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SI and Colon Flashcards

1
Q

Diarrhea definition

A

3 or more liquid/semisolid stools/d for 2-3 consecutive days

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2
Q

Secretory diarrhea

A

Large volume w/o inflamm.

Indicates pancreatic insufficiency, ingestion of preformed bac. toxins, or laxative use

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3
Q

Inflammatory diarrhea

A

Bloody diarrhea w/ fever

Indicates invasive organisms or IBD

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4
Q

ABX-assoc diarrhea

A

Caused by C. difficile colitis

–if severe, causes pseudomembranous colitis

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5
Q

E. coli cause of diarrhea

A

Tx w/ bismuth/loperamide

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6
Q

Giardia lamblia diarrhea

A

Tx w/ metronidazole, 250mg BID x10d

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7
Q

Cyclospora diarrhea

A

Tx w/ Bactrim BID x 7d

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8
Q

Causes of purulent, bloody diarrhea

A

Enterohemorrhagic e coli (ground beef), shigella (Fecal oral), campylobacter (undercooked poultry)
tx supportive

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9
Q

Constipation gen

A

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

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10
Q

Cryptosporidia

A

Lasts 30d, tx supportive, HIV tx

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11
Q

Constipation tx

A

INC fiber to 10-20g/d
INC fluid to 1.5-2L/d
INC exercise
Lasts more than 2wk? look for underlying cause

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12
Q

Bowel obstruction

A

most SI obs due to adhesions or hernias
–other cause: stricture, hernia, volvulus, intussusception, fecal impaction
STRANGULATION –> infarction, necrosis, peritonitis, death

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13
Q

Bowel obs clinical

A

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

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14
Q

Bowel obs labs and tx

A

dehydration and electrolyte imbalance – CMN
XR: air-fluid levels

tx: NPO, NG suctioning, IV fluid, monitor – surgery likely

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15
Q

Distinguish maldigestion and malabsorption

A

D-xylose test

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16
Q

Celiac dz gen

A

Most CMN genetic condition in US and Europe

Inflamm of SI w/ ingestion of gluten such as wheat, rye, and barley leading to malabsorption

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17
Q

Celiac dz clinical

A

Diarrhea, steatorrhea, flatulence, wt loss, weakness, abd distension
Infants and kids – failure to thrive
Older – IDA, coagulopathy, hypoCa

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18
Q

Celiac dz dx

A

IgA antiendomysial and antitissue tranglutaminase Ab

SI bx REQ to confirm dx

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19
Q

Crohn’s dz gen

A 
Regional enteritis
IBD
MC: terminal ileum and R colon
Rectum FREQ spared
SKIP AREAS -- characteristics
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20
Q

Crohns complication

A

Fistulas, abscesses, aphthous ulcers, renal stones, predisposition to colonic cancer

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21
Q

Crohns clinical

A

MC presenting complaint:
-abd cramps and diarrhea in pt < 40y/o
low fever, polyarthralgia, anemia, fatigue, bloody stool

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22
Q

Diff b/w crohns and UC

A 
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
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23
Q

Crohns labs

A

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

24
Q

Crohns tx

A

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

25
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
26
U/C clinical
MC sx: TENESMUS and bloody, pus diarrhea Pain less CMN, but usu in LLQ severe: wt loss, malaise, fever
27
UC complications
Complications (more likely in UC): toxic MC and malignancy -scleritis, episcleritis, arthritides, sclerosing cholangitis, skin manifestations (erythema nodosum and pyoderma gangrenosum)
28
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
29
UC tx
Topical/PO aminosalicylates and CS -- mainstays of tx --immunomodulator for refrac dz Surgery can be CURATIVE, total proctocolectomy is MC surgical cure
30
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
31
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
32
IBS labs
usually nml | r/o other path
33
IBS tx
high fiber diet, bulking agents (psyllium hydrophilic mucilloid) -- mainstays antispasmodics, antidiarrheals, prokinetics, antidepressants
34
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
35
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
36
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!!
37
Inttussusception tx
ALL hospitalized, air or Ba enema for kids, if not curative then surgery. Adults usu req surgery
38
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
39
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
40
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
41
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
42
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
43
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
44
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
45
Ischemic bowel dz tx
SURGICAL REVASCULARIZATION for acute/chronic mesenteric ischemia
46
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
47
Toxic megacolon clin and labs
Fever, prostration, severe cramps, abd distension RIGID abd XR: colonic dilatation
48
toxic megacolon tx
decompression of the colon REQUIRED | colostomy or complete colonic resection may be required
49
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
50
Polyps clin
generally asx Constipation, flatulence, and rectal bleeding may occur Bleeding can cause anemia
51
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
52
Polyps tx
Depends on sz and histology of polyps | larger/dysplasstic should be removed
53
Colorectal CA gen
3rd leading cause of CA death in US after lung and skin | 90% of cases occur in 50y/o+
54
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%
55
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
56
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 ```
57
Colorectal CA tx
surg resection +chemo in stage III (Dukes C) or higher RAdiation for rectal tumors

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