Lower GI Flashcards
What increases the secretions and motility of the GI?
Food
Nervous system –> CNS vs PNS
Activity –> light activity stimulates, rapid stops, sedentary slows
Disease –>inflammation, disease can increase or decrease
What decreases secretions and motility?
diet (fibre)
Age
Stretching of colon –> peristalsis
What kind of instestinal infarction needs to occur to impact the GI?
A large clot of a major artery; GI has many redundancies so when one issue arises there are other ways around the problem
What kind of altered motility is Diarrhea? Describe what occurs. What can cause it? How is it Treated?
Excessive motility, Loss of fluids has a potential for dehydration
Commonly caused by infectious or toxic agents leading to epithelial disruption
Can be caused by drugs, chemo, foods, and more
Treated with: rehydration, bulkng agents,
anti-motility drugs (loperamide) –> not alwyas used, if from sickness or infection might be left to ride it out unless it is direct cause of dehydration
What kind of altered motility is Constipation? Describe what occurs. What can cause it? How is it Treated?
Inadequate/ reduced motility. Stool becomes harder and more difficult to pass
Impactions and discomfort, Enteric nervous system disruption
Treated: motility agents (sennosides, bisacodyl, PEG), fluids, bulking agents (fibre), stool softeners (docusate)
Who is at risk for Diarrhea?
Travelers, children in daycare, elderly in nursing homes, food workers, hospitalized pts
What are the main differences between Non-inflammatory and Inflammatory diarrhea?
Non-inflammatory is less sevre but can cause dehydration
Inflammatory has presence of blood and fecal leukocytes; more severe illness
What main organisms can cause diarrhea?
Camphylobacter jejuni, Salmonella, Shigella, E. coli
When do you refer diarrhea to a physician?
blood
>7 days
travel-associated
Immunocompromised
fever, severly ill, debilitated
extremes in age young/old
complex patient
What is the self management for diarrhea?
Hydration
Rest
hygiene
healthy diet
Loperamide to reduce duration of symptomms
Simethicone for gas and cramping
Are neoplasms of the small intestine common?
No
What are the 3 types of hernia obstructions?
Bulging through
telesxcoping
Twisting
What kind of tumor accounts for 90% of all tumors in intestinal neoplasms?
Epithelial tumors (adenomas and carcinomas)
What are some common signs of a small bowel neoplasm?
nausea, affected apetite, changes in bowel habits, diffuculty or pain on eating, wt loss
What causes IBD?
Combination of genetics, environment, and immune response
What can happen to nearby hollow organs in intestinal diseases?
Can be affected; disease can chew through and affect those organs to such as the bladder
When is IBD typically daignosed?
In adolescence or early adulthood
What percent of people are diagnosed at >65 years of age?
15%
What are some additional risk factors for IBD?
smoking, family history, fatty diet, hormonal medications, stress, urban residence, environmental pollution
What other extraintestinal symptoms can occur in IBD?
arthritis, some eye conditions, fever, aphthous ulcers
Symptoms of IBD?
Abdoinal pain
mouth and stomach ulcers
diarrhea
rectal bleeding
loss of apetite
wt loss
fever
fatigue
change or loss of menstrual cycle
What are some long term complications with IBD?
malnutrition/ malabsorbtion
anemia
perforated bowel
fistua
strictures
abcesses
eye sorness/ redness
swelling/ joint pain
osteoporosis
increased risk of colon cancer
What is the etiology of Crohns disease?
Unknown; infectious and immunolgic mechanisms have been proposed
How does a smal intestine look in Crohns dsiease?
Mucosa surface irregular, hypereia, focal uceration
Skip lessions; segements of normal and irregular
How does ulcerative colitis present itself?
gradual onset of symptoms
18-35 years old
restricted to the colon
diarrhea, pain, redness, swelling, loss of function
What are the treatment aims for ulcerative colitis?
Reduce inflammation
Reduce Pain
Prevent further inflammation
What are risk factors for ulcerative colitis?
genetics, environmental factors, dysregulated immune response in GI tracdt, antibiotic and NSAID use
What are some symptoms of ulcerative colitis?
Ulcers or sores in colon
Periods of active inflammation and remission
small harder stools
flare ups ranging in severity
What is the natural disease progression of ulcerative colitis?
immune system not able to turn off
chronic inflammation until ulcers are removed or treated
last 6 inches of colon always involved and can move up over time
What are some non GI tract symptoms of Ulcerative colitis?
fatigue, fever, low energy, joint pain, liver inflammation, osteoporosis, skin problems, eye problems
WHich of the listed features are not similar in Crohns and Ulcerative Colitis?
familial
peak age
immune distrubance
extraintestinal complication
treatment
distribution
transmural
granuloma
fistula
megacolon
cancer
familial- same
peak age - same (15-25)
immune distrubance - same
extraintestinal complication - same
treatment- same
distribution - different (C: segmental including ileum, UC: diffuse, colon only)
transmural - different; (C:++ UC: -)
granuloma- different (C: + UC: -)
fistula - different (C: + UC: -)
megacolon - different (C: - UC: +)
cancer - both yes, but more so in UC
What is the ladder of Therapy for IBD?
Controling inflammation moving up ladder when ineffective
Aminosallicyliates - anti-inflam
Corticosteroids - anti-inflam; SE not great for long term use
Immunomodulators - suppress immune system; increased risk of infection though
Antibiotics - Used to prevent and control infection in UC and CD
Biologics - block protein called tumor necrosis factor (only in moderate-severe cases)
Which biologics are used for UC?
Infliximab, Adalimumab, Golimumab, Vedolizumab,
Etrolizumab(only UC only drug)*
WHich biologics are used for Crohns?
Infliximab, Adalimumab, Golimumab, Vedolizumab
Crohns only: Certolizumab,Natalizumab, Ustekinumab
What is used to measure inflammation decrease in fecal matter?
Fecal calprotectin
