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Ex3GI CM > Lower GI- Paulson > Flashcards

Lower GI- Paulson Flashcards

1
Q

__________ & ________- make up inflammatory bowel disease

A

Chrons & Ulcerative colitis

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2
Q

This disease is an inflammatory condition involving the mucosal surface of the colon that starts distally and progresses proximally without skip areas

A

ulcerative colitis (UC)

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3
Q

What are sxs of UC?

A
  • **Bloody diarrhea
  • Frequent urge to defecate
  • constipation, frequent blood and mucus discharge
  • colicky abdominal pain
  • onset usually gradual and progressive
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4
Q

What are some extraintestinal manifestations of UC?

A
  • Arthritis, ankylosing spondylitis
  • uveitis, episcleritis
  • erythema nodosum
  • pyoderm gangrenosum
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5
Q

What are some lab abnormalities in UC?

A
  • Anemia
  • inc ESR/CRP bc inflammation
  • Electrolyte abnormalities
  • Fecal calprotein inc (tells you if intestinal inflamm or not
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6
Q

Is imaging required for UC?

A

No but you can get xray, barium enema, CT/MRI

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7
Q

How to dx UC?

A
  • Chronic diarrhea ≥4 weeks
  • Evidence of active inflammation on endoscopy
  • Chronic changes on biopsy

*must exclude other causes of colitis

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8
Q

What would an endoscopy find on UC?

A
  • Loss of vascular markings

- Petechiae, exudates, edema, erosions, friability to touch, spontaneous bleeding

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9
Q

Are there normal areas of mucosa in UC?

A

No it is continuous (no skippage areas)

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10
Q

What characterizes mild UC?

A
  • Less than or eq to 4 stools/day with or without blood
  • normal ESR
  • no severe abd pain, fever, weight loss, or bleeding
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11
Q

What characterizes moderate UC?

A
  • > 4 loose stools/day
  • mild anemia
  • mod abd pain
  • low grade fever
  • no weight loss
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12
Q

What characterizes severe UC?

A
  • frequent loose bloody stools >6/day
  • severe abd pain
  • systemic sxs
  • could have rapid weight loss
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13
Q

Treatment for UC if the dz is confined to the distal part of rectum?

A

Topical 5-ASA:
Mesalamine 1 PR BID
-topical you put on distal rectum

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14
Q

Treatment for UC if the dz extends further than the distal part of rectum?

A

Mesalamine enema + suppository

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15
Q

Treatment for more extensive colitis past sigmoid or left-sided colitis or pancolitis?

A

Oral and topical 5-ASA combo

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16
Q

In patients with UC, we should be careful about __________ and consider what test if there is a stricture of the colon?

A

Colorectal CA and biopsy

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17
Q

This is a disease that causes inflamm of the GI tract with inflammation and skip areas in the colon

A

Chron’s disease

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18
Q

What are some clinical manifestations of chron’s?

A
  • crampy abd pain
  • malabsorption
  • less gross blood than UC
  • diarrhea
  • fistulas and ulcers common
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19
Q

What clinical manifestation could distinguish UC from Chrons?

A

UC has more gross blood than Chrons

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20
Q

People with chrons often feel better if they _______

A

don’t eat

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21
Q

What lab finding could distinguish chrons from UC?

A

In chrons there will be an elevated ESR/CRP more so than in UC

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22
Q

What other lab test could help diagnose IBD and distinguish CD from UC?

A

Antibody tests-

pANCA and ASCA may be + in Chrons

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23
Q

How can you dx chrons?

A

colonoscopy- may show cobblestone appearance and skipping

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24
Q

String sign is in what disease?

A

Chrons

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25
Q

What imaging should you do for chrons and abscess?

A

CT

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26
Q

If a patient is totally asymptomatic, what stage of chrons is this?

A

Clinical remission

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27
Q

If a patient is fine, no systemic symptoms, what stage of chrons is this?

A

mild chrons

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28
Q

If a pt has prominent symptoms, what stage of chrons is this?

A

mod-severe

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29
Q

A pt with chrons in which tx doesnt work and systemic sxs, what stage chrons is this?

A

Severe-fulminant disease

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30
Q

What is step-up therapy for chrons?

A
  • Start with less potent meds (but fewer side effects)

* Use more potent meds if initial therapies not effective

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31
Q

What is top-down therapy for chrons

A

• Start with more potent therapies early in the course of the disease before they
become glucocorticoid-dependent

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32
Q

What is the tx for mild-mod and ileum or proximal colon chrons disease?

A

Budesonide

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33
Q

What is the tx for diffuse colitis or left colonic involvement?

A

Pred

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34
Q

Tx for oral chrons lesions

A

Triamcinolone acetonide

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35
Q

What are some adverse effects of Budesonide?

A

since it is a corticosteroid, can cause osteoporosis, immunosuppression

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36
Q

What if a patient with chrons relapses?

