complicated diverticulitis?

A

Hartmann’s procedure (proctosigmoidectomy)
Primary resection/ anastomosis
Precutaneous drainage - access around the bowel
Laparoscopic lavage and drainage - peritonitis

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11
Q

Causes of acute and chronic colitis?

A

Infective colitis
Ulcerative colitis
Crohns colitis
Ischaemic colitis

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12
Q

Causes of acute and chronic colitis?

A

Infective colitis
UC
Crohns colitis
Ischaemic colitis

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13
Q

Symptoms of acute and chronic colitis?

A 
Diarrhoea with/ without blood
Abdominal cramps
Dehydration
Sepsis
Weight loss
Anaemia
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14
Q

Diagnosis of acute and chronic colitis?

A

Plain x-ray
Stool culture
Sigmoidoscopy + biopsy
Barium enema (Not usually in acute colitis in order to prevent irritating the bowel)

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15
Q

What sign on an AXR is suggestive of colitis?

A

Thumb-printing - mucosal oedema

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16
Q

Treatment for UC/ Crohns colitis?

A

IV fluids
IV steroids (once infective/ ischaemic colitis ruled out)
GI rest

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17
Q

3 main types of bowel ischaemia?

A

Acute mesenteric ischaemia (almost always small bowel)
Chronic mesenteric ischaemia
Ischaemic colitis

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18
Q

Cause of ischaemic colitis?

A

Low flow in the inferior mesenteric artery

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19
Q

presentation of ischaemic colitis?

A

Lower left sided abdominal pin

+/- bloody diarrhoea

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20
Q

Tests for ischaemic colitis?

A

CT may be useful but colonoscopy and biopsy is the gold standard

21
Q

What is colonic angiodysplasia?

A

angiodysplasia is a small vascular malformation of the gut. It is a common cause of otherwise unexplained gastrointestinal bleeding and anemia. Lesions are often multiple, and frequently involve the cecum or ascending colon, although they can occur at other places.

22
Q

How is colonic angiodysplasia diagnosed?

A

Can do a colonoscopy but would see much

Do a angiography and look for bleeding into the colon

23
Q

How is colonic angiodysplasia treated?

A

Embolisation
Endoscopic ablation
Surgical resection

24
Q

Causes of a large bowel obstruction? (3)

A

Colorectal cancer
Benign obstruction
Volvolus

25
Q

Symptoms of a bowel obstruction?

A

Abdominal pain
Distension
Vomiting
Constipation

26
Q

Treatment of a large bowel obstruction?

A

Resuscitate

Operate

27
Q

What is a sigmoid volvulus?

A

An obstruction caused by the bowel twisting on it mesentery - may become gangrenous, can also cause ischaemia and subsequent perforation

28
Q

How is a sigmoid volvulus diagnosed?

A

Plain AXR
Rectal contrast may need to be added
Can use CT non-invasively assess for ischaemia

29
Q

Treatment of sigmoid volvulus?

A 
Flatus tube to decompress colon
Surgical resection (especially in younger patients when it has happened a few times
30
Q

What is pseudo-obstruction?

A

a clinical syndrome caused by severe impairment in the ability of the intestines to push food through. It is characterized by the signs and symptoms of intestinal obstruction without any lesion in the intestinal lumen - like a mechanical obstruction but no cause found (in comparison to paralytic ileus when there is absence of normal peristaltic contractions (tends to be in elderly/ debilitated)

31
Q

What is a functional bowel disorder?

A

In medicine, the term functional colonic disease (or functional bowel disorder) refers to a group of bowel disorders which are characterised by chronic abdominal complaints without a structural or biochemical cause that could explain symptoms.

32
Q

What patients tend to get faecal impaction?

A

Elderly bed ridden patients on strong analgesics

33
Q

What side does ischaemia of the large bowel tend to occur?

A

Left side

34
Q

What heart condition can lead to ischaemia of the bowel?

A

A. fibrillation

35
Q

Histopathological clues of ischaemic colitis?

A

Withering of crypts
Pink smudgy lamina propria
Fewer chronic inflammatory cells

36
Q

Complications of ischaemic colitis?

A

Massive bleeding
Rupture
Stricture

37
Q

What is pseudomembranous colitis?

A

acute, exudative colitis usually caused by Clostridium difficile

38
Q

What antibiotics are used to treat severe pseudomembranous colitis/

A

Vancomycin and metronidzole (may need colectomy)

39
Q

What toxins are involved with pseudomembranous colitis?

A

Toxins A and b - attack endothelium and epithelium

40
Q

What causes normal mucosa and watery diarrhoea?

Biopsy showing large bands of collagen laid down?

A

Collagenous colitis

41
Q

Features of collagenous colitis?

A

Thickened basement membrane
Disease is patchy
Associated with intraepithelial inflammatory cells
No chronic architectural changes

42
Q

What causes watery diarrhoea with no mucosal change - normal crypt archicgeuctre but massive increase in intraepithelial lymphocytes on biopsy?

A

Lymphocytic colitis (in children this may be associated with coeliac disease)

43
Q

Features of lymphocytic colitis?

A

No chronic architectural changes in crypts
Intraepithelial lymphocytes are raised
No thickening of BM

44
Q

What is microscopic colitis?

A

Used to describe colitis that has features of both Collagenous colitis and lymphocytic colitis on biopsy - normal endoscopic appearance

45
Q

What is radiation colitis?

A

Inflammation of large bowel due to radiation in that area e.g. cervix, prostate, etc.

46
Q

Features of radiation colitis?

A

Telangectasia - small dilated blood vessels near the skin or mucous membrane surface
Bizarre stromal cells and vessels

47
Q

Features of acute infective colitis?

A

Busy epithelium but no crypt irregularity

Florid diffuse acute cryptitis in otherwise unremarkable colonic mucosa

48
Q

Is acute colitis always infective?

A

No, it could be the onset of IBD

Study Notes - Gastroenterology (42 decks)

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