Unit1_Pathophysiology&Diz Flashcards
WHat is the disease ~w/ the following Sx:?
- Hematochezia
- Mucus in stool
- Tenesmus
Ulcerative Colitis
What is the disease ~w/ the following Sx:?
- Nausea/vomiting
- Steatorrhea
- Fistula symptoms
Crohn’s Diz
Where is the abd. pain in Crohn’s pt.?
mid or lower abd pain
Where is the abd. pain in Ulcerative Colitis pt.?
LOWER abd pain
What Sx/signs are common in both Ulcerative Colitis & Crohn’s pt.s?
Chronic diarrhea
Weight loss
Fatigue
What is the gold standard test used to dX IBD?
Direct visualization and biopsy
What region of the bowel does Crohn’s diz affect?
Entire GI tract
What region of the bowel does Ulcerative Colitis affect?
Colon only!
Does Ulcerative Colitis result in Fistulae or abscesses?
NO.
Crohn’s has fistula and abscesses!
Which type of IBD are strictures common in?
Crohn’s!
UC does NOT result in Strictures.
A “skip lesions” distribution is ~w/ with which IBD?
Crohns
UC has a DIFFUSE distribution.
Which IBD has inflammation that is transmural?
Crohns. m
UC inflammation is Mucosa +/- SM
Which IBD has supperficial and confluent ulcers?
Ulcerative Colitis
Which IBD has granulomas?
Crohn’s (20-35% of pt.)
Which IBD is ~w/ obstruction, malabsorption and recurrence after colectomy?
Crohn’s!
Which IBD is ~w/ toxic Megacolon?
Ulcerative Colitis
What are the extra-intestinal manifestationals of IBD (mostly in UC):
Eyes: ?
Skin: ?
Eye: Scleritis, episcleritis.
Skin: Pyoderma gangrenosum, erythema nodosum.
What are the extra-intestinal manifestationals of IBD (mostly in UC):
Liver/Bile duct: ?
Joints: ?
Liver/bile duct: Primary sclerosing cholangitis (PSC) and cholangiocarcinoma.
Joints: Sacroiliitis, Ankylosing spondylitis.
Is Microscopic colitis a A.I. disease?
YES!
What is the clinical presentation of Microscopic Colitis?
Mild, chronic secretory diarrhea.
- water, non-bloody. 4-10 stools/day
- minimal to no weight loss.
- salt and water loss in the colon
What other diz has a mild association with Microscopic Colitis?
celiac disease
What is the pX of Microscopic Colitis?
good!
- No bleeding, dehydration, or other complications
- No increase in cancer risk or mortality
How do you dX Microscopic Colitis?
Colonoscopy - usually normal, b/c its microscopic, can’t see anything with the naked eye.
Biopsy is definitive
- Lymphocytic infiltration of mucosa and SM (LC)
- Thickened collagenous band (CC) in submucosa
Can’t make dX based on imaging, or other labs!
BIOPSY ONLY WAY!!!
Chronic inflammation with lymphocytic infiltration, is the histological finding of which type of Microscopic Colitis?
Lymphocytic colitis
Thickened subepithelial collagen band +/- lymphocytic surface injury, is the histological finding of which type of Microscopic Colitis?
Collagenous colitis
What colitis is commonly in watershed vascualr area like the splenic flexure, rectosigmoid junction,
Ischemic colitis: Fundamental insult = acute compromise in colonic bloodflow.
What is the endoscopic findings of Ischemic colitis?
edema, ulceration, +/- bleeding confined to a vascular region.
What is the clinical ppt. of Ischemic colitis?
- Abrupt-onset, crampy, lower abdominal pain
- Urgent need to defecate
- Mild diarrhea and/or hematochezia.
- Clinical Presentation depends on…cause, extent of vascular compromise, speed of development, degree of collateralization, comorbid conditions
- EVEN THOUGH THESE ARE THE TYPICAL SIGNS/SYMPTOMS, MOST IMPORTANT THING IS FOR PHYSICIAN TO HAVE A HIGH INDEX OF SUSPICION. (HTN, high risk factors)
How long does it take to recover from an event of Ischemic colitis?
1-2 weeks, typical
What are other/rare causes of Ischemic colitis?
Vasculitis – Lupus (SLE), Polyarteritis Nodosa (PAN), Henoch-Schonlein
Substance abuse - cocaine, amphetamines
Medications - estrogens, migraine medications
Mesenteric thrombosis - Protein C/S deficiency, Factor V Leiden def., etc.
Rare: Marathon running, extreme dehydration
Pt. w/ Acute (< 4-week) diarrhea —> think!?
Travel to developing countries
- Traveler’s diarrhea (GNR).
Undercooked beef
- E. Coli.
Contaminated poultry, eggs, milk, lettuce
- Salmonella/Shigella, Campylobacter, Yersinia.
Antibiotic use, hospitalization
- C. Difficile.
Anal intercourse
- Syphilis, gonorrhea, HSV proctitis.
What HLA type is ~w/ IBD?
HLA-B27 associated with IBD
_____________ : outpouching of colon wall composed of mucosa and submucosal layers that herniate outward through muscularis propria but are contained by serosa
Diverticulosis
What is the top risk factors for Diverticulosis?
low fiber diet!!
low fiber diet → decreased stool bulk → increase peristaltic squeeze pressure and intra-colonic pressure → mucosal herniation through focal defects in bowel wall
What is the common complciation of Diverticulosis?
Diverticular hemorrhage.
- usually from right colon.
Painless hematochezia, often heavy, typically stops w/in 2-3 days
____________ : fecalith obstruction of diverticulum → distension from bacterial gas and neutrophils, micro perforation, abscess, or frank perforation with peritonitis
Diverticulitis
What are the Sx of Diverticulitis?
Lower abd pain, nausea, fever.
NO diarrhea & NO bleeding!
What are the Tx of Diverticulitis?
- Oral/IV abx for uncomplicated diverticulitis
- Percutaneous drainage, surgery for complicated diverticulitis (perforation, stricture, recurrent disease)
- Not a ER issue, unless there is frank bleeding/perf.
What are the Complications of Diverticulitis?
- Perforation: rupture of diverticulum due to multiplication and expansion of bacteria
- Obstruction
- Abscess formation
What is the most common cause of lower GI bleed?
Diverticulosis
The following Sx of a lower GI bleed is indicative of what disease?
Chronic abdominal pain and diarrhea.
IBD
The following Sx of a lower GI bleed is indicative of what disease?
Weight loss, new constipation, anemia
Neoplasia
The following Sx of a lower GI bleed is indicative of what disease?
Painless, heavy bleeding in o/w healthy, elderly patient.
Diverticulosis
The following Sx of a lower GI bleed is indicative of what disease?
Hematochezia after major surgery or M.
Ischemic colitis
The following Sx of a lower GI bleed is indicative of what disease?
Acute dysentery, travel, ill contacts, or antibiotic use.
Infectious diarrhea
The following Sx of a lower GI bleed is indicative of what disease?
Chronic, microcytic anemia.
Neoplasia or AVMs
The following Sx of a lower GI bleed is indicative of what disease?
Hx of heavy/chronic NSAIDs use.
Drug-induced colitis
The following Sx of a lower GI bleed is indicative of what disease?
History of pelvic radiation.
Radiation proctitis
___________ is commonly associated with lower gastrointestinal bleeding, but may also occur from a brisk upper gastrointestinal bleed.
Haematochezia