A

Begin another dose of corticosteroid

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37
Q

For more severe chrons we will usually refer, but what is the top-down med approach we would use?

A

Biologic + immunomodulatory for induction

“umab” and methotrexate
-may also get a glucocorticoid for symptom relief

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38
Q

Constipation is caused by inadequate ______ & _______ consumption

A

fiber, water

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39
Q

What are some clinical manifestations of constimation?

A
  • Hard/lumpy stools
  • feeling of incomplete voiding
  • straining
  • abdominal discomfort and bloating
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40
Q

Treatment for constipation?

A
  • Fiber (metamucil, citrucel)
  • Hyperosmolar agent (miralax)
  • Stimulant (senna/colase)
  • Enema
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41
Q

A mass of compacted feces in the large intestine that can’t be evacuated spontaneously common in the elderly?

A

Fecal impaction

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42
Q

Signs and symptoms of fecal impaction?

A
  • Rectal discomfort
  • abd pain or cramping
  • overflow fecal incontinence
  • could hit something hard on DRE (feces)
43
Q

Treatment for fecal impaction

A
  • Manual disimpaction
  • Enema
  • Osmotic laxatives
  • address underlying cause
44
Q

Inflammation of the small bowel (small intestine) due to ingesting gluten-containing foods (wheat, barley, rye, oats)

A

Celiac disease

45
Q

What are some symptoms of celiac?

A
  • Diarrhea with bulky, foul-smelling floating stools (steatorrhea)
  • weight loss & weakness
  • IDA
  • osteoporosis
46
Q

What is a common manifestation of celiac not in the intestines?

A

Dermatitis herpetiformis

47
Q

T/F: All celiac testing should be done while a patient is on a gluten containing diet?

A

True!

48
Q

What are the testing options for celiac?

A

Low probability= serologic testing

high probability= serologic testing + small bowel bx with endoscopy

49
Q

What is the preferred serologic test for celiac?

A

tTG IgA test

50
Q

If tTG IgA test is positive, what is the next step?

A

If serology positive -> small bowel biopsy needed to confirm diagnosis

51
Q

Endoscopy for celiac disease may show _____ & _____

A

scalloping & nodules

52
Q

T/F: One biopsy can confirm dx of celiac?

A

False! 4 bx are needed to confirm dx. They will be from different sites

53
Q

Management of celiac?

A
  • Refer
  • Gluten-free diet
  • Need pneumococcal vaccine
  • DXA scan

**INCREASED RISK FOR MALIGNANCY

54
Q

A leading cause of cancer deaths in the US

A

Colorectal cancer

55
Q

What are RF that don’t influence colorectal CA screening?

A
  • Obesity
  • DM
  • Red & processed meat
  • Smoking
  • Alcohol consumption
56
Q

What are suspicious sx/sxs of colorectal CA?

A
  • Change in bowel habits
  • Unexplained IDA
  • Rectal bleeding + change in bowel habits
  • Rectal mass or abdominal mass
  • Abdominal pain
57
Q

How do you dx colorectal CA and what finding might you expect?

A

Colonoscopy with apple core lesions

58
Q

Apple core

A

Colorectal CA on colonoscopy

59
Q

What marker do we use to tract and follow progression of someone with colorectal CA?

A

CEA

60
Q

How to treat colorectal cancer?

A
  • If carcinoma in a polyp, then endoscopic removal

- if CA then surgical resection then chemo/radiation

61
Q

At what age do we initiate colorectal CA screening in a person without RF? How often do we get colonoscopies?

A

50 yrs

Every 10 years

62
Q

When do you d/c screening for colorectal CA?

A

age 75

63
Q

Other options besides colonoscopy?

A

FIT testing, CT colonography “virtual colonoscopy,” sigmoidoscopy

64
Q

If you have a first-degree relative (FDR) diagnosed at age <60 years when should you start screening for colorectal CA?

A

age 40 or 10 years before FDR’s dx and then a colonoscopy every 5 years

65
Q

If you have ≥2 FDRs diagnosed at any age, when do you start screening?

A

age 40 or 10 years before FDR’s dx and then a colonoscopy every 5 years

66
Q

If you have one FDR diagnosed at age ≥60 years, when do you start screening?

A

begin screening at age 40

67
Q

When do you screen for Lynch Syndrome?

A

20-25 years old or 2-5 years prior to the earliest age of CRC diagnosis in the family

68
Q

When do you start screening for Familial adenomatous polyposis (FAP)?

A

yearly colonoscopy starting at age 10- 12 years old if classic FAP and colonoscopy every 1-2 years starting at age 25 for attenuated FAP

69
Q

When do you start screening for Peutz-Jeghers syndrome?

A

EGD, video capsule endoscopy, and colonoscopy starting at age 8

70
Q

Tear, cut or crack in the lining of the distal half of the anal canal

A

Anal fissures

71
Q

Clincial manifestations of anal fissures?

