SI and Colon Flashcards
Diarrhea definition
3 or more liquid/semisolid stools/d for 2-3 consecutive days
Secretory diarrhea
Large volume w/o inflamm.
Indicates pancreatic insufficiency, ingestion of preformed bac. toxins, or laxative use
Inflammatory diarrhea
Bloody diarrhea w/ fever
Indicates invasive organisms or IBD
ABX-assoc diarrhea
Caused by C. difficile colitis
–if severe, causes pseudomembranous colitis
E. coli cause of diarrhea
Tx w/ bismuth/loperamide
Giardia lamblia diarrhea
Tx w/ metronidazole, 250mg BID x10d
Cyclospora diarrhea
Tx w/ Bactrim BID x 7d
Causes of purulent, bloody diarrhea
Enterohemorrhagic e coli (ground beef), shigella (Fecal oral), campylobacter (undercooked poultry)
tx supportive
Constipation gen
NML: 3/d to3/wk
Constipation: dec in stool vol and inc in stool firmness accompanied by straining
New in 50y/o+, eval for colon CA
Cryptosporidia
Lasts 30d, tx supportive, HIV tx
Constipation tx
INC fiber to 10-20g/d
INC fluid to 1.5-2L/d
INC exercise
Lasts more than 2wk? look for underlying cause
Bowel obstruction
most SI obs due to adhesions or hernias
–other cause: stricture, hernia, volvulus, intussusception, fecal impaction
STRANGULATION –> infarction, necrosis, peritonitis, death
Bowel obs clinical
SI: abd pain, distension, vomiting of partially digested food, obstipation
BS: high pitch in rushes, late- silent
LI: distension and pain
Can be febrile and tachy –> shock
Bowel obs labs and tx
dehydration and electrolyte imbalance – CMN
XR: air-fluid levels
tx: NPO, NG suctioning, IV fluid, monitor – surgery likely
Distinguish maldigestion and malabsorption
D-xylose test
Celiac dz gen
Most CMN genetic condition in US and Europe
Inflamm of SI w/ ingestion of gluten such as wheat, rye, and barley leading to malabsorption
Celiac dz clinical
Diarrhea, steatorrhea, flatulence, wt loss, weakness, abd distension
Infants and kids – failure to thrive
Older – IDA, coagulopathy, hypoCa
Celiac dz dx
IgA antiendomysial and antitissue tranglutaminase Ab
SI bx REQ to confirm dx
Crohn’s dz gen
Regional enteritis IBD MC: terminal ileum and R colon Rectum FREQ spared SKIP AREAS -- characteristics
Crohns complication
Fistulas, abscesses, aphthous ulcers, renal stones, predisposition to colonic cancer
Crohns clinical
MC presenting complaint:
-abd cramps and diarrhea in pt < 40y/o
low fever, polyarthralgia, anemia, fatigue, bloody stool
Diff b/w crohns and UC
Crohns: gradual mouth to anus, R sided, SKIP areas depth-transmural CMN complications: fistulas UC: sudden/gradual distal to proximal, CONTINUOUS MUCOSAL surface bloody, PUS-filled diarrhea, tenesmus
Crohns labs
Colonoscopy!! good for est dx, determining extent and severity, guiding tx
NO contrast or endoscopic in fulminant
–can induce toxic megacolon/perforation
Bx reveals involvement of entire bowel wall
Granulomas FREQ
CBC: INC sed rate, anemia, nutritional/elec imbalance
Crohns tx
acute attacks: PO corticosteroids
-Metronidazole or cipro in perianal dz, fissures or fistulae
-Infliximab if refractory
Elemental diet
MESALAMINE – best for maintenance
Supplement w/ vit B12, folic acid, and vit D
Smoking cessation – to dec freq and severity
Surgery is NOT curative, reserved for tx complications. segmental is approach of choice
U/C gen
Generally starts distally at rectum and progresses proximally – dz continuous, NO skip
generally gradual, but can be abrupt
Smoking is PROTECTIVE
-recently quit? –> UC flares
U/C clinical
MC sx: TENESMUS and bloody, pus diarrhea
Pain less CMN, but usu in LLQ
severe: wt loss, malaise, fever
UC complications
Complications (more likely in UC): toxic MC and malignancy
-scleritis, episcleritis, arthritides, sclerosing cholangitis, skin manifestations (erythema nodosum and pyoderma gangrenosum)
UC labs
anemia, INC sed rate, DEC serum albumin
Abd XR: colonic dilatation
Colonoscopy and Ba enema – AVOID in acute dz – INC risk of toxic MC and perf
UC tx
Topical/PO aminosalicylates and CS – mainstays of tx
–immunomodulator for refrac dz
Surgery can be CURATIVE, total proctocolectomy is MC surgical cure
IBS gen
no known pathology – combo: altered motility, hypersensitivity, psych distress
MCC of chronic or recurrent abd pain in US
intermittent and lifelong, usu begin early-mid adulthood
More in women, exacerbate w/ menses/stress
IBS clinical
Abd pain anywhere, but can be localized to hypogastrium or LLQ
- can be worsened by food, relieved w/ defecation
-INC gas, associated spasm of sm musc
-Postprandial urgency CMN
PE – nml, but sigmoid colon might be tender/palpable, hyperres over abd
changes in stool freq and char.
