Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med - GI > diseases of intestine > Flashcards

diseases of intestine Flashcards

1
Q

what portion of the GI tract can Crohns disease affect

A

any portion mouth to anus
50% include terminal ilium and colon
30% with terminal ilium only
20% with colon only
<5% with upper GI tract involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what id dysbiosis

A

alternation in normal flora of the gut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how do you describe inflammation with Crohns

A

tranmural - aka full thickness
‘cobblestoning’ or ‘skip lesions’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the presentation of Crohns

A

variable - depending on location and severity of dz
many have RUQ pain + diarrhea
+/- systemic symptoms (fever, weight loss, fatigue)
may present with obstruction from strictures, parianal or other GI tract manifestations or extra-intestinal manifestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the workup for crohns disease

A

no lab testing specific for Crohns
stool studies to r/o other causes of diarrhea
+/- elevated ERC/CRP and evidence of malabsorption
Mainstay of dx is colonoscopy with biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is ulcerative colitis

A

like crohns, inflammatory condition but pathogenesis unknown
hereditary risk, environmental risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what can lower the severity of UC

A

smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

where is UC located in the GI tract

A

confined to colon
25% isolated to recosigmoid region
50% have disease extending to splenic flexure
25% have disease extending more proximally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is inflammation confied to the mucosa

A

ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the presentation of UC

A

variable based on location and severity of dz
-MOST with bloody diarrhea +/- mucus
LLQ, abdominal cramping, fecal urgency, tenesmus
+/- fever, weight loss
+/- extraintestinal manifestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the workup for UC

A

mainstay of dx is colonoscopy with biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when is colonoscopy with biopsy contraindicated

A

acute disease - risk for bowel perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the pharmacologic treatments of crohns and UC

A

5-aminosalicylates: (5ASA; sulfasalazine, mensalamine, balsalazide)
Corticosteroids
Immunomodulators (Mercaptopurine, azathioprine, methotrexate)
Biologic agents: TNF inhibitors, Anti-integrins, anti-IL antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the treatment of acute crohns

A

ensure adequate nutrition
antidiarrheal agents (loperamide)
pharmacotherapy:
mensalamine
+/- oral abx
corticosterioids (budesonide first line)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is maintenance therapy for crohns

A

pts usually on zathioprine or mercaptopurine + infliximab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the treatment of acute UC

A

normal oral intake if mild/moderate
AVOID anti-diarrhea (loperamide)
pharmacologic:
topical mesalamine (first line: suppository or enema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is fulminant UC disease

A

severe, rapidly progressive (1-2 weeks) and toxic
fever, hypovolemia, hemorrhage, abdominal distension and tenderness
risk for bowl perforation and toxic megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the treatment of fulminant UC disease

A

NPO 24-48 hours
resuscitation: fluid, blood products, correct electrolytes
topical hydrocortison -> infliximab +/- cyclosporine
R/o Toxic Megacolon with abd xr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the first line maintenance tx of UC

A

continue 5-ASA agent: topical or oral
if no improvement in 4-8 weeks: add pred or methylpred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

when is surgical intervention recommended for UC/Crohn’s

A

refractory UC/Crohns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the indications for bowel resection with crohn’s and UC

A

refractory
hemorrhage
abscess
obstruction
fistulas
bowel perforation
fulminant colitis
toxic megacolon
carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is an immunogenic response to gluten

A

celiac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are gene associations with celiac disease

A

HLA-DQ2 gene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the result of the antibodies with celiac disease

A

damage to intestinal mucosa (villi)
tissue transflutaminase (tTG) antibodies
anti-gliadin antibodies
anti-endomysial antibodies (EMA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the presentation of celiac disease

A

classic symptoms: chronic diarrhea, dyspepsia, flatulence +/- steatorrhea
malabsorption: weight loss, abdominal distention, weakness, muscle wasting, delayed growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is the workup for celiac disease

A

first line for dx testing is serology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is the most specific and sensitive test for celiac disease

A

serology - IgA tissue transgluraminase (IgAtTG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is the definitive diagnostic test for celiac disease

A

mucosal biopsy
-atrophy or scalloping of duodenum, blunting of intestinal villi, hypertrophic of intestinal crypts, lymphocytes in lamina propria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the tx of celiac disease

