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G2F > Small Bowel and Colon DSA > Flashcards

Small Bowel and Colon DSA Flashcards

1
Q

Noninfl diarrhea- viral, protozoal, bacterial enterotoxin production

A
  • norovirus, rotavirus
  • Giardia, Cryptosporidium, Cyclospora
  • preformed enterotoxin- Staph aureus, Bacillus cereus, Clostridium perfringens
  • Enterotoxin production- ETEC, Vibrio cholera
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2
Q

Infl diarrhea- viral, protozoal, cytotoxin production, mucosal invasion

A
  • CMV
  • Entamoeba histolytica
  • Cytotoxin production- EHEC, Vibrio parahaemylyticus, C difficile
  • Mucosal invasion- shigella, campylobacter, salmonella, EIEC, others
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3
Q

Initial diagnostic tests

A
  • CBC, serum electrolytes, liver fxn tests, ca, phosphorus, TSH, vit A and D levels, INR, ESR, CRP
  • tTG test- celiac dz
  • stool studies- ova, parasites, fat, occult blood, leukocytes or lactoferrin
  • colonoscopy and mucosal biopsy- exclude CD, microscopic colitis, colonic neoplasia
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4
Q

chronic diarrhea- exclude? tests?

A
  • causes of acute diarrhea
  • lactose intolerance
  • IBS
  • previous gastric surgery or ileal resection
  • parasitic infections
  • medications
  • systemic dz
  • fecal leukocytes and occult blood; colonoscopy with biopsy; small bowel imaging with barium, CT, or MR enterography
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5
Q

chronic diarrhea- Lab tests

A
  • serologic tests for neuroendocrine tumors

- breath test- dx small bowel bacterial overgrowth

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6
Q

Pernicious Anemia Gastritis

A
  • rare autosomal disorder- fundic glands
  • achlorhydria, dec IF secretion, vit B12 malab
  • severe gland atrophy and intestinal metaplasia
  • autoimmune destruction of gastric fundic mucosa
  • anti-IF ab’s
  • achlorhydria leads to hypergastrinemia!!- 5% of pts develop carcinoid tumors
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7
Q

weight loss, m wasting- malabsorption of?

A

fat, protein, carbs

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8
Q

microcytic anemia- malabsorption of?

A

iron

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9
Q

macrocytic anemia- malabsorption of?

A

vit B12 or folic acid

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10
Q

paresthesia, tetany, Trousseau and Chvostek signs- malabsorption of?

A

-Calcium, Vit D, magnesium

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11
Q

bone pain, fractures, skeletal deformities- malabsorption of?

A

calcium, vit D

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12
Q

bleeding tendency (ecchymoses, epistaxis)- malabsorption of?

A

-Vit K (prolonged PT or INR)

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13
Q

Milk intolerance (cramps, bloating, diarrhea)- malabsorption of?

A

lactose

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14
Q

edema- malabsorption of?

A

protein

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15
Q

Celiac Dz- essentials of diagnosis

A
  • typical sx- weight loss, chronic diarrhea, abd distension, growth retardation
  • atypical sx- dermatitis herpetiformis, iron def anemia, osteoporosis
  • abnormal serologic test results
  • abnormal small bowel biopsy
  • clinical improvement on gluten-free diet
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16
Q

Celiac dz- in who?

A
  • N europeans

- HLA-DQ2/8

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17
Q

Celiac dz- lab testing

A
  • deficiencies
  • IgA tTG ab!!
  • confirmation- mucosal biopsy- intraepit lymphocytes
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18
Q

Celiac dz- treatment

A
  • removal of gluten from diet

- dietary supplements (short-term)

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19
Q

Whipple Disease- essentials of diagnosis

A
  • multisystem dz
  • fever, lymphadenopathy, arthralgias
  • weight loss! (most common sx), malabs, chronic diarrhea
  • duodenal biopsy with PAS-positive macrophages with characteristic bacillus
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20
Q

Whipple disease- caused by? in who?

