Disease of the intestines Flashcards by Melissa Ring

When does IBD typically present

30
*crohns more common than UC

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Where in the world is IBD more common

Developed countries
*northern climates

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What is dysbiosis

alterations in normal flora of the gut

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What doubles the risk for crohns disease

Cigarette smoking

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Where in the body does Crohns effect

Anywhere from mouth to anus

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What type of disease are skip lesions associated with

Crohns

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What are the common presentations of crohns disease

Dependent on location involved and disease severity

RUQ pain and diarrhea

+/- extra intestinal manifestations

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What is the mainstay diagnosis for crohns disease

colonoscopy with biopsy

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What lowers the risk of UC

smoking

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How is the inflammation different between crohns and UC

UC inflammation is confined to the mucosa

Crohns inflammation involves the entire bowel wall

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Where is UC found in the body

confined to the colon

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What is the difference in stool presentation with crohns vs UC

UC generally has bloody diarrhea

Crohns generally has normal diarrhea

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What may be seen on xray with UC

Thumbprinting
lead-pipe colon
colonic dilation

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What is the mainstay of diagnosis for UC

Colonoscopy with biopsy

Will have contiguous inflammation

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When is a colonoscopy with biopsy contraindicated with UC

Why?

During acute disease

Risk for bowel perf

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Where is the pain usually located with UC

LLQ

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What are the treatment options for crohns and UC

Aminosalicylates (sulfasalazine) oral or topical

Steroids for acute tx (IV, Oral, Topical)

Immunomodulators (Methotrexate)

biologics

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Which immunomodulators increase risk for non-hodgkin lymphoma

Mercaptopurine
azathioprine

Monitor with CBC

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If a patient is prescribed methotrexate, what needs to be given as adjunct therapy

Folic Acid

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What biologics can be given for UC and Crohns

TNF inhibitors (inflixumab)
Anti-integrins (natalizumab)
Anti-IL antibody agents (Usetkinumab)

only used once they have failed all other therapy

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What is the first pharmacological option in the tx of Crohns disease

mesalamine

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What is the maintenance therapy for crohns disease

azathioprine or mercaptopurine + inflixumab

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If someone has a UC acute attack what drugs should they be given and what should be avoided

Topical mesalamine (suppository/enema)
-move to oral if topical fails

avoid antidiarrheals (loperamide)

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What is the greatest risk with fulminant UC

toxic megacolon

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How do you r/o toxic megacolon

KUB

What is the maintenance therapy for UC

First line is to continue 5-ASA | oral is better if there is more proximal involvment ## Footnote steroids are added if there is no improvement in 4-8 weeks

When is surgery done for UC and crohns | What type of surgery

Refractory disease bowel resection

What is the first line steroid for treatment of crohns

budesonide

What is celiacs disease

Immunologic response to gluten | Different from gluten intolerance

What is the gene mutation with celiac

HLA-DQ2

What are the classic symptoms for celiac disease

Chronic diarrhea dyspepsia flatulence steatorrhea

What symptoms are seen in kiddos with celiac

weight loss abdominal distention weakness muscle wasting delayed growth

What atypical symptoms may appear with celiac disease

dermatitis herpetiformis | Pruritic papulovesicules on extensor surfaces

What is the first line diagnostic test for celiac | What specific test

Serology | IgA levels are more sensitive and specific

What is the definitive diagnosis for celiac

Mucosal bx

What is the primary treatment for celiac

lifestyle modification *true gluten free diet

What should be avoided until the celiac is under control

Dairy

What is the difference between diverticulitis and diverticulosis

Diverticulosis is the presence of diverticula (asymptomatic) Diverticulitis is infection/inflammation of the diverticula

What is one of the most common intestinal disorder

Diverticulitis | increasing prevelance with age ## Footnote Men m/c until 50y/o then women m/c

What helps decrease the risk of diverticulitis

high fiber diet <4 servings of red meat/week physical activity | nuts and seeds can contribute to inflammation