Dyspepsia CMN
Urinary urgency and freq CMN in women
IBS labs
usually nml
r/o other path
IBS tx
high fiber diet, bulking agents (psyllium hydrophilic mucilloid) – mainstays
antispasmodics, antidiarrheals, prokinetics, antidepressants
Intussusception gen
invagination of proximal segment into portion just distal to it
MC in kids (95%), usu following viral infxn
adults – almost always d/t neoplasm
intussusception clin
kids: severe colicky pain, mucus/bloody/ CURRANT JELLY stools, sausage shaped mass
Adults: indolent course of crampy abd pain, bloody stool/abd mass – RARE
intussusception labs
kids: Ba or air enema can dx and tx
Adults: NO Ba enema, abd XR shows nonspecific obs, CT = best means of dx!!
Inttussusception tx
ALL hospitalized, air or Ba enema for kids, if not curative then surgery. Adults usu req surgery
Diverticular dz gen
Outpouchings of mucosa in colon
60% >60y have diverticula, 20% sx
20% acute diverticulitis < 40y/o
can prevent diverticulitis and complications w/ high-fiber diet and avoidance of obs/ constipating foods
Diverticulitis clin
SUDDEN onset abd pain, usu LLQ or suprapubic region w/ or w/o fever
Can range from mild to severe w/ peritonitis
Altered bowel movement, N/V CMN
Diverticulitis labs
Occult blood, mild-mod leukocytosis, plain film XR to r/o free air, CT if pt doesn’t respond to therapy
AVOID Ba enema in acute episode
Diverticulitis tx
Low residue diet, broad-spectrum ABX – for mild
Hospitalization w/ IV ABX, bowel rest, analgesics.
NG tube if ileus develops
Surg in severe including peritonitis, large abscess, fistulae, obs
Diverticulosis: high fiber, don’t need to avoid nuts, seeds, popcorn
Ischemic bowel dz gen
Mesenteric ischemia – usu > 50y/o and have other CV or collagen vasc dz
Acute: caused by arterial embolus/thrombosis or venous thrombosis; EMERGENCY, mortality is high
Intestinal infarction is more CMN in SI
Shock is CMN
Ischemic bowel dz clin
Chronic: abd angina, pain 10-30min after eating, somewhat relieved by SQUATTING or lying down
Acute: SUDDEN severe abd pain out of proportion, later- invol guarding, rebound, and heme+ stool
ischemic bowel dz labs
XR and CT performed to r/o other causes of abd pain
Colonoscopy– OPTIMAL TEST to eval ischemia of colon
Angiography may be helpful
Ischemic bowel dz tx
SURGICAL REVASCULARIZATION for acute/chronic mesenteric ischemia
Toxic megacolon gen
EMERGENCY
Ext dilatation/immobility of colon
Congenital: Hirschsprung –aganglionosis of colon –> fxnal obs in newborn
Adults: complication of UC, chrohns, pseudomembranous colitis, or infxn
Toxic megacolon clin and labs
Fever, prostration, severe cramps, abd distension
RIGID abd
XR: colonic dilatation
toxic megacolon tx
decompression of the colon REQUIRED
colostomy or complete colonic resection may be required
Polyps gen
CMN in industrialized world
Maybe malignant or benign
Removal can DEC occurrence of colon CA
Familial polyposis: genetic predisposition to mult polyps w/ near 100% risk of Colon CA
Polyps clin
generally asx
Constipation, flatulence, and rectal bleeding may occur
Bleeding can cause anemia
polyps labs
Heme+ stool CMN
Ba enema, flexible sigmoidoscopy and colonoscopy can detect polyps
Histologic eval needed to determine dysplasia
Family members of those w/ familial polyposis should be eval 1-2y starting at 10-12
Polyps tx
Depends on sz and histology of polyps
larger/dysplasstic should be removed
Colorectal CA gen
3rd leading cause of CA death in US after lung and skin
90% of cases occur in 50y/o+
Colorectal CA prognosis
Good in early dz
CA only involves mucosa, DUKES A, 5y survival rate is 90%
Through wall or involves lymph nodes, DUKES B, 5y survival rate 70-80%
Metastasis, DUKES C (lymph node+), and DUKES D (distant metastases), survival rate 5%
Colorectal CA clin
SLOW growing, sx appear late
abd pain, change in bowel habits, occult bleeding, intestinal obs
Fatigue/weakness can be d/t chronic blood loss/anemia
Changes in stool sz/shape
Colorectal CA labs
Occult blood in stool -- EARLY marker -good to screen in adults >40y/o Colonoscopy flexible in 40-50y/o Screen general pop 50y/o+ Carcinoembryonic Ag can be used to monitor CA
Colorectal CA tx
surg resection
+chemo in stage III (Dukes C) or higher
RAdiation for rectal tumors
