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Flashcards in diseases of colon Deck (37):
1

colon sphincters

ileocecal valve, internal and external anal sphincters

2

Does colon have villi

no

3

Functions of colon

absorption of water and ions (ascending), bacterial fermentation of nonabsorbed nutrients (transverse and descending), storage and elimination (descending and rectum)

4

irritable bowel disease symptoms

Suggestive symptoms (e.g., diarrhea, crampy abd pain, bleeding) lasting > 2 weeks , Negative work-up for other causes of colitis (infection, ischemia, medications), Extraintestinal symptoms

5

How is irritable bowel disease diagnosed

Direct visualization and biopsy

6

signs/symptoms of ulcerative colitis

Diarrhea, Weight loss, Fatigue, Lower abd pain, Hematochezia , Mucus in stool, Tenesmus

7

signs/symptoms of Crohns

Diarrhea, Weight loss, Fatigue, Mid or lower abd pain, Nausea/vomiting, Fistula symptoms

8

For Crohns and ulcerative colitis List: bowel region, fistulae/abscess, strictures and distribution

Crohns: entire GI tract, fistulae and abscesses common, strictures common, skip lesions. UC: Colon, NO fistulaes or abscesses, no strictures, diffuse

9

For Crohns and ulcerative colitis List: location of inflammation, location and type of ulcers, presence of fibrosis, presence of granulomas

Crohns: transmural inflammation, deep linear ulcers, lots of fibrosis, 20% get granulomas. UC: mucosal +/- smooth muscle inflammation, superficial confluent ulcers, mild to no fibrosis, no granulomas

10

For Crohns and ulcerative colitis List whether it has each of the following: obstruction, malabsorption, malignant potential, recurrence after colectomy, toxic megacolon

Crohns: obstruction YES, malabsorption YES, malignant potential with colonic involvement, recurrence after colectomy common, toxic megacolon NO. UC: obstruction NO, malabsorption NO, malignant potential YES, recurrence after colectomy NO, toxic megacolon YES

11

Extraintestinal manifestations of ulcerative colitis

eye: scleritis, episcleritis. Skin: Pyoderma gangrenosum (ulcers on lower extremities), erythema nodosum (nodules with erythrodermous patch). Liver: Primary sclerosing cholangitis (PSC- fibrosis of hepatic bile ducts). Joints: Sacroiliitis, Ankylosing spondylitis

12

How is IBD (crohns and UC) treated

Corticosteroids during flares, 5-aminosalicylates, immunomodulators, TNF-alpha antagonists, surgery (colectomy, partial small bowel resection or stricturoplasty)

13

Colon cancer and UC

risk increases with disease duration

14

What is microscopic colitis

Chronic secretory diarrhea that is watery and non-bloody (4-10 stools per day, minimal nocturnal or fasting symptoms). Mainly occurs in females age 50-80, autoimmune but trigger is unknown.

15

Microscopic colitis diagnosis

Colonoscopy usually normal. Biopsy shows Lymphocytic infiltration of mucosa and SM (LC) and Thickened collagenous band (CC)

16

Types of microscopic colitis

Based on histology: lymphocytic (chronic inflammation) or collagenous (thickened subepithelial collagen band with lymphocytic surface injury)

17

microscopic colitis treatment

antidiarrheals (loperamide, diphenoxylate), bismuth, topical steroids

18

Ischemic colitis triggers

vasospasm, dehydration, hypotension, cardiopulmonary insult (MI, PE