What are the symptoms of diverticulitis

LLQ / suprapubic pain abdominal tenderness N/V/F change in bowel habits

What are some complications with diverticulitis

abscess formation ruptured diverticulum fistula hemorrhage

How do you treat moderate diverticulitis

NPO + oral abx - cipro is preferred

What is the most common cause of acute surgical abdomen

appendicitis

If appendicitis is left untreated for 24-36 hours, what happens

perforation gangrene abscess

What is the patient presentation with appendicitis

peritoneal signs, fever, tachycardia +/- other signs of sepsis

What is Rovsings sign and what is it used for

Appendicitis palpate LLQ and have rebound tenderness on opposite side

What may be seen on US with appendicitis

target sign

What is the imaging of choice in adults with appendicitis

What is the preferred tx of appendicitis

laparoscopic appendectomy

Where are obstructions most common

small bowel | can be mechanical or movement issue ## Footnote if movement issue = paralytic ileus

What are signs of a bowel obstruction

Crampy w/ intermittent abdominal pain no BM or flatus abdominal distention

What is the most common cause of SBO

Surgery hernia

What is the most common cause of LBO

History of cancer | #1 is carcinoma

What will be seen on physical exam with a bowel obstruction

Tympanic to percussion decreased BS high pitched BS

What is the workup like for a bowel obstruction | imaging specific

KUB first (2 view) TOC = abdominal CT

What pathology is indicative of an apple core lesion on an abdominal film

colonic carcinoma

What is the initial tx for a bowel obstruction | Definitive tx?

NGT | definitive is to treat underlying cause and decompress the bowel

What is a volulus | Where is it most common

bowel twists on itself, causing strangulation | 1. signmoid colon m/c, then cecum, in kids-> small intestine

what is the patient presentation of a volvulus | What about if there is a perf

Acute onset hematochezia abdominal pain / distention | abdominal tenderness, rigidity, guarding

What is the first line tx for a volvulus | What would be seen with a BE

Abdominal Xray *coffee bean appearance" | Birds beak appearance

What type of test can be diagnostic and therapuetic for a volvulus

Flexible signmoidoscopy

What is the initial treatment for a volvulus | What about if refractory?

Sigmoidoscopy | Surgical management

What is the most common cause of bowel obstruction in young kiddos | What age

Intussesception | most cases before age 2 *if over 4y/o its typically boys

If a child is over 6 with an intussusception, what should be a big differential

Lymphoma

When in the year does intussusception generally occur

Viral enteritis season

What is the presentation of an intussusception

sudden onset of colicky abd pain vomiting bloody stool (currant jelly color) lethargy palpable abd mass (sausage shape)

What is the test of choice to dx intussusception

US is test of choice *target sign is seen | BE is diagnostic and therapeutic

What is the treatment of choice for an intussusception

Air or barium enema | if unsuccessful -> surgical reduction

Which patients have an increased risk of ischemic colitis

IBS or COPD

What is the patho behind ischemic colitis

Hypoperfusion through the IMA

When might ischemic colitis present

post op from aortic procedures | females more common generally >65

What is the presentation of ischemic colitis

LLQ pain / tenderness/cramping bloody diarrhea low grade fever

What is first line imaging for ischemic colitits | What can confirm dx

CT | colonoscopy

When is surgery needed with ischemic colitis

When full thickness necrosis is present

What is overt vs. occult

Overt: symptomatic w/ obvious presentation occult: asymptomatic, no visible blood

Where do GI bleeds typically occur | Which patients have a higher mortality rate

usually UGI | over 65 and hospitalized

What are the common causes of UGI bleed | how about LGI bleed

Gastric esophageal | colonic, anal

What is a different presenting symptoms between UGI and LGI bleeds

UGI will have hematemesis

How do you treat a GI bleed if its a secondary cause from liver disease

octreotide

How do you treat a GI bleed

embo surgical mngmnt TIPS if variceal

What are common causes of occult bleeding

Neaoplasms PUD IBD

What is the diagnostic test of choice of occult GI bleed | if positive?, if less than 60?, if greater than 60?

Fecal occult blood test (FOBT) | Colonoscopy & EGD check small bowel is less than 60 over 60 + neg = iron

Disease of the intestines Flashcards

(83 cards)