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Flashcards in 2 Disease of colon [5] Deck (26):
1

Types of IBD

Crohns disease
Ulcerative colitis

2

Suggestive symptoms of IBD
tx?

Diarrhea
crampy abdominal pain
bleeding
>2 weeks
+ extra intestinal symp.

mange with corticosteroids

3

Crohns and UC presentation

both:
Diarrhea
weight loss
fatigue

Crohns:
mid or lower abdominal pain
n/v
steatorrhea
fistula symp

UC:
lower abdominal pain
hematochezia
mucus in stool
tenesmus (extreme urgency to defecate)

4

Crohns or UC?
no fistula/abcess -
protected by smoking -
recurrance with colectomy -
malignancy potential -

no fistula/abcess - UC
protected by smoking - UC
recurrance with colectomy - crohns (bc whole GI)
malignancy potential - both

5

Pathology of crohns

transmural inflammation
deep and linear or focal ulcers
- not superficial (UC)
marked fibrosis
granulomas (20%)

6

Pathology of UC

Inflammation at mucosa +/- submucosa
- not transmural (Crohns)
mild-no fibrosis
no granulomas
circumferential ulceration
Pseudopolyps

7

Crohns or UC?
Entire GI tract -
Diffuse distribution -
skip lesions -
strictures -
extra-intestinal manifestations -

Entire GI tract - crohns
Diffuse distribution - UC
skip lesions - crohns
strictures - crohns
extra-intestinal manifestations - UC

8

extra-intestinal manifestations of UC

eye
- scleritis, episcleritis

Skin
- pyoderma gangrenosum, erythema nodosum

Liver
- primary sclerosing cholangitis (PSC)

Joints
- sacroiliitis, ankylosing spondylitis

9

Different causes of colitis

Microscopic Colitis
ischemic colitis
infxn colitis
Diverticulosis

10

Microscopic colitis
- population affected
- what is it
- prognosis

elderly female (50-80)
autoimmune with unknown trigger → causes salt and water loss in colon
- chronic secretory water (non-bloody) diarrhea

11

dx of microscopic colitis

HISTOLOGY ONLY
Lymphocitic colitis
- chronic inflammation, lymphocyte infiltration (mucosa+submucosa)
Collagenous colitis
- thickened subepithelial collagen band

COLONOSCOPY IS NORMAL

12

Ischemic colitis
- population affected
- what is it
- commonly found where in the GI

old patients (>60) with no vascular or GI diseases

fundamental insult: acute compromise in colonic blood flow
- vasospasm, dehydration, hypotension, cardiopulmonary insult

Commonly found in watershed vascular areas
- Splenic flexure (IMA, SMA)
- rectosigmoid (IMA, sup rectal artery)

13

dx of ischemic colitis

endoscope std dx - colonoscopy
- edema, ulceration +/- bleeding confined to a vascular region

Support antibiotics, and volume support
- 1-2 weeks to recover completely

14

Infectious colitis
- risk
- presentation

- hx of traveling, sick contact, and being in hospital with antibiotic uses
- Inflammatory dirrhea +/- hematochezia, crampy lower abdominal pain

15

diverticulosis
-population
-presentation

outpouching of colon wall

>50% in elderly
80% asymptomatic
20% result in diverticulitis and hemorrhage

16

Complications of diverticular disease

diverticular hemorrhage
- usually in R colon
- vasa recta w/in dome of diverticulum →
diverticulum erodes into adjacent vasa recta →
intraluminal bleeding →
painless hematochezia (stops in 2-3 days)
- occurs in 5% of those with diverticulosis

Acute diverticulitis
- LLQ
- fecalith obstructs a diverticulum →
distention from bacterial gas + neutrophils + abcess →
macroperforation with peritonitis
- nausea, fever

17

Name that disease!
Chronic abdominal pain + diarrhea

IBD

18

Name that disease!
weight loss, new constipation, anemia

neoplasia

19

Name that disease!
sudden onset & cessation of bleeding, elderly pt

diverticulosis

20

Name that disease!
Hematochezia after surgery or MI

ischemic colitis

21

Name that disease!
acute dysentery, travel, ill contacts, ab use

infectious diarrhea

22

Name that disease!
chronic, microcytic anemia

neoplasia or AVMs

23

Name that disease!
NSAIDS

drug induced colitis

24

Name that disease!
radiation

radiation proctitis

25

presentation of colonic obstruction

n/v
upper abdominal distension
constipation
obstipation

tx: surgical resection or metal stent

26

majority of colonic obstruction caused by?

adenocarcinoma of the colon/rectum, volvulus, benign strictures from acute diverticulosis