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GI > SI and Colon > Flashcards

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
Q

U/C gen

A

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
Q

U/C clinical

A

MC sx: TENESMUS and bloody, pus diarrhea
Pain less CMN, but usu in LLQ
severe: wt loss, malaise, fever

27
Q

UC complications

A

Complications (more likely in UC): toxic MC and malignancy
-scleritis, episcleritis, arthritides, sclerosing cholangitis, skin manifestations (erythema nodosum and pyoderma gangrenosum)

28
Q

UC labs

A

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
Q

UC tx

A

Topical/PO aminosalicylates and CS – mainstays of tx
–immunomodulator for refrac dz
Surgery can be CURATIVE, total proctocolectomy is MC surgical cure

30
Q

IBS gen

A

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
Q

IBS clinical

A

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
Q

IBS labs

A

usually nml

r/o other path

33
Q

IBS tx

A

high fiber diet, bulking agents (psyllium hydrophilic mucilloid) – mainstays
antispasmodics, antidiarrheals, prokinetics, antidepressants

34
Q

Intussusception gen

A

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
Q

intussusception clin

A

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
Q

intussusception labs

A

kids: Ba or air enema can dx and tx
Adults: NO Ba enema, abd XR shows nonspecific obs, CT = best means of dx!!

37
Q

Inttussusception tx

A

ALL hospitalized, air or Ba enema for kids, if not curative then surgery. Adults usu req surgery

38
Q

Diverticular dz gen

A

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
Q

Diverticulitis clin

A

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
Q

Diverticulitis labs

A

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
Q

Diverticulitis tx

A

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
Q

Ischemic bowel dz gen

A

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
Q

Ischemic bowel dz clin

A

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
Q

ischemic bowel dz labs

A

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
Q

Ischemic bowel dz tx

A

SURGICAL REVASCULARIZATION for acute/chronic mesenteric ischemia

46
Q

Toxic megacolon gen

A

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
Q

Toxic megacolon clin and labs

A

Fever, prostration, severe cramps, abd distension
RIGID abd
XR: colonic dilatation

48
Q

toxic megacolon tx

A

decompression of the colon REQUIRED

colostomy or complete colonic resection may be required

49
Q

Polyps gen

A

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
Q

Polyps clin

A

generally asx
Constipation, flatulence, and rectal bleeding may occur
Bleeding can cause anemia

51
Q

polyps labs

A

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
Q

Polyps tx

A

Depends on sz and histology of polyps

larger/dysplasstic should be removed

53
Q

Colorectal CA gen

A

3rd leading cause of CA death in US after lung and skin

90% of cases occur in 50y/o+

54
Q

Colorectal CA prognosis

A

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
Q

Colorectal CA clin

A

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
Q

Colorectal CA labs

A 
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
Q

Colorectal CA tx

A

surg resection
+chemo in stage III (Dukes C) or higher
RAdiation for rectal tumors

GI (5 decks)

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