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Clinical Medicine II Exam 3 GI > Toxic Megacolon > Flashcards

Toxic Megacolon Flashcards

1
Q

What is toxic megacolon?

A

Total or segmental nonobstructive colonic dilatation (>6cm) that occurs in the context of systemic toxicity

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2
Q

Incidence of toxic megacolon?

A

Unknown

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3
Q

Toxic megacolon affects what age groups?

A

Affects all ages

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4
Q

Etiologies of toxic megacolon?

A

Complications of IBD (Ulcerative colitis MC), Infectious colitis (C. difficile MC, CMV), Ischemic colitis, Volvulus, Diverticulitis, Radiation, Obstructive colorectal cancer

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5
Q

HPI for toxic megacolon?

A

Profound bloody diarrhea, abdominal pain & distention, nausea, vomiting, tenesmus (feeling of needing to pass stool even though bowels are empty)

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6
Q

Physical exam for toxic megacolon?

A

Lower abdominal tenderness & distention, dehydration (+/-) signs of peritonitis (rigidity, guarding, rebound tenderness)

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7
Q

Lab diagnostics fot toxic megacolon?

A

CBC w/ diff, CMP, Lactic acid, ESR & CRP, Lipase, TSH, Stool culture

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8
Q

Imaging diagnostics for toxic megacolon?

A

-Abdominal xr (Radiologic evidence of colon >6cm)
-Abdominal/pelvic CT to assess for complications

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9
Q

What is contraindicated with toxic megacolon?

A

Bowel prep, barium enema, complete colonoscopy (can cause colonic perforation)

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10
Q

What may be seen on radiologic imaging with toxic megacolon?

A

Gross dilatation of large and small intestines *Lead pipe appearance

-Small bowel dilatation: thin transverse folds of the valvulae conniventes (arrowhead)
-Large bowel dilatation: characteristic thick haustral markings that don’t extend cross the entire lumen

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11
Q

Diagnostic criteria for toxic megacolon?

A

Radiographic evidence
plus
3 or more of the following: Fever >38C, Pulse >120bpm, Neutrophilic leukocytosis >10,500/microL, anemia
plus
at least 1 of the following: Hypotension, Dehydration, Electrolyte abnormalities, Altered mental status (AMS)

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12
Q

Treatment of toxic megacolon?

A

MAINSTAY: supportive care (admit, bowel rest, NG tube, broad-spectrum abx (ceftriaxone + metronidazole), fluid/electrolyte repletion, serial labs /abdominal films

*treat underlying cause

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13
Q

When is surgery indicated for toxic megacolon?

A

In colonic perf, necrosis, full-thickness ischemia, intra-abdominal HTN, abdominal compartment syndrome, clinical signs of peritonitis or worsening abdominal pain despite adequate medical therapy, and end-organ failuire

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14
Q

What is another name for Ogilvie syndrome?

A

Acute colonic psuedo-obstruction

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15
Q

What is Ogilvie syndrome?

A

A disorder characterized by acute dilatation of the colon in the absence of an anatomic lesion that obstructs the flow of intestinal contents

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16
Q

Which part of the colon is usually involved in Ogilvie syndrome?

A

Cecum and right colon

17
Q

Who does Ogilvie syndrome more commonly affect?

A

Men >60 y/o

18
Q

Is the exact Patho physiology of Ogilvie syndrome known?

A

No

19
Q

Usually Ogilvie syndrome occurs in hospitalized/institutionalized patients in association with what?

A

A severe illness, after surgery/in conjunction w/ metabolic imbalance, administration of culprit med

20
Q

Which meds cause Ogilvie syndrome?

A

Opioids, anticholinergics, alpha-2-adrenergic agonists, antipsychotics, CCBs, cytotoxics, dopaminergics, epidural anesthesia

21
Q

What kinds of trauma/ortho surgery can be associated with Ogilvie syndrome?

A

Fractures, hip and spine surgery

22
Q

What kinds of obstetric and gynecological conditions are related to Ogilvie syndrome?

A

Pelvic surgery esp involving spinal anesthesia, c-section, vaginal (normal or instrumental) delivery

23
Q

What cardiothoracic surgeries or diseases are associated with Ogilvie syndrome?

A

Cardiac surgery including transplants, myocardial infarction, heart failure, pneumonia

24
Q

What neurological disorders are associated with Ogilvie syndrome?

A

Parkinson’s, stroke, dementia

25
Q

What retroperitoneal diseases are associated with Ogilvie disease?

A

Malignancy, hemorrhage

26
Q

Infection of which virus is associated with Ogilvie syndrome?

A

Herpes zoster

27
Q

HPI for Ogilvie syndrome?

A

Abdominal distention (main sx), nausea, vomiting, abdominal pain, constipation, paradoxical diarrhea (overflow diarrhea)

28
Q

Physical exam findings for Ogilvie syndrome?

A

Abdominal distention, tympanitic on percussion, high-pitched bowel sounds

29
Q

What symptoms of Ogilvie syndrome are suggestive of colonic ischemia or perforation (or their impending development)?

A

Fever, marked abdominal tenderness, and presence of peritoneal signs (guarding, rigidity, rebound tenderness)

30
Q

Lab diagnostics for Ogilvie syndrome?

A

CBC, CMP, LFTs, Serum lactate, TSH, stool cultures if diarrhea

31
Q

Diagnostic scans for Ogilvie syndrome?

A

Abdominal radiographs, Abdominal CT is preferred

32
Q

What may be seen on an abdominal CT of Ogilvie syndrome?

A

Proximal colonic dilatation, dilation may extend to rectum

33
Q

Goal of management of Ogilvie syndrome?

A

To decompress the colon in order to minimize risk of colonic perforation/ischemia

34
Q

Treatment for Ogilvie syndrome w/o ischemia/perforation/peritonitis (colon dilation <12cm)?

A

Supportive/conservative care: NPO, NG tube, IV fluid/electrolyte repletion, treat underlying disease, d/c offending meds
Serial exams, serial abdominal radiographs, serial labs every 12-24 hrs

35
Q

Treatment for patients with Ogilvie syndrome, at risk for perforation (>12cm)/severe abdominal pain/failed conservative treatment?

A

Med: Neostigmine
Colonoscopic decompression: reserved for failed conservative tx, Neostigmine contraindications/failure
Serial exams, serial abdominal radiographs, serial labs ever 12-24 hrs

36
Q

What is the perforation rate and risk of mortality for colonoscopic decompression?

A

Perf rate: ~2%
Mortality risk: 1%
*technically difficult procedure

Clinical Medicine II Exam 3 GI (14 decks)

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