Miscellaneous GI Disorders

Question 1

Chronic and relapsing abdominal pain, bloating and changes in bowel habits including diarrhea and constipation
Syndrome not a disease
Pathogenesis poorly understood – psychologic stressors, diet, abnormal GI motility, visceral hypersensitivity

Answer 1

Irritable bowel syndrome

20-40 yo female

Question 2

Rome III criteria for IBS

Answer 2

Recurrent abdominal pain or discomfort at least 3 days/month in tell last 3 months associated with 2 or more of the following:

1. improvement with defecation
2. onset associated with change in frequency of stool
3. onset associated with change in form (appearance) of stool

Question 3

Pseudodiverticular outpouching of the colonic mucosa and submucosa
Unique structure of colonic muscularis propria
Nerves and arterial vasa recta penetrate the inner circular muscle coat to create discontinuities in the muscle wall

Answer 3

Diverticular disease

> 60 yo, under condiciones of elevated intraluminal pressure in sigmoid colon, may be exacerbated by diets low in fiber

Question 4

Obstruction of diverticula

Answer 4

Leads to diverticulitis – which can lead to perforation –> can lead to formation of pericolonic abscesses, development of sinus tracts and occasional peritonitis

Question 5

Treatment of diverticulitis

Answer 5

Resolves spontaneously or after antibiotics

Question 6

Deep tenderness at 2/3rd distance from the umbilicus to the right anterior superior iliac spine

Answer 6

McBurney’s sign

Question 7

Ranges form mucosal infarction to transmural infarction

Answer 7

Ischemic colitis

Question 8

What causes mucosal infarction?

Answer 8

Usually from hypo perfusion – hypotension or arterial spasm

Question 9

What causes transmural infarction?

Answer 9

Arterial occlusion

Acute arterial thrombosis or embolism

Question 10

What areas are particularly susceptible to ischemia?

Answer 10

Watershed zones = splenic flexure, sigmoid colon and rectum

Question 11

Treatment for ischemic colitis

Answer 11

Usually self-limited – resolves when inciting event resolves (hypotension is corrected)

Question 12

Who usually gets ischemic colitis?

Answer 12

Older people with coexisting cardiac or vascular disease

Acute transmural infarction typically manifests with sudden, severe abdominal pain and tenderness

Question 13

What is small intestinal bacterial overgrowth?

Answer 13

The small intestine is usually relatively sterile compared to the colon b/c it is protected by gastric acid and ICV (ileocecal valve) – disruption by surgery, antacids or slow motility can cause increased bacterial content and unabsorbed carbs
**Difficult to diagnose – use duodenal aspirate or hydrogen breath test

Question 14

Chronic, watery, non-bloody diarrhea

Answer 14

Microscopic colitis

Question 15

Characterized by presence of dense subepithelial collagen layer and increased number of intraepithelial lymphocytes
Typically in middle-aged/elderly women

Answer 15

Collagenous colitis

Question 16

Histologically sub epithelial collage layer is normal but increased intraepithelial lymphocytes
Associated with CD and other autoimmune diseases

Answer 16

Lymphocytic colitis

Question 17

Occurs after allogenic hematopoietic stem cell transplantation, effects small bowel and colon
Caused by targeting of antigens on the recipient’s epithelial cells by donor T cells
Symptoms of nausea, cramping and watery diarrhea

Answer 17

Graft versus host disease