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DEMS_BTRAN > Unit1_Pathophysiology&Diz > Flashcards

Unit1_Pathophysiology&Diz Flashcards

1
Q

WHat is the disease ~w/ the following Sx:?

  • Hematochezia
  • Mucus in stool
  • Tenesmus
A

Ulcerative Colitis

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2
Q

What is the disease ~w/ the following Sx:?

  • Nausea/vomiting
  • Steatorrhea
  • Fistula symptoms
A

Crohn’s Diz

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3
Q

Where is the abd. pain in Crohn’s pt.?

A

mid or lower abd pain

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4
Q

Where is the abd. pain in Ulcerative Colitis pt.?

A

LOWER abd pain

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5
Q

What Sx/signs are common in both Ulcerative Colitis & Crohn’s pt.s?

A

Chronic diarrhea

Weight loss

Fatigue

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6
Q

What is the gold standard test used to dX IBD?

A

Direct visualization and biopsy

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7
Q

What region of the bowel does Crohn’s diz affect?

A

Entire GI tract

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8
Q

What region of the bowel does Ulcerative Colitis affect?

A

Colon only!

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9
Q

Does Ulcerative Colitis result in Fistulae or abscesses?

A

NO.

Crohn’s has fistula and abscesses!

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10
Q

Which type of IBD are strictures common in?

A

Crohn’s!

UC does NOT result in Strictures.

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11
Q

A “skip lesions” distribution is ~w/ with which IBD?

A

Crohns

UC has a DIFFUSE distribution.

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12
Q

Which IBD has inflammation that is transmural?

A

Crohns. m

UC inflammation is Mucosa +/- SM

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13
Q

Which IBD has supperficial and confluent ulcers?

A

Ulcerative Colitis

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14
Q

Which IBD has granulomas?

A

Crohn’s (20-35% of pt.)

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15
Q

Which IBD is ~w/ obstruction, malabsorption and recurrence after colectomy?

A

Crohn’s!

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16
Q

Which IBD is ~w/ toxic Megacolon?

A

Ulcerative Colitis

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17
Q

What are the extra-intestinal manifestationals of IBD (mostly in UC):

Eyes: ?

Skin: ?

A

Eye: Scleritis, episcleritis.

Skin: Pyoderma gangrenosum, erythema nodosum.

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18
Q

What are the extra-intestinal manifestationals of IBD (mostly in UC):

Liver/Bile duct: ?

Joints: ?

A

Liver/bile duct: Primary sclerosing cholangitis (PSC) and cholangiocarcinoma.

Joints: Sacroiliitis, Ankylosing spondylitis.

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19
Q

Is Microscopic colitis a A.I. disease?

A

YES!

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20
Q

What is the clinical presentation of Microscopic Colitis?

A

Mild, chronic secretory diarrhea.

  • water, non-bloody. 4-10 stools/day
  • minimal to no weight loss.
  • salt and water loss in the colon
21
Q

What other diz has a mild association with Microscopic Colitis?

A

celiac disease

22
Q

What is the pX of Microscopic Colitis?

A

good!

  • No bleeding, dehydration, or other complications
  • No increase in cancer risk or mortality
23
Q

How do you dX Microscopic Colitis?

A

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!!!

24
Q

Chronic inflammation with lymphocytic infiltration, is the histological finding of which type of Microscopic Colitis?

A

Lymphocytic colitis

25
Q

Thickened subepithelial collagen band +/- lymphocytic surface injury, is the histological finding of which type of Microscopic Colitis?

A

Collagenous colitis

26
Q

What colitis is commonly in watershed vascualr area like the splenic flexure, rectosigmoid junction,

A

Ischemic colitis: Fundamental insult = acute compromise in colonic bloodflow.

27
Q

What is the endoscopic findings of Ischemic colitis?

A

edema, ulceration, +/- bleeding confined to a vascular region.

28
Q

What is the clinical ppt. of Ischemic colitis?

A
  • 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)
29
Q

How long does it take to recover from an event of Ischemic colitis?

A

1-2 weeks, typical

30
Q

What are other/rare causes of Ischemic colitis?

A

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

31
Q

Pt. w/ Acute (< 4-week) diarrhea —> think!?

A

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.

32
Q

What HLA type is ~w/ IBD?

A

HLA-B27 associated with IBD

33
Q

_____________ : outpouching of colon wall composed of mucosa and submucosal layers that herniate outward through muscularis propria but are contained by serosa

A

Diverticulosis

34
Q

What is the top risk factors for Diverticulosis?

A

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

35
Q

What is the common complciation of Diverticulosis?

A

Diverticular hemorrhage.

  • usually from right colon.

Painless hematochezia, often heavy, typically stops w/in 2-3 days

36
Q

____________ : fecalith obstruction of diverticulum → distension from bacterial gas and neutrophils, micro perforation, abscess, or frank perforation with peritonitis

A

Diverticulitis

37
Q

What are the Sx of Diverticulitis?

A

Lower abd pain, nausea, fever.

NO diarrhea & NO bleeding!

38
Q

What are the Tx of Diverticulitis?

A
  • 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.
39
Q

What are the Complications of Diverticulitis?

A
  • Perforation: rupture of diverticulum due to multiplication and expansion of bacteria
  • Obstruction
  • Abscess formation
40
Q

What is the most common cause of lower GI bleed?

A

Diverticulosis

41
Q

The following Sx of a lower GI bleed is indicative of what disease?

Chronic abdominal pain and diarrhea.

A

IBD

42
Q

The following Sx of a lower GI bleed is indicative of what disease?

Weight loss, new constipation, anemia

A

Neoplasia

43
Q

The following Sx of a lower GI bleed is indicative of what disease?

Painless, heavy bleeding in o/w healthy, elderly patient.

A

Diverticulosis

44
Q

The following Sx of a lower GI bleed is indicative of what disease?

Hematochezia after major surgery or M.

A

Ischemic colitis

45
Q

The following Sx of a lower GI bleed is indicative of what disease?

Acute dysentery, travel, ill contacts, or antibiotic use.

A

Infectious diarrhea

46
Q

The following Sx of a lower GI bleed is indicative of what disease?

Chronic, microcytic anemia.

A

Neoplasia or AVMs

47
Q

The following Sx of a lower GI bleed is indicative of what disease?

Hx of heavy/chronic NSAIDs use.

A

Drug-induced colitis

48
Q

The following Sx of a lower GI bleed is indicative of what disease?

History of pelvic radiation.

A

Radiation proctitis

49
Q

___________ is commonly associated with lower gastrointestinal bleeding, but may also occur from a brisk upper gastrointestinal bleed.

A

Haematochezia

DEMS_BTRAN (8 decks)

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