Lecture 6- GI Flashcards
what two syndromes make up inflammatory bowel disease?
Crohn’s disease
Ulcerative colitis
What causes Crohn’s disease?
Genetic + Environmental factors
strong twin concordance
Most people with Crohn’s and UC are of what two ancestries?
Northern European
Ashkenazi Jewish
Crohn’s and UC disease has a _____ distribution of age of presentation
bimodal
fTeens to 30’s and 50’s
What is SBFT?
Small Bowel Follow Through study
What does the SBFT show on Crohn’s?
Narrowing, irregularity, and ulceration in the distal ileum (String sign)
Where does Crohn’s disease occur?
Anywhere in the GI tract (pharynx to anus)
How is inflammation of Crohn’s described?
transmural-cobblestoning
where is Crohn’s disease rarely found?
Esophagus
Stomach
Duodenum
List the three patterns of dz distribution of Crohn’s
Ileocecal- distal SB and proximal colon (most common)
Terminal ileum- fistulas common
colon only with +/- rectal sparing
Is Crohn’s disease contiguous or does it skip lesions?
Skips lesions (normal sections bordered by abnormal sections)
What are some deficiencies that are common with Crohn’s?
Malabsorption of VIt B 12
Iron deficiency or pernicious anemia
What cancers can commonly occur with Crohn’s dz?
colon cancer
Small bowel carcinoma
lymphoma
Where can you get fistulas with Crohn’s dz?
Enteric (between 2 loops of bowel)
Bladder
Skin
Vaginal
why may you have iron deficiency with Crohn’s dz?
bleeding
not absorbing iron
Why can renal stones develop with Crohn’s dz?
calcium oxalate
Free fatty acid binding
also with dehydration and volume depletion
People who _____ have less frequency of what?
Ulcerative colitis
Does ulcerative colitis skip sections or is it contiguous?
Contiguous
Is the rectum involved in UC?
Yes- always
What is the presentation with UC?
Pain Diarrhea Urgency Bleeding Mucus analysis
If UC is severe what might be required?
Colectomy
Where does UC often start then go?
Rectum then creeps proximal
why is there mucus with UC?
Mucosa is inflamed
What are some complications with UC?
Megacolon- fever, pain, bloody diarrhea
Perf from over dilation (<15 cm)
Anemia- Fe defieincy
Bone marrow supression
What cancer are you more at risk for with UC?
adenocarcinoma (10-20 fold increase after 10 years)
What usually has a worse prognosis- UC or Crohn’s?
Crohn’s
Why do you bone marrow suppression from UC potentially?
Body can’t tend to normal things when it is stressed
energy is fighting off the infection from UC
What should you rule out for IBD?
infectious etiologies of diarrhea, pain
assess extra-intesitnal manifestations of IBD
what are skin extra-intestinal manifesetations of IBD?
E. Nodosum (red nodules on lower legs) Pyoderma Gangrenosum (inflamed, ulcerated skin)
What are hepatobiliary signs of IBD?
Autoimmune Hepatitis
GB stones
Primary Sclerosing Cholangitis
Musculoskeletal manifestations of IBD
Seronegative arthritis
Ankylosing Spondylitis
Sacroiliitis
Ocular manifestations of IBD
Uveitis
Episcleritis
Misc extra-intestinal manifestations of IBD
Hypercoag
AutoImHemolytic Anemia
Amyloidosis (amyloid deposited everywhere)
How do you manage mild UC?
5-ASA PO or per rectum
How do you manage moderate UC?
5-ASA Steroids Azathioprine Sulfasala > Mesalamine Rowasa Canasa
How do you manage severe UC?
IV steroid
Azathioprine
Cyclosporine
Surgery
How do you treat mild Crohn’s?
5-ASA
Elemental diet
Antibiotics
How do you treat moderate Crohn’s?
5-ASA Antibiotics Steroids Azathiop Methotrexate (treatogenic)
How do you treat severe Crohn’s?
IV steroid
Infliximab/ Rituximab (lessens autoimmune, $$$)
Azathiop
Surgery
Are any IBD cured?
No, they are controlled
Is there an identifiable pathology in IBS?
No
What is IBS frequently associated with?
History of sexual abuse of childhood molestation
what are some symptoms of IBS?
abdominal distention and pain
Flatulence
Constipation/ Diarrhea
Aggravated by stress, travel, change in diet
What are some red flag symptoms of IBS that can indicate something more severe? (6 of them)
Weight loss Anemia Nocturnal symptoms (Celiac dz) steatorrhea onset after age 50
What criteria is used for IBS?
Rome I criteria & Manning criteria
How do you measure IBS?
Serial weight record
Dietary history
Basic lab and stool studies
Endoscopy with appropriate biopsies
should you start people with IBS on narcotics?
no
What should you do for someone with IBS?
history and physical
basic lab and GI workup
What meds can help someone with IBS?
increase dietary fiber anticholinergics (cramping) acid suppression (if also have reflex) motility agents pain management
What is a non medication way to help someone with IBS?
counseling and antidepressants
what is the hallmark of depression?
Sleep disorder
What are bacteria that commonly cause intestinal infection
shigella
salmonella
E. Coli
What does inflammatory diarrhea have?
White cells and red cells
What 2 types of diarrhea are watery?
secretory
osmotic
What are viruses that commonly cause infections of the intestines?
Norwalk virus
Rotavirus
What are parasites/ protozoa that can cause intestinal infections?
Giardia
AMoeba
What are some food products that can cause infections of the intestines
dairy
poultry
meat
fruit
What things in the immunosupression category of causing infections of the intestines.
Cryptosporidium, Isospora, Cyclospora
What is caused by the overgrowth of C. Diff?
Pseudomembranous Colitis
what is one way to prevent the reoccurance of C. Diff?
Transplantation of stool from healthy individuals to patients with recurrent C. difficile restores these strains and breaks the cycle of recurrence
(toxin elaborating) – colonize small bowel, enterotoxin causes hypersecretion of isotonic fluid-Vibrio chol
Secretory infections
elaborating-destroy mucosal epithelial cells (C. dificile)
Cytotoxin
elaborating-one cause of food poisoning & vomiting (Staph A)
Neurotoxin
pathogens-inflammatory damage (Salmonella, Norwalk Virus., Entamoeba )
Invasive pathogens
How do you treat GI disease?
Hemodynamic assessment
fluid resuscitation/ simple carbs (BRAT)
stool exam
What does BRAT stand for?
Bananas
Rice
Applesauce
Tea/Toast
Villi with enzymes on them for proteins, fats, carbs. Complex enzymes at top. When you have diarrhea what happens?
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
Should you give people who are naseau and vomiting water?
No, it will come right back up
give them ginger-ale/ 7-Up, tea with sugar
Do most people w/ divertic have symptoms?
no
what can perforation of the colon lead to?
Peritonitis (silent bowel sounds, rebound)
What can cause profuse passing of blood?
Diverticula or internal hemorrhoid
what labs should you get with diverticular dz?
WBC, differential Fecal studies (WBC, RBC, mucus) pain films (flat, upright) Barium enema (unprepped) colonoscopy, GI capsule camera Abdominal CT Arteriography
How can you treat diverticular dz?
Dietary management
Bulk or fiber laxative (psyllium)
If someone has a bout of diverticulitis what should you do?
bowel rest (NPO or clear liquids or IV) IV fluids w/ appropriate electrolytes
If someone is spetic of febrile with diverticulitis what should you do?
Antibiotics (febrile or septic)
