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Old DOOS > Lecture 6- GI > Flashcards

Lecture 6- GI Flashcards

1
Q

what two syndromes make up inflammatory bowel disease?

A

Crohn’s disease

Ulcerative colitis

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2
Q

What causes Crohn’s disease?

A

Genetic + Environmental factors

strong twin concordance

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3
Q

Most people with Crohn’s and UC are of what two ancestries?

A

Northern European

Ashkenazi Jewish

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4
Q

Crohn’s and UC disease has a _____ distribution of age of presentation

A

bimodal

fTeens to 30’s and 50’s

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5
Q

What is SBFT?

A

Small Bowel Follow Through study

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6
Q

What does the SBFT show on Crohn’s?

A

Narrowing, irregularity, and ulceration in the distal ileum (String sign)

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7
Q

Where does Crohn’s disease occur?

A

Anywhere in the GI tract (pharynx to anus)

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8
Q

How is inflammation of Crohn’s described?

A

transmural-cobblestoning

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9
Q

where is Crohn’s disease rarely found?

A

Esophagus
Stomach
Duodenum

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10
Q

List the three patterns of dz distribution of Crohn’s

A

Ileocecal- distal SB and proximal colon (most common)
Terminal ileum- fistulas common
colon only with +/- rectal sparing

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11
Q

Is Crohn’s disease contiguous or does it skip lesions?

A

Skips lesions (normal sections bordered by abnormal sections)

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12
Q

What are some deficiencies that are common with Crohn’s?

A

Malabsorption of VIt B 12

Iron deficiency or pernicious anemia

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13
Q

What cancers can commonly occur with Crohn’s dz?

A

colon cancer
Small bowel carcinoma
lymphoma

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14
Q

Where can you get fistulas with Crohn’s dz?

A

Enteric (between 2 loops of bowel)
Bladder
Skin
Vaginal

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15
Q

why may you have iron deficiency with Crohn’s dz?

A

bleeding

not absorbing iron

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16
Q

Why can renal stones develop with Crohn’s dz?

A

calcium oxalate
Free fatty acid binding
also with dehydration and volume depletion

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17
Q

People who _____ have less frequency of what?

A

Ulcerative colitis

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18
Q

Does ulcerative colitis skip sections or is it contiguous?

A

Contiguous

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19
Q

Is the rectum involved in UC?

A

Yes- always

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20
Q

What is the presentation with UC?

A 
Pain
Diarrhea
Urgency
Bleeding
Mucus analysis
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21
Q

If UC is severe what might be required?

A

Colectomy

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22
Q

Where does UC often start then go?

A

Rectum then creeps proximal

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23
Q

why is there mucus with UC?

A

Mucosa is inflamed

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24
Q

What are some complications with UC?

A

Megacolon- fever, pain, bloody diarrhea
Perf from over dilation (<15 cm)
Anemia- Fe defieincy
Bone marrow supression

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25
Q

What cancer are you more at risk for with UC?

A

adenocarcinoma (10-20 fold increase after 10 years)

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26
Q

What usually has a worse prognosis- UC or Crohn’s?

A

Crohn’s

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27
Q

Why do you bone marrow suppression from UC potentially?

A

Body can’t tend to normal things when it is stressed

energy is fighting off the infection from UC

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28
Q

What should you rule out for IBD?

A

infectious etiologies of diarrhea, pain

assess extra-intesitnal manifestations of IBD

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29
Q

what are skin extra-intestinal manifesetations of IBD?

A 
E. Nodosum (red nodules on lower legs) 
Pyoderma Gangrenosum (inflamed, ulcerated skin)
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30
Q

What are hepatobiliary signs of IBD?

A

Autoimmune Hepatitis
GB stones
Primary Sclerosing Cholangitis

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31
Q

Musculoskeletal manifestations of IBD

A

Seronegative arthritis
Ankylosing Spondylitis
Sacroiliitis

32
Q

Ocular manifestations of IBD

A

Uveitis

Episcleritis

33
Q

Misc extra-intestinal manifestations of IBD

A

Hypercoag
AutoImHemolytic Anemia
Amyloidosis (amyloid deposited everywhere)

34
Q

How do you manage mild UC?

A

5-ASA PO or per rectum

35
Q

How do you manage moderate UC?

A 
5-ASA
Steroids
Azathioprine
Sulfasala > Mesalamine
Rowasa
Canasa
36
Q

How do you manage severe UC?

A

IV steroid
Azathioprine
Cyclosporine
Surgery

37
Q

How do you treat mild Crohn’s?

A

5-ASA
Elemental diet
Antibiotics

38
Q

How do you treat moderate Crohn’s?

