Week 6 - Lower GI Inflammatory Disorders Flashcards
list 3 inflammatory disorders of the lower GI system
- appendicitis
- peritonitis
- gastroenteritis
what is appendicitis
- inflammation of the vermiform appendix
what is the appendix
- narrow tube-like structure emerging from the cecum (beginning of the large intestine)
what commonly causes appendicitis (2)
- obstruction of the appendix by fecalith or foreign material (bc it is a hollow tube)
- twisting of the appendix
what is fecalith
- stone or hard piece of feces
what does obstruction or twisting of the appendix & inflammation lead to? (5)
- now the mucus being released from the intestinal lumen is trapped
- trapped bacteria
- increased pressure –> compresses the blood vessels –> ischemia –> necrosis
- increased pressure may also cause the appendix to perforate or rupture = generalized peritonitis
- compresses nerves = pain
how does inflammation effect the permeability of the appendix? what does this cause?
- increases the permeability = intestinal bacteria leaks into the peritoneal cavity
= localized peritonitis
list the manifestations of appendicitis (6)
- pain
- NV
- fever
- leukocytosis
- general signs & symptoms of peritonitis
what kind of pain is associated with appendicitis? what causes it?
- starts periumbilical
- followed by localized lower right quadrant pain as the appendix becomes permeable and localized peritonitis occurs
- if the appendix ruptures, get generalized peritonitis = whole abdomen tender
what is peritonitis
- inflammation of the peritoneal membranes
what can cause peritonitis (2)
- chemical irritation
- bacterial infection
peritonitis due to chemical irritation can cause _____, leading to…
- inflammation = increased permeability of the intestinal wall
- this leads to bacteria leaking into the peritoneal cavity & bacterial peritonitis
how long could it take for chemical peritontits to become bacterial peritonitis
- can occur in a # of hours
list common causes of peritonitis (7)
- perforated ulcer
- ruptured gallbladder
- pancreatitis
- ruptured spleen
- hemorrhage
- perforated appendix
- intestinal obstruction
list manifestations of peritonitis (9)
- generalized abdominal pain
- NV (due to inflammation)
- rigid abdomen
- rebound tenderness
- septicemia
- hypovolemic shock with tachy
- paralytic ileus
- fever
- leukocytosis
what is meant by rebound tenderness
- pain when let go from palpating
what causes hypovolemic shock with peritonitis
- the inflammation causes formation of exudate
- inflammation = increased permeability of vessels = causes fluid shift from peritoneal and intestinal blood vessels = 3rd spacing
how does paralytic ileus effect bowel sounds?
- causes absent bowel sounds
what causes fever & leukocytosis during peritonitis
- sign of inflammation & infection (from the bacteria)
what causes a rigid abdomen in peritonitis
- the pain leads to reflex contraction of abdominal muscle
what causes paralytic ileus during peritonitis
- inflammation of the peritoneal membrane = impaired nerve transmission
- this causes decreased peristalsis
= paralytic ileus (obstruction)
what are 2 types of inflammatory bowel disease
- crohn’s disease
- ulcerative colitis (UC)
what type of diseases are crohn’s disease and UC?
- chronic inflammatory bowel disorders
- autoimmune in nature
what % of pts have both crohn’s and UC
- 10%
where does crohn’s effect?
- can effect anywhere along the GI tract
- but most commonly effects the ileum
what is crohn’s characterized by?
- ulcerative “skip lesions” that involve the entire thickness of the GI wall
- creation of nodules or a “cobblestone” appearance to the mucosa
what is meant by skip lesions
- distribution of affected segments alternating with normal segments of bowel
what contributes to the development of crohn’s
- strong family history & genetic component
when does crohn’s disease often develop
- childhood or adolescence
list manifestations of crohn’s (6)
- right lower quad pain & distension
- diarrhea
- fistulas
- intestinal obstruction
- exacerbations & remissions
- weight loss
what causes intestinal obstruction in crohn’s
- the inflammation leads to fibrosis which affects all layers of the GI tract
- this leads to a thick, rigid wall (stricture) which predisposes to obstruction
what causes diarrhea in crohn’s (2)
- damage to the mucosa prevent absorption
- inflammation can increase motility
what is a fistula
- an abnormal connection between 2 hollow spaces
what causes fistulas in crohn’s
- inflammation of the affected bowel can create ulcers may penetrate the GI wall to create an abcess or fistula between adjacent structures
what are the characteristics of exacerbations in crohn’s
- diarrhea
- cramping
- melena
what can induce remissions of crohn’s
- anti inflammatory drugs
list indications for surgical therapy of crohn’s
- drainage of abdominal abscess
- failure to respond to conservative therapy (such as corticosteroids)
- fistulas
- inability to decrease corticosteroids
- intestinal osbtruction
- massive hemorrhage
- perforation
- secondary hydronephrosis
- severe anorectal disease
- suspicion of carcinoma
where does ulcerative colitis effect?
- begins at the rectum and progresses proximally thru the large intestine
what layers of the GI tract does ulcerative colitis effect?
- mucosa & submucosa
describe the onset of ulcerative colitis
- adulthood
describe epidemiology of ulcerative colitis
- similar to crohn’s
- family history & genetic components involved
describe manifestations of ulcerative colitis (5)
- rectal bleeding
- blood loss
- diarrhea
- tenemus –> painful spasms of the rectal sphincter = LLQ pain
- colon obstruction & dilation
what causes rectal bleeding in ulceratitive colitis
- the submucosa contains blood vessels
- ulceration is more continuous
what can rectal bleeding result in?
- blood loss anemia
what causes diarrhea in ulceratitive colitis
- tissue destruction interferes w absorption in the large
= small volume diarrhea
what is diarrhea often accompanied by in UC
- tenesmus
what is tenesmus
- painful spasms of the rectal sphincter
what causes colon obstruction & dilation in ulcerative colitis
- inflammation impairs peristalsis = functional obstruction & filation
= toxic megacolon
outline the main differences between crohn’s and ulcerative colitis
- crohn’s = skip lesions & UC = starts in rectum and is continuous
- crohn’s = all 4 layers & UC = only mucosa & submucosa
- crohn’s first systemic effect = weight loss & UC = anemia
- differences in S&S
