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DEMS unit 1 > Pathophysiology of Colon > Flashcards

Pathophysiology of Colon Flashcards

1
Q

Colon anatomy

A

5’
tubular structure with all 5 layres
- inner circular, outer longitudinal smooth muscle layers
- ileocecal valve, internal and external anal sphincters
- NO villi

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2
Q

Multiple colonic functions

A
  • water/ion absorption (ascending)
  • bacterial fermentation of nonabsorbed nutrients (splenic flexure)
  • storage of waste/indigestible materials (descending)
  • elimination of waste/indigestible materials (rectum)
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3
Q

IBD pathophys

A

genetic susceptibility, immune dysregulation, environmental triggers

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4
Q

Diagnosis of IBD

A

When:

  • suggestive symptoms > 2 weeks
  • negative work-up for other causes of colitis (infection, ischemia, meds)
  • extra-intestinal sxs
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5
Q

type of IBD

A

Ulcerative colitis, Crohn’s dz (10-20% have features of both)

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6
Q

signs/sxs of Ulcerative colitis

A

diarrhea, weight loss, fatigue, LOWER ad pain, Hematochezia, mcuus in stool, tenesmus (needing to defecate)

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7
Q

Crohn’s sxs

A

diarrhea, weight loss, fatigue, mid or lower abd pain, nausea/vomiting, fistula sxs

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8
Q

Crohns vs UC region affected

A

C: Entire GI tract
UC: Colon,

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9
Q

C vs UC: Obstruction

A

C: yes
UC: no

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10
Q

C vs UC: malabsorption?

A

C: Yes
UC: no

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11
Q

C vs UC: Malignant potential

A

C: with colonic involvement
UC: yes

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12
Q

C vs UC: recurrence after colectomy

A

C: common since can be affecting whole GI
UC: no

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13
Q

C vs UC: Toxic megacolon?

A

C: no
UC: yes

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14
Q

C vs UC: Inflammation- area affected

A

C: transmural
UC: mucosa and/or submucosa

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15
Q

C vs UC: Ulcers?

A

C: deep, linear
UC: superficial, confluent

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16
Q

C vs UC: Fibrosis?

A

C: Marked
UC: mild to none

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17
Q

C vs UC: Granulomas?

A

C: Yes- 20%
UC: No

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18
Q

Crohn’s fistula types

A
  • entero-cutaneous
  • entero-enteral,
  • enterogastric,
  • entero-vesical,
  • entero-vaginal
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19
Q

Treatment of fistulas

A

usually requires biologic therapy or surgery

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20
Q

Extraintestinal manifestations

A
  • mostly UC
  • Eye– scleritis, episcleritis
  • Skin – pyoderma gangenosum, erythema nodosum
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21
Q

Extraintestinal liver manifestations

A

Primary sclerosing cholangitis (PSC)

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22
Q

Joint involvement of IBD

A

sacroiliitis, ankylosing spondylitis

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23
Q

IBD management

A 
Start with medical treatment
- corticosteroids
- 5-aminosalicylates
Immunomodulators
TNF-alpha antagonists

Surgery–colectomy, partial SB resection or stricturoplasty
(refractory dz, obstruction, fistula, HG dysplasia, or cancer)

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24
Q

Colon cancer surveillance

A
  • risk increases with IBD duration
  • yearly colonoscopy after 7-8 years
  • biopsies from every segment
  • LowGrade dysplasia common in IBD
  • HighGrade dysplasia or cancer –> colectomy
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25
Q

Microscopic colitis prevalence

A

usually 50 -80, female: male 15:1

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26
Q

Microscopic colitis

A

autoimmune, trigger unknown

- salt and water loss in colon

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27
Q

Microscopic colitis presentation

A

chronic secretory diarrhea

  • watery, non-bloody
  • 4-10 stools per day
  • minimal nocturnal or fasting sxs
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28
Q

Subtypes of microscopic colitis

A

Lymphocytic, collagenous

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29
Q

microscopic colitis association

A

mild association with celiac dz

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30
Q

Prognosis of microscopic colitis

A

good prognosis

  • no bleeding, dehydration, or other complications
  • no increase in cancer risk/mortility
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31
Q

Diagnosis of microscopic colitis

A
  • colonoscopy usually normal

- Biopsy = definitive
lymphocytic infilatration ofmucosa and SM (LC); thickened collagenous band (CC

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32
Q

Histology

A

?

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33
Q

Ischemic colitis

A

90% of patients > 60 years old

  • most have not vascular or GI disease
  • Fundamental insult = acute compromise in blood flow
34
Q

ischemic colitis triggers

A

vasospasm, dehydration, hypotension, or cardiopulmonary insult (e.g. MI, PE)

35
Q

ischemic coliits areas affected

A

most common in watershed vascular areas (splenic flexure, rectosigmoid)

36
Q

IC presentation

A

abrupt onset, crampy, lower abd pain;

  • urgent need to defecate
  • mild diarrhea and/or hematochezia (severe diarrhea/bleeding suggests other diagnosis)
37
Q

ischemic colitis endoscopic findings

A

edema, ulceration/ +/- bleeding confined to avascular region

38
Q

can ischemic colitis present with severe diarrhea or bleeding

A

NO–suggests other cause

39
Q

Ischemic colitis less common cause

A
  • Vasculitis (SLE, polyarteritis nodosa, Henoch-Schonlein)
  • SUbstance abuse (cocaine, amphetamine)
  • Meds (estrogens, migrain meds)
  • mesenteric thrombosis (protein C/S deficiency, factor V Leiden def, etc)
  • Rare: Marathon running, extreme dehydration
40
Q

Infectious colitis

A

inflammatory diarrhea +/- hematochezia (mucosal infasion, toxin-related injury)
- Hx- short duraiton, travel, ill contacts, antibiotic use

41
Q

Hx of acute diarrhea

A

Think infectious!!