A
  • Tropheryma whipplei (bacillus)

- white men; 40-60’s

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21
Q

Whipple disease- dx

A

-endoscopic biopsy of duodenum- shows infiltration of lamina propria with PAS-positive macrophages that contain gram-positive bacilli

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22
Q

Short Bowel Syndrome- causes

A
  • malabsorptive condition- due to removal of segments of the small intestine
  • causes- CD, mesenteric infarction, radiation enteritis, volvulus, tumor resection, trauma
  • malabs depends on length and site of resection
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23
Q

terminal ileal resection

A
  • malabs of bile salts and vit B12

- no bile salts- steatorrhea and malabs of fat-soluble vitamins

24
Q

extensive small bowel resection

A
  • weight loss and diarrhea due to nutrient, water, and electrolyte malabsorption
  • if have less than 100-200 cm of proximal jejunum- require parenteral nutrition
25
Q

Lactase Deficiency- essentials of diagnosis

A
  • diarrhea, bloating, flatulence, abd pain after ingestion of milk-containing products
  • dx supported by symptomatic improvement on lactose-free diet
  • dx confirmed by hydrogen breath test
26
Q

Lactase Deficiency- in who?

A

-90% asian ams, 70% Af ams, 95% native ams, 50% mexican ams, 60% jewish ams, <25% of white adults

27
Q

Lactase Deficiency- lab findings

A

-hydrogen breath test!

28
Q

Irritable Bowel Syndrome- essentials of diagnosis

A
  • chronic fxnal disorder characterized by abd pain or discomfort with alterations in bowel habits
  • sx usually begin in late teens to early 20’s
  • limited evaluation to exclude organic causes of sx’s
29
Q

Irritable Bowel Syndrome- defined as?

A
  • sx’s not explicable by the presence of structural or biochemical abnormalities!!
  • chronic (>6 months) abd pain/discomfort and altered bowel habits
  • relieved with defecation, onset assoc with a change in freq of stool, or onset assoc with a change in form of stool (2 out of the 3!)
30
Q

Irritable bowel syndrome- pathogenesis

A
  • abnormal motility
  • visceral hypersensitivity
  • enteric infection
  • psychosocial abnormalities (50% have depression, anxiety, or somatization)
31
Q

Irritable bowel syndrome- treatment

A
  • reassurance, education, support
  • explain mind-gut interaction- visceral motility and sensitivity changes can be exacerbated by environmental, social, or psyhological factors
32
Q

Constipation- causes

A
  • most common- inadequate fiber/fluid intake, poor bowel habits
  • systemic dz- endocrine, metabolic, neurologic
  • medications- opioids
  • structural abnormalities
  • slow colonic transit
  • pelvic floor dyssynergia
  • IBS
33
Q

Fecal Impaction- predisposing factors, presentation

A
  • fecal impaction in rectal vault- can lead to large bowel obstruction
  • predisposing factors- medications (opioids), psychiatric dz, prolonged bed rest, neurogenic disorders of colon, spinal cord disorders
  • dec appetite, N/V, abd pain and distension
  • tx- enemas or digital disruption of the impacted fecal material
34
Q

Antibiotic-Associated Colitis- essentials of diagnosis

A
  • most cases of abx-assoc diarrhea are not due to C difficile and are usually mild and self-limited
  • sx- vary from mild to fulminant- almost all colitis is due to C difficile
  • dx- stool assay
35
Q

Antibiotic-Associated Colitis- caused by

A

C difficile- TcdA and TcdB (toxins)

  • major cause of diarrhea in pts who have been hospitalized for >3 days
  • transmitted from pt to pt by hospital personnel
  • handwashing!
36
Q

Antibiotic-Associated Colitis- virulent strain

A

-NAP1- higher toxin A and B production

37
Q

Antibiotic-Associated Colitis- sx

A
  • mild-moderate greenish, foul-smelling watery diarrhea
  • leukocytosis
  • severe/fulminant dz occurs in 10%- fever, hemodynamic instability, abd distension and pain
38
Q

Antibiotic-Associated Colitis- exam

A
  • EIAs for toxins TcdA and TcdB
  • PCR assay- more sensitive
  • flexible sigmoidoscopy (doesnt need to be done if pts have a positive stool toxin assay)- pseudomembranes
39
Q

Microscopic colitis

A
  • idiopathic
  • lymphocytic and collagenous types
  • mucosal biopsies- chronic infl in lamina propria, inc intraepit lymphocytes
  • collagenous colitis- thickened band of subepit collagen
  • women- 5-6 decades
  • tx- loperamide
40
Q

Diverticular Disease of the Colon

A
  • uncomplicated diverticulosis
  • diverticulitis
  • diverticular bleeding
41
Q

Uncomplicated diverticulosis

A
  • 90% of pts with diverticulosis have uncomplicated dz and no sx!!
  • usually an incidental finding
  • tx- high-fiber diet
42
Q

Diverticulitis- essentials of diagnosis

A
  • acute abd pain and fever
  • left lower abd tenderness and mas
  • leukocytosis
43
Q

Diverticulitis- imaging

A
  • empiric medical therapy first!

