Surgical Tut - Colitis

Question 1

colitis presents?

Answer 1

diarrhoea - typically bloody
abdo pain
fever

Question 2

3 causes of infectious colitis? and their organisms

Answer 2

bacterial: C.diff, salmonella, shigella, camp, yersinia
viral: CMV
parasitic: entamoeba, cryptosporidium

Question 3

who gets CMV colitis?

Answer 3

immunosuppressed,

transplant patients

Question 4

history of someone with entamoeba hystolytica?

Answer 4

liver lesions
diarrhoea
recent travel

Question 5

C.diff two types?

Answer 5

Toxin A - enterotoxin (osmotic diarrhoea)

Toxin B - cytotoxin (kills cells)

Question 6

what Antibiotic likely to cause C.diff?

Answer 6

clindamycin
augmentin DF
cephs

Question 7

C.Diff ask Abx therapy within what time frame?

Answer 7

6 weeks

Question 8

C.Diff worse outcome for colon?

Answer 8

toxic megacolon: adynamic colon of more than 6 cm

subsequent perforation

Question 9

how to treat C.Diff?

Answer 9

metronidozole
vanco
surg for colectomy

Question 10

how many C.Diff produce toxin A vs. B

Answer 10

98% produce toxin A

100% produce toxin B

Question 11

ischaemic colitis risk factors?

Answer 11

age, HTN, DM2,smoking

hypercoagulable
cocaine
extreme physical activity

Question 12

right side colon/caecum susceptible to what ischaemia?

Answer 12

emboli from SMA

low flow states

Question 13

sigmoid colon susceptible to ischaemia why?

Answer 13

IMA from atherosclerosis or AAA repair

Question 14

ischaemic colitis from hospital causes?

Answer 14

post AAA

post CABG

Question 15

why Abx in ischaemic colitis?

Answer 15

prophylaxis for translocation along wall

Question 16

how to rule out colitis infections?

Answer 16

faecal MCS

Question 17

erythema nodosum association?

Answer 17

crohn’s

Question 18

association of UC?

Answer 18

Primary sclerosing cholangitis

Question 19

surgery for crohn’s?

Answer 19

Nope, need more surg and higher risk of complications

Risks of enterocutaneous fistula

Question 20

crohn’s extra intestinal manifestations?

Answer 20

Ankyspon
uveitis
erythema nodosum

Question 21

UC presents with?

Answer 21

PROCTITIS

frequent bloody stools, tenesmus
fever, weight loss

Question 22

whatis backwash ileitis?

Answer 22

UC backwashes inflammatory mediators through iliocaecal valve causes local ilietis?

Question 23

PSC with UC is what?

Answer 23

stricturing of biliary tree

Question 24

UC plus PSC gives you risk of?

Answer 24

dysplasia and colon cancer

Question 25

smoking in crohn’s?

Answer 25

bad

Question 26

smoking in UC?

Answer 26

protective

Question 27

inflammation in crohn’s?

Answer 27

transmural

Question 28

crohn’s histopath?

Answer 28

granulomas
neutrophils
crypt abscesses

Question 29

crohn’s see what on colonoscopy?

Answer 29

deep fissures
ulcers
skip lesions

Question 30

UC involved what infiltrate?

Answer 30

lymphocitic mostly

Question 31

UC affects which structures in colon?

Answer 31

mucosa and submucosa

Question 32

ulcers in UC?

Answer 32

may not

Question 33

colitis involves usually what?

Answer 33

mucosa rather than transmural

Question 34

diverticulum is what?

Answer 34

serosa and muscosa without muscle blow out where there’s a gap in the vasculature

Question 35

why does diverticulum occur?

Answer 35

constipation and higher pressures

Question 36

diverticulitis happens where?

Answer 36

left mostly

right sometimes in Asians