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Gastroenterology exam 2 > Colitis > Flashcards

Colitis Flashcards

1
Q

What is the most frequent form of intestinal ischemia? who has the highest risk?

A

Ischemic Colitis

highest risk = pts w recent cardiovascular surgery

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2
Q

How does ischemic injury to the colon usually occur? how is this aggravated?

A

hypoperfusion to the intramural vessels of the colon MUCOSAL wall (rarely transmural)

aggravated by chronic atherosclerosis/vasculitis

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3
Q

What two areas of the colon are most at risk for ischemia? What area is usually spared?

A

Watershed areas:

  1. Splenic flexure
  2. Left colon (rectro sigmoid jxn)

rectum is usually spare (dual blood supply)

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4
Q

What is the clinical presentation of colonic ischemia

A

Sudden-onset of severe crampy left lower quadrant abdominal pain

followed shortly after w Hematochezia*
AFEBRILE

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5
Q

What are complications of Ischemic colitis

A

Colon gangrene
bowel perforation
Chronic Segmental Ulcerating Colitis
Colonic strictures

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6
Q

What does Ischemic Colitis look like on abdominal xray?

A

“thumbprinting” = thickening of the colon wall caused by intramural hemorrhage

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7
Q

What does Ischmic Colitis look like on CT?

A

Double Halo Sign - bowel wall thickening

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8
Q

What does colonoscopy look like in Ischemic Colitis?

A

Submucosal hemorrhage, ulceration or necrosis

Segmental distribution of ischemia

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9
Q

What is the Tx for Ischemic Colitis?

A

Most pts: Sx resolve within 24-48 hrs

Tx: IVF’s, bowel rest

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10
Q

What is the endoscopic appearance of crohn’s colitis?

A

Rake ulcers - deep, linear
Aphthous ulcers
Cobblestone appearance
rectal sparing

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11
Q

What are the Dx serum markers for IBD:

  1. UC
  2. CD
A
  1. pANCA

2. ASCA

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12
Q

What are general histological findings in IBD?

A
  1. acute inflammation:
    neutrophilis cryptitis
  2. chronic inflammation:
    Crypt distortion, plasmacytic infiltration of the lamina propria
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13
Q

What is Microscopic Colitis?

A

Chronic diarrhea w. voluminous, watery, nonbloody diarrhea in pts with NORMAL endoscopic appearance but biopsies have histological evidence of inflammation

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14
Q

What are the two histologic types of microscopic colitis? what are characteristics

A

Lymphocytic
Collagenous - subepithelial collagen deposition

-both have lymphocytic infiltration of the colonic epithelium

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15
Q

Who does Microscopic Colitis affect the most? What is it associated with?

A

Female 10:1
a/w autoimmune diseases
induced by NSAIDS

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16
Q

What are symptoms and signs of Microscopic Colitis?

A
  1. Watery diarrhea 5-10 times a day
  2. Nocturnal diarrhea
  3. chronic/intermittent
  4. Normal physical exams and labs
17
Q

What are the Dx histologic findings in Lymphocytic colitis and Collagenous colitis

A

LC: excess of intraepithelial lymphocytes, inflammation of the lamina propria w plasma cells, eosinophils, mast cells

CC: band of eosinophilic deposite under epithelium (type III collagen and fibronectin), inflammation of lamina propria

18
Q

What are the treatments of Microscopic Colitis (Mild, Moderate, Severe)

A

first: stop associated meds: NSAIDs
mild - Loperamide
moderate - Bismuth
Severe - Budesonide

19
Q

What is Radiation Colitis and what are Sx?

A 
Acute/Chronic damage to normal colon and rectum after radiation treatment
Sx:
1. acute self-limiting diarrhea
2. tenesmus
3. abdominal cramping
4. bleeding (rare)

happens b/c of damage to epithelial lining with sloughing of mucosa

20
Q

What does sigmoidoscopy show in Radiation colitis?

A

telangiectasia
inflammation
ulcers
strictures

21
Q

What is Tx of radiation colitis?

A

Cautery of telangiectasia (stop bleeding)
Steroid/Sucralfate enemas
iron supplement

22
Q

What is a major cause of hospital acquired diarrhea? what are its characteristics?

A

Clostridium difficile (Pseudomembranous colitis)

Gram +
heat/alcohol resistant
spore forming
anaerobic bacillus

23
Q

What does C. diff produce that causes diarrhea? what is the action of this product?

A

enterotoxin A and B
binds epithelium = inflammatory reaction
produces protein rich exudates w neutrophils, enterocytes = PSEUDOMEMBRANE

24
Q

What are the 3 antibiotics implicated in causing C. diffi infections?

A

Clindamycin - 15%
Aminopenicillins - 35%
Cephalosporins - 30%

25
Q

What are Sx of C. diff infections? What can result in severe cases?

A

Watery diarrhea
campy lower abdominal pain +/- fever
leukocytosis up to 3 months after Abx treatment
colonoscopy - pseudomembranes = YELLOW OR WHITE PLAQUES IN COLON

severe cases: toxic megacolon

26
Q

No hand cleansers, alcohol based cleaners destroy C. diff?

A

NO

27
Q

What virus can cause colitis? What are the Sx?

A

CMV (immunocompromised pts at highest risk)

  1. Abdominal pain
  2. watery diarrhea leading to Hemorrhagic colitis
  3. Colonoscopy = Diffuse colitis to hemorrhagic colitis with DEEP IRREGULAR ULCERATIONS
28
Q

What is the Tx for CMV colitis?

A

Ganciclovir

Gastroenterology exam 2 (19 decks)

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