A

TRUE gluten free diet (lifestyle modification)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is a herniation of the intestinal mucosa and submucosa through the muscularis

A

diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is the presence of diverticula

A

diverticulosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is inflammation and/or infection or the diverticula

A

diverticulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what are diet and lifestyle factors that contribute to inflammation with diverticulitis

A

high fat, high protein, refined grain diet (western diet)
red meat consumption
eating nuts and seeds
obesity
smoking
immunosuppression
NSAID use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is the presentation of diverticulitis

A

acute ssx
LLQ or suprapubic abdominal pain
+/- palpable mass
abdominal tenderness
N/V
fever
change in bowel habits
etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is the workup for diverticulitis

A

CBC
ABD CT is test of choice
after resolution of acute episode - colonoscopy, barium enema or CT colonography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what are complications of diverticulitis

A

abscess formation
ruptured diverticulum
fistula
hemorrhage

37
Q

what is the tx of diverticulitis

A

mild: rest and liquid diet, abx no necessary
mod/complicated/comorbidities: NPO plus oral abx (metronidazole + fluoroquinolone preferred)
if severe: admit and IV abx
large abscess: drainage
perforation: surgical intervention

38
Q

what is the most common cause of an acute surgical abdomen

A

appendicitis

39
Q

if appendicitis is left untreated, within 24-36 hours what does it lead to

A

perforation
gangrene
abscess

40
Q

what is the presentation of appendicitis

A

acute onset constant and worsening abd pain
other non-specific symptoms: dyspepsia, N/v, anorexia, diarrhea, constipation, low grade fever

41
Q

what is suggestive of perforation, abscess or gangrene with appendicitis

A

peritoneal signs, fever, tachy or other signs of sepsis

42
Q

what is seen on PE with appendicitis

A

guarding and rigidity
tendernss at McBurneys point
rebound tenderness
Rovsing’s sign
Psoas sing
Obturator sign

43
Q

what is the diagnostic test of choice for appendicitis

A

CT scan for adults

44
Q

What is the tx of appendicitis

A

laparaoscopic appendectomy
abx

45
Q

what is the inability of contents to pass through the bowels

A

bowel obstruction

46
Q

where are bowel obstructions more common

A

small bowel obstruction

47
Q

what are risk factors for bowel obsturctions

A

prior abdominal surgery
malignancy
IBD
hernias
radiation to the area
mostly things that increase risk for adhesions, strictures

48
Q

what can the accumulation of contents within the bowel cause

A

increase in intraluminal pressure and dilation

49
Q

what is the presentation of small bowel obstruction (SBO)

A

hx abd surgery or hernia
crampy, intermittent abd pain
periumbilical or diffuse abd pain
vomiting, early onset, that is bilious
no BM or flatusus
abdominal distenstion

50
Q

what is the presentation of LBO

A

+/- hx of CA (caricnoma #1)
crampy, intermittened abd pain
hypogastric abd pain
vomiting, late onset, that is later feculent
No BM or flatus
abdominal distention

51
Q

what is seen on PE with bowel obsturction

A

abdominal distention
abdominal tenderness
tympanic to percussion
decreased BS
high pitched BS
+/- peritoneal signs

52
Q

what is the first diagnostic tests run for concern with bowel obstruction

A

abdominal x-ray
-absence of air or stool in rectal vault, bowel distention, air-fluid levels

53
Q

what is the test of choice for bowel obstruction

A

abdominal CT (confirms obstruction and location)

54
Q

what is the initial treatment for bowel obstruction

A

NPO
fluid resuscitation
electrolyte management
NG tube insertion for decompression
pain management
anti-emetics
+/- prophylactic abx

55
Q

what is the definitive treatment for bowel obstruction

A

treat the underlying cause
if partial obstruction or SBO without complications: NG decompression
Next step if no perf: endo/colonoscopic decompression
if unstable or perf: surgical management, exlap with bowel resection

56
Q

what occurs when the bowel twists on itself anc causes strangulation

A

volvulus

57
Q

where is vulvulus most common

A

sigmoid colon: elderly males, pts with chronic constipation
Cecum is second most common: young females
in kids: small intestines

