Large Intestine Disease

Question 1

What are the most common causes of appendicitis in children and adults?

Answer 1

1. lymphoid hyperplasia - child

2. fecalith - adults (impacted feces)

Question 2

What are the usual symptoms of appendicitis?

Answer 2

periumbilical pain –> then localizes to RLQ

-fever, nausea, guarding and rebound tenderness

Question 3

What is IBD? what do they think is the cause?

Answer 3

chronic relapsing inflam of bowel

abnormal immune response to enteric flora

Question 4

Who is the classic patient with IBD and what are the usual symptoms?

Answer 4

young women - west, caucasians, eastern european

-bloody diarrhea, abdominal pain

Question 5

Where does ulcerative colitis occur?

Answer 5

mucosal and submucosal layers

begins in rectum and can extend proximally to cecum

Question 6

What are the symptoms of ulcerative colitis?

Answer 6

LLQ pain, bloody diarrhea, cramping, fever

Question 7

What are the typical pathognomonic signs of ulcerative colitis?

Answer 7

crypt abscesses with neutrophils
pseudopolyps
loss of haustra “ lead pipe “ sign

Question 8

What are some complications of ulcerative colitis? What is the risk based on?

Answer 8

toxic megacolon and carcinoma

- extent of involvement and duration

Question 9

What are some systemic associations of ulcerative colitis?

Answer 9

Primary sclerosing cholangitis – liver disease
pANCA positivity, thromboembolism, DVTs
Arthritis, uveitis, erythema nodosum
Pyoderma gangrenosum – noninfective deep purulent ulcers - serious

Question 10

Is smoking protective against ulcerative colitis or crohns disease?

Answer 10

ulcerative colitis

Question 11

Where are the lesions found in crohns disease?

Answer 11

FULL THICKNESS
anywhwere from mouth to anus
terminal ileum is most common*

Question 12

Are skip lesions seen in ulcerative colitis or crohn disease?

Answer 12

crohn disease

Question 13

What are the symptoms of crohns disease?

Answer 13

RLQ pain
non bloody diarrhea
recurrent fever

Question 14

What are the typical pathognomonic signs of crohn’s disease?

Answer 14

noncaseating granulomas in the submucosa
cobblestone appearance
submucosal fibrosis
strictures - narrow lumen 
"creeping fat"

Question 15

What are some complications of Crohns disease?

Answer 15

malabsorption with nutritional deficiency
calcium oxalate nephrolithiasis
Fistula formation – rupture and connection
Carcinoma – only if colonic disease is present
Liver disease – sclerosing cholangitis
amyloidosis

Question 16

What are some systemic associations of crohns disease?

Answer 16

o	Ankylosing spondylitis 
o	Sacrolitis
o	Migratory polyarthritis
o	Erythema nodosum
o	Uveitis – visual disturbance

Question 17

What is hirshsprungs disease?

Answer 17

defective relaxation and peristalsis of rectum and distal sigmoid colon
-segmental absence of ganglion cells - failure to descend from neural crest

Question 18

What is hirsphrungs disease highly associated with?

Answer 18

down syndrome

Question 19

What are some clinical features of hirshsprungs disease?

Answer 19

o Failure to pass meconium
o Empty rectal vault on DRE
o Massive dilation of bowel proximal to obstruction
o Inc in nonmyelinated cholinergic nerve fibers

Question 20

How would you diagnose hirshsprungs disease?

Answer 20

rectal suction biopsy

-look for lack of ganglion cells

Question 21

What is colonic diverticulosis?

Answer 21

outpouching of mucosa and submucosa through muscularis propria

Question 22

What is believed to be the cause of colonic diverticulosis?

Answer 22

low fiber diet , constipation

Question 23

Where do colonic diverticula typically occur?

Answer 23

where vasa recta traverse muscularis propria

-sigmoid colon

Question 24

Although diverticula are usually asymptomatic, what are some possible complications?

Answer 24

Alternating Constipation and Diarrhea,
colicky abdominal pain, flatulence 
Rectal bleeding – hematochezia
Diverticulitis – appendicitis like symptoms 
fistula

Question 25

What is angiodysplasia?

Answer 25

acquired malformation of mucosal and submucosal capillary beds

Question 26

Where does angiodysplasia occur?

Answer 26

cecum and right colon due to high wall tension

Question 27

What is the presentation of angiodysplasia?

Answer 27

hematochezia in an older adult

Question 28

What are hemorrhoids?

Answer 28

dilated venous channels of hemorrhoidal plexus

Question 29

Where would atherosclerosis affect the colon?

Answer 29

the SMA - splenic flexure is typically affected

Question 30

How does ischemic colitis present?

Answer 30

postprandial pain

digestion requires inc blood

Question 31

What is IBS?

Answer 31

relapsing abd pain with bloating and flatulence

• change in bowel habits
• improves with defecation
• related to disturbed intestinal motility