  • Undercooked beef- e coli
  • Contaminated poultry, eggs, milk, lettuce (salmonella/shigella, campylobacter, yersinia)
  • antibiotic use, hospitalization (C diff)
42
Q

other Colitis

A

Hx important

  • Endoscopy (location/appearance)
  • Biopsy if needed, definitive
43
Q

management of Non-IBD coliitis?

A
  • microscopic: antidarrheals, BIsmuth, topical steroids
  • infectious- support +/- antibiotics
  • ischemic: support: antibiotics, volume support
  • Drug-induced: support, d/c offending
    drug
  • Radiation colitis - topical agents, endoscopic ablation
  • Surgery- rare; severe/ refractory cases
44
Q

Diverticulosis prevalence

A
  • > 50% in elderly
  • Western > developing countries (increased intra-colonic pressure, low-fiber diet)
  • 80% asymptomatic
  • 20% diverticulitis, hemorrhage
45
Q

Diverticulitis

A

outpouching of bowe wall

46
Q

Prevalence/cause of diverticular hemorrhage

A
  • 5% pts with diverticulosis
  • usually from right colon
  • vasa recta within dome of diverticula
47
Q

Presenation of diverticular hemorrhage

A

painless hematochezia, often heavy, typically stops w/in 2-3 days

48
Q

Acute diverticulitis

A
  • 10-15% pts with diverticula
  • fecolith obstructs diverticulum –> distention from bacterial gas/neutrophils, nicroperforation, abscess, macroperforation with peritonitis
49
Q

Acute diverticulitis sxs

A

LLQ pain, nausea, fever

50
Q

Diverticulitis diagnosis/management

A
  • Diagnosis: CT or MRI
  • Treat: oral or IV antibiotics, abscess drainage, surgery

strictures may require dilation/resection

51
Q

Lower GI bleeding

A
  • bleeding distal to ligament of Treitz
  • colonic bleeding&raquo_space;> SB bleeding
  • usually hematochezia (less commonly melena)
52
Q

Lower GI bleeding mortality

A

1-2%; ceases in 90% without intervention

53
Q

Recurrence of GI bleeding

A

frequent if cause not identified

54
Q

Etiologies of lower GI bleeding

A

Diverticulosis, arteriovenous malformations, colitis, neoplaslm, radiation colitis, post-polypectomy/biopsy, miscellaneous (internal hemorrhoids, solitary rectal ulcer, anal fissure, Dieulafoy’s lesion)

55
Q

Chronic abdominal pain and diarrhea history cue?

A

IBD

56
Q

Cue for weight loss, new constipation, anemia

A

neoplasia

57
Q

Sudden onset and vessation of bleeding,elderly pt cues to…

A

Diverticulosis

58
Q

Hematochezia after surgery or MI cues …

A

ischemic colitis

59
Q

Acute dysentery, travel, ill contacts, or antibiotics, –cues…

A

infectious diarrhea

60
Q

Chronic microcytic anemia cues…

A

neoplasia or arteriovenous malformation

61
Q

NSAIDs cues—

A

drug-induced colitis

62
Q

History of pelvic radiation cues—

A

radiation proctitis

63
Q

Lower GI bleeding daignosis

A

colonoscopy, tagged rbc scan, angiography

64
Q

Lower GI bleed treatment

A

support, endoscopic therapy, angiographic therapy, surgical resection (refractory or recurrent bleeding)

65
Q

arteriovenous malformation

A

junction between artery/vein in colon wall–can burst and bleed

66
Q

Treat AVM

A

go in and ablate

67
Q

Colon obstruction sxs

A

N/V, abd distension, constipation or obstipation (severe/complete constipation)

68
Q

Colon obstruction causes

A

cancer, adhesions, strictures, volvulus (twisting), foreign body (inserted/ingestion)

69
Q

Colon obstruction diagnosis

A

tentative- plain x-ray, confirmed and defined with CT or MRI for surgery
- don’t need endoscopy

70
Q

colonic obstruction- treatment

A

admission to hospital, NPO, NGT tube decompression, colonoscopy if suspected cancer or volvulus, surgical resection standard, metal stent for select patients

71
Q

Lower abd pain + hematochezia associated with?

A

colitis (can be cancer)

- DIagnose via endoscopy/bx

72
Q

Microscopic colitis

A

mild secretory diarrhea in elderly women, manage medically

73
Q

colonic obstruction sxs and diagnosis

A
  • N/V and abd

- diagnose by Xray/CT

74
Q

suggestive IBD sxs

A

diarrhea, crampy abd pain, bleeding > 2 weeks

75
Q

Diagnosis IBD

A
  • imaging can be suggestive

- direct visualization/biopsy= gold standard

76
Q

C/UC fistula or abscess?

A

C: yes
UC: no

77
Q

C vs UC: strictures

A

C: common
UC: no

78
Q

C vs UC distribution

A

C: “Skip lesions”
UC: diffuse

79
Q

Celiac Disease extraintestinal manifestations

A

fatigue, Fe deficiency anemia, pubertal delay, short stature, aphthous stomatitis, dermatitis herpetiformis (blistering skin dz)
- increased incidence of lymphocytic gastritis/colitis

80
Q

Celiac-associated malignancies

A

Enteropathy-associated T cell lymphoma (EAT lymphoma) and small intestinal adenocarcinoma

DEMS unit 1 (15 decks)

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