58
Q

what is the presentation of vulvulus

A

most with acute onset of symptoms
abdominal pain/distention
vomiting
constipation/obstipation
hematochezia
hemodynamic instability

59
Q

if the patient has an associated perforation with volvulus what is this presentation

A

abdominal tenderness
rigidity
guarding

60
Q

what is the initial study of choice for vulvulus

A

abdominal x-ray:
characteristic coffee bean appearance

61
Q

what will be seen on a barium enema with volvulus

A

birds beak appearance

62
Q

what can be diagnostic and therapeutic for vulvulus

A

flexible sigmoidoscopy

63
Q

what is the initial treatment of volvulus

A

sigmoidoscopy: insufflation at site of rotation, decompression with rectal tube

64
Q

what is the refractory treatment of volvulus

A

surgical management - bowel resection due to risk for recurrence

65
Q

what is the most common cause of bowel obstruction in young children

A

intussesception

66
Q

what is telescoping of the intestines

A

intussesception

67
Q

what is the presentation of intussesception

A

sudden onset colicky abdominal pain: reoccurs every 15-20 min
abdominal pain later becomes constant
vomiting
bloody stools; ‘currant jelly’ colored
lethargy
palpable mass: “sausage shaped”

68
Q

what is the test of choice for intussusception

A

US

69
Q

what is seen on US with intussesception

A

‘target sign’

70
Q

what test can be diagnostic and therapeutic for intussesception

A

barium enema - risk for peritonitis if performation present

71
Q

what is the treatment of intussusception

A

air or barium enema is the tx of choice
if air enema is unsuccessful: surgical reduction

72
Q

what is ischemic colitis

A

hypo-perfusion through the IMA - sloughing of the intestinal mucosa

73
Q

who is at a increased risk of ischemic colitis

A

IBS or COPD 2-4x increased risk
more common in pts with pre-existing cardiac or peripheral vascular disease or coagulopathy

74
Q

what is the presentation of ischemic ocolitis

A

LLQ abdominal pain
abdominal tenderness
abdominal cramping
diarrhea, usually bloody
low grade fever

75
Q

what is the first line for assessing ischemic colitis

A

Ct scan

76
Q

what is the tx of ischemic colitis

A

tx underlying cause
main adequate BP
IV fluids
prophylactic abx
bowel rest (NPO except clear liquids)
in full thickness necrosis - surgical intervention

77
Q

if there is a bleed proximal to the ligament of treitz it is what type of bleed

A

Upper GI bleed

78
Q

if there is a bleed distal to the ligament of treitz it is what type of bleed

A

lower IG bleed

79
Q

what is occult

A

often asymptomatic, no visible blood

80
Q

who is at an increased risk of mortality with GI bleeding?

A

patients over 60 and hospitalized patients

81
Q

what can cause UGI bleeding

A

PUD
portal HTN (varices)
mallory-weiss tear
vascular anomalies
gastric/esophageal CA
erosive gastritis/esophagitis
hiatal hernia
coagulopathy

82
Q

what can cause LGI bleeding

A

diverticulosis
vascular anomalies (angioectasias)
colonic/anal CA
IBD
anorectal disease
ischemic colitis
inflammatory diarrhea
hemorrhoids
lower abdominal or anorectal trauma

83
Q

what is the presentation of UGI bleed

A

anemia
hematemesis
melena
+/- hematochezia
+/- hemodynamic instability

84
Q

what is the presentation of LGI bleed

A

anemia
+/- melena
hematochezia
+/- hemodynamic instability

85
Q

what are the diagnostic tests that can be done for GI bleeding

A

endoscopy /colonoscopy
nuclear scans
angiography
capsule imaging

86
Q

what is the treatment for GI bleeding

A

endoscopic tx
pharmacologic options: IV or oral PPI, octreotide if liver disease
intra-arterial embolization
surgical management
TIPS for variceal bleeds

87
Q

what are common causes of occult GI bleeding

A

neoplasms
angiogenectasis
PUD
infection
meds
IBD

88
Q

what are the diagnostic tests of choice for occult bleeding

A

Fecal occult blood test (FOBT)
fecal immunochemical test (FIT; cologuard)
if FOBT or FIT positive -> colonoscopy and EGD

Clin Med - GI (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions