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Flashcards in Bowel Diseases II Deck (82)
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1

Diseases of the Colon and Rectum

-Irritable bowel syndrome
-Antibiotic-associated colitis
-Inflammatory Bowel Disease (Crohns and UC)

2

IBS

An idiopathic clinical entity characterized by chronic (more than 6 months) abdominal pain or discomfort that occurs in association with altered bowel habits
-can be continuous or intermittent
-diagnosis of exclusion
-s/s usually start in late teens to 20s, more common in women

3

Definition of irritable bowel syndrome is abdominal discomfort or pain that has 2 of the following:

1. Relieved with defecation
2. Onset associated with a change in frequency of stool
3. Onset associated with a change in form (appearance) of stool

4

Other S/S of IBS

abnormal stool frequency; abnormal stool form (lumpy or hard; loose or watery); abnormal stool passage (straining, urgency, or feeling of incomplete evacuation); passage of mucus; and bloating or a feeling of abdominal discomfort

5

Non GI complaints associated with IBS

dyspepsia, heartburn, chest pain, headaches, fatigue, myalgias, urologic dysfunction, gynecologic symptoms, anxiety, or depression

6

Possible causes of IBS

-Abnormal Motility
-Visceral Hypersensitivity
-Enteric Infection
-Psychosocial Abnormalities

7

3 categories of IBS

1. Irritable bowel syndrome with diarrhea
2. Irritable bowel syndrome with constipation
3. Irritable bowel syndrome with mixed constipation and diarrhea

8

"Alarm symptoms” that suggest a diagnosis other than irritable bowel syndrome and warrant further investigation

-Acute onset of symptoms
-Nocturnal diarrhea, severe constipation or diarrhea, hematochezia, weight loss, and fever
-Family history of cancer, inflammatory bowel disease, or celiac disease

9

Physical exam with IBS

-usually normal
-abdominal tenderness, esp in lower abdomen is common but not pronounced

10

Testing for IBS

-dont need routine blood tests
-stool specimen for ova/parasites
-no colonoscopy necessary in young pts
-colonoscopy in pts 50+ who haven't had one to exclude malignancy (take biopsy during)
-if diarrhea is present test for celiacs
-no hydrogen breath test for overgrowth necessary

11

IBS treatment

-Reassurance, education, and support
-Dietary Therapy (intolerances)
-Pharmacologic Measures:
– Antispasmodic agents
– Antidiarrheal agents
– Anticonstipation agents
– Psychotropic agents
– Nonabsorbable antibiotics
– Probiotics
-Psychological Therapies (Cognitive behavioral therapies, relaxation techniques, hypnosis)

12

Antibiotic Associated Colitis

-Occurs during the period of antibiotic exposure, is dose related, and resolves spontaneously after discontinuation of the antibiotic
-In most cases, this diarrhea is mild, self-limited, and does not require any specific laboratory evaluation or treatment
-Stool examination usually reveals no fecal leukocytes, and stool cultures reveal no pathogens

13

Most cases of antibiotic-associated diarrhea are due to

changes in colonic bacterial fermentation of carbohydrates and are not due to C diff

14

C difficile colitis is the major cause of diarrhea in

patients hospitalized for more than 3 days (most of whom used antibiotics)
-symptoms usually begin during or shortly after antibiotic therapy but may be delayed for up 8 weeks
(prevent with hand washing and gloves)

15

________ to people who are receiving antibiotics reduced the incidence of C difficile–associated diarrhea

Prophylactic administration of the probiotics

16

S/S of antibiotic associated Colitis

-Most patients report mild to moderate greenish, foul-smelling watery diarrhea 5–15 times per day with lower abdominal cramps
-Normal abdominal exam or mild left lower quadrant tenderness
-Colitis is most severe in the distal colon and rectum
-Over half of hospitalized patients diagnosed with C difficile colitis have a white blood count greater than 15,000/mcL
-Severe or fulminant disease occurs in 10–15% of patients

17

Treatment for Antibiotic associated colitis

-Antibiotic therapy should be discontinued
-Start metronidazole, PO vancomycin, or fidaxomicin
-For patients with severe disease, PO vancomycin and IV metronidazole
-Early surgical consultation is recommended for all patients with severe or fulminant disease
-Total abdominal colectomy or loop ileostomy with colonic lavage may be required in patients with toxic megacolon, perforation, sepsis, or hemorrhage

18

With antibiotic associated colitis, imaging studies for sever disease may show

true pseudomembranous colitis (if sever, during flexible sigmoidoscopy)

19

Up to 25% of patients have a relapse of diarrhea from C difficile within 1 or 2 weeks after stopping initial therapy
– Most relapses respond promptly to _________

a second course of the same regimen used for the initial episode

-Probiotic therapy is recommended as adjunctive therapy in patients with relapsing disease

20

For patients with two relapses, use ________

a 7-week tapering regimen of vancomycin is recommended

21

For patients with three or more relapses, updated 2013 guidelines recommend consideration of __________

“fecal transplantation” from healthy donor into the terminal ileum or proximal colon (by colonoscopy) or into the duodenum and jejunum (by nasoenteric tube)

22

Submucosal stripe- UC or C?

UC

23

Full thickness enhancement- UC or C?

C

24

Skip lesions- UC or C?

C

25

Abscesses- UC or C?

C

26

Fistulas- UC or C?

C

27

Involvement of terminal ileum- UC or C?

C, sometimes UC

28

Fibrofatty proliferation- UC or C?

C

29

Wall thickening/Increased wall enhancement- UC or C?

both

30

Increased signal intensity of mucosa- UC or C?

C