- colonoscopy or CT or barium enema- to exclude colonic neoplasms

44
Q

Diverticulitis- complications

A
  • fistula formation

- strictures- obstruction

45
Q

Diverticular bleeding

A

-diverticulosis causes 1/2 of all cases of acute lower GI bleeding!

46
Q

polyps of the colon

A
  • mucosal adenomatous polyps
  • mucosal serrated polyps (hyperplastic, sessile serated)
  • mucosal nonneoplastic polyps (juvenile, hamartomas, infl)
  • submucosal lesions
  • 70% are adenomatous
47
Q

Nonfamilial adenomatous and serrated polyps

A
  • in 30% of adults > 50 yo
  • 95% of adenocarcinomas arise from these lesions!
  • inact of APC gene
  • adenoma > 1cm, dysplasia- advanced!
48
Q

Nonfamilial adenomatous and serrated polyps- fecal occult blood or multitarget DNA tests

A
  • FOBT, FIT, fecal DNA tests- screening

- Cologuard- fecal DNA test with test for stool hemoglobin

49
Q

Nonfamilial adenomatous and serrated polyps - radiologic tests

A

-polyps IDed by barium enema exams or CT colonography

50
Q

Nonfamilial adenomatous and serrated polyps- endoscopic tests

A
  • colonoscopy- best way of detecting and removing adenomatous and serrated polyps
  • done in all pts who have positive FOBT, FIT, fecal, or DNA tests
51
Q

Familial Adenomatous Polyposis- essentials of diagnosis

A
  • inherited condition- characterized by early development of 100-1000s of colonic adenomatous polyps and adenocarcinoma
  • extracolonic manifestations- duodenal adenomas, desmoid tumors, osteomas
  • attenuated variant with <500 colonic adenomas
  • genetic testing- mutation of APC (90%) or MUTYH (8%)
  • prophylactic colectomy- recommended to prevent colon cancer
52
Q

FAP- sx

A
  • colorectal polyps at age 15; cancer at 40 yo
  • colorectal cancer inevitable by age 50- unless prophylactic colectomy
  • extraintestinal manifestations- hypertrophy of retinal pigment, desmoid tumors, osteomas
53
Q

FAP- genetic testing

A
  • APC

- MUYTH

54
Q

FAP- treatment

A

-complete proctocolectomy with ileoanal anastomosis or colectomy with ileorectal anastomosis!!- b/f age 20!

55
Q

Hamartomatous Polyposis Syndromes

A
  • Peutz-Jeghers syndrome (AD- polyps, mucocutaneous pigment, 40% chance of malignancy)
  • Familial juvenile polyposis (AD- several polyps in colon, 50% risk of adenocarcinoma)
56
Q

Lynch syndrome (HNPCC)- essentials of diagnosis

A
  • AD
  • mutations in gene that detects/repairs DNA base-pair mismatches- results in DNA MSI and inact of tumor suppressor genes
  • inc risk of colorectal cancer, endometrial cancer
  • dx suspected by tumor tissue immunohistochemical staining for MMR proteins or testing for MSI!!
  • dx confirmed by genetic testing
57
Q

Lynch Syndrome- Bethesda criteria

A
  • colorectal cancer < 50 yo
  • colorectal or Lynch syndrome-assoc tumor regardless of age (endometrial, stomach, ovary, pancreas, ureter and renal pelvis, biliary tract, brain)
  • colorectal cancer with 1 or more first degree relatives with colorectal or lynch syndrome-related cancer occuring b/f age 50
  • colorectal cancer with 2 or more second-degree relatives
  • tumors with infiltrating lymphocytes, signet ring differentiation, or medullary growth pattern in pts < 60 yo
  • should be genetically tested!!!

G2F (17 decks)

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