A
  • Anal pain
  • “papercut of anus” feeling
  • Pain worsens w/ defecation
72
Q

What is the mc location of anal fissure?

A

Posterior midline and anterior midline 2nd mc

73
Q

Acute anal fissure appearance?

A

fresh like a papercut

74
Q

Chronic anal fissure appearance?

A

Raised edges, fibrotic appearance often accompanied by a skin tag (sentinel pile)

75
Q

How do you dx anal fissures?

A

history + physical exam (either direct visualization or reproduce the pain)

76
Q

Treatment for anal fissures?

A
  • Fiber + water and/or stool softeners
  • Sitz bath
  • lidocaine jelly topical
  • Nifedipine gel or topical nitroglycerin
77
Q

Swollen veins in the rectum and anus that can lead to discomfort, prolapse and bleeding

A

Hemorrhoids

78
Q

This type of hemorrhoid is distal (below) to the dentate line?

A

external hemorrhoid

  • Somatic innervation
  • > more sensitive to pain/irritation
79
Q

This type of hemorrhoid is proximal (above) to the dentate line?

A

internal hemorrhoid

*Visceral innervation -> less sensitive to pain/irritation

80
Q

Clinical manifestations of hemorrhoids?

A
  • bleeding that is painless and associated with a bowel mvmt
  • BRBPR
  • mild fecal incontinence, mucus d/c, wet sensation
81
Q

How do you dx hemorrhoids?

A

Classical symptoms + visualization of hemorrhoids

82
Q

How are you able to dx and see internal hemorrhoids?

A

Anoscopy

83
Q

What grade hemorrhoid is this?

Prolapse with defecation or other times, needs manual reduction

A

Grade III

84
Q

What grade hemorrhoid is this?

No prolapse

A

Grade I

85
Q

What grade hemorrhoid is this?

Prolapse with defecation, spontaneously reduces

A

Grade II

86
Q

What grade hemorrhoid is this?

Permanently prolapsed/irreducible, Visible externally, may strangulate.

A

Grade IV

87
Q

What is the first line treatment for hemorrhoids besides increasing fiber and water intake to produce soft stools?

A
  • Topical steroids: hydrocortisone cream
  • Lidocaine gel
  • Warm sitz baths
  • Nitroglycerin ointment
88
Q

When to refer a patient with hemorrhoids?

A

Low grade that has been refractory to 6-8 wks tx and any grade higher

89
Q

What are potential surgical options for hemorrhoids?

A
  • Rubber band ligation
  • Sclerotherapy
  • Infrared coagulation

Grade III to IV

90
Q

What is the difference between a diverticulum and diverticulosis?

A

Diverticulum: a sac-like protrusion of the colonic wall
Diverticulosis: defined by the presence of diverticula

91
Q

Difference between diverticulosis and diverticulitis?

A

Diverticulosis is small pouches called diverticula in the colon

Diverticulitis is infection or inflammation in diverticula

92
Q

Painless hematochezia is what type of diverticular disease?

A

Diverticular bleeding

93
Q

Inflammation of a diverticulum

A

Diverticulitis

94
Q

Inflammation in the interdiverticular mucosa, without involvement of the diverticular orifices

A

Diverticular colitis

95
Q

Persistent abdominal pain attributed to diverticula without overt colitis or diverticulitis?

A

Symptomatic uncomplicated diverticular disease

96
Q

RF for diverticular disease?

A
  • Low fiber, high fat diet
  • Nuts, seeds and corn NOT associated with increased risk
  • lack of physical activity
  • Smoking
  • NSAIDs, opoids, steroids
97
Q

Functional disorder of the GIT with chronic abdominal pain and altered bowel habits

A

IBS

98
Q

A hallmark of this disease is worse with stress and better with bowel movements

A

IBS

99
Q

What are clinical manifestations of people with IBS?

A
  • Diarrhea
  • Constipation
  • Alternating diarrhea and constipation
  • Normal bowel habits alternating with diarrhea and/or constipation
100
Q

What is the diagnostic criteria of IBS?

A

Rome Criteria which basically says that you have to have recurrent abd pain on avg at least once/wk in past 3 months associated with 2 or more of the following:

  • related to defication
  • associated with change in stool frequency
  • change in stool appearnace
101
Q

Treatment for IBS?

A

Education & reassurance

  • Diet modification (FODMAPs)
  • Increased fiber (Miralax)
  • Antidiarrheals (imodium)
102
Q

Tx for IBS and abd pain?

A
  • Antispasmodics: Dicyclomine, Hyoscyamine (“amines”)

* helps improve post-prandial abd pain, bloating, fecal urgency

103
Q

What treatment for IBS can slow intestinal time (dec diarrhea) and help abd pain?

A

TCAs: “triptylines”

104
Q

Do you use abx in someone with IBS?

A

In mod-severe IBS without constipation if failed to respond to other therapies, can try rifaximin (this is a 3rd, 4th line therapy)

Ex3GI CM (15 decks)

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