A 
5-ASA
Antibiotics
Steroids
Azathiop
Methotrexate (treatogenic)
39
Q

How do you treat severe Crohn’s?

A

IV steroid
Infliximab/ Rituximab (lessens autoimmune, $$$)
Azathiop
Surgery

40
Q

Are any IBD cured?

A

No, they are controlled

41
Q

Is there an identifiable pathology in IBS?

A

No

42
Q

What is IBS frequently associated with?

A

History of sexual abuse of childhood molestation

43
Q

what are some symptoms of IBS?

A

abdominal distention and pain
Flatulence
Constipation/ Diarrhea
Aggravated by stress, travel, change in diet

44
Q

What are some red flag symptoms of IBS that can indicate something more severe? (6 of them)

A 
Weight loss
Anemia
Nocturnal symptoms (Celiac dz) 
steatorrhea
onset after age 50
45
Q

What criteria is used for IBS?

A

Rome I criteria & Manning criteria

46
Q

How do you measure IBS?

A

Serial weight record
Dietary history
Basic lab and stool studies
Endoscopy with appropriate biopsies

47
Q

should you start people with IBS on narcotics?

A

no

48
Q

What should you do for someone with IBS?

A

history and physical

basic lab and GI workup

49
Q

What meds can help someone with IBS?

A 
increase dietary fiber
anticholinergics (cramping) 
acid suppression (if also have reflex) 
motility agents 
pain management
50
Q

What is a non medication way to help someone with IBS?

A

counseling and antidepressants

51
Q

what is the hallmark of depression?

A

Sleep disorder

52
Q

What are bacteria that commonly cause intestinal infection

A

shigella
salmonella
E. Coli

53
Q

What does inflammatory diarrhea have?

A

White cells and red cells

54
Q

What 2 types of diarrhea are watery?

A

secretory

osmotic

55
Q

What are viruses that commonly cause infections of the intestines?

A

Norwalk virus

Rotavirus

56
Q

What are parasites/ protozoa that can cause intestinal infections?

A

Giardia

AMoeba

57
Q

What are some food products that can cause infections of the intestines

A

dairy
poultry
meat
fruit

58
Q

What things in the immunosupression category of causing infections of the intestines.

A

Cryptosporidium, Isospora, Cyclospora

59
Q

What is caused by the overgrowth of C. Diff?

A

Pseudomembranous Colitis

60
Q

what is one way to prevent the reoccurance of C. Diff?

A

Transplantation of stool from healthy individuals to patients with recurrent C. difficile restores these strains and breaks the cycle of recurrence

61
Q

(toxin elaborating) – colonize small bowel, enterotoxin causes hypersecretion of isotonic fluid-Vibrio chol

A

Secretory infections

62
Q

elaborating-destroy mucosal epithelial cells (C. dificile)

A

Cytotoxin

63
Q

elaborating-one cause of food poisoning & vomiting (Staph A)

A

Neurotoxin

64
Q

pathogens-inflammatory damage (Salmonella, Norwalk Virus., Entamoeba )

A

Invasive pathogens

65
Q

How do you treat GI disease?

A

Hemodynamic assessment
fluid resuscitation/ simple carbs (BRAT)
stool exam

66
Q

What does BRAT stand for?

A

Bananas
Rice
Applesauce
Tea/Toast

67
Q

Villi with enzymes on them for proteins, fats, carbs. Complex enzymes at top. When you have diarrhea what happens?

A

Microvilli get shaved off

Only still have the enzyme that has carbs otherwise the food will go right on through and make the diarrhea worse

68
Q

Should you give people who are naseau and vomiting water?

A

No, it will come right back up

give them ginger-ale/ 7-Up, tea with sugar

69
Q

Do most people w/ divertic have symptoms?

A

no

70
Q

what can perforation of the colon lead to?

A

Peritonitis (silent bowel sounds, rebound)

71
Q

What can cause profuse passing of blood?

A

Diverticula or internal hemorrhoid

72
Q

what labs should you get with diverticular dz?

A 
WBC, differential
Fecal studies (WBC, RBC, mucus)
pain films (flat, upright)
Barium enema (unprepped)
colonoscopy, GI capsule camera
Abdominal CT
Arteriography
73
Q

How can you treat diverticular dz?

A

Dietary management

Bulk or fiber laxative (psyllium)

74
Q

If someone has a bout of diverticulitis what should you do?

A 
bowel rest (NPO or clear liquids or IV)
IV fluids w/ appropriate electrolytes
75
Q

If someone is spetic of febrile with diverticulitis what should you do?

A

Antibiotics (febrile or septic)

Old DOOS (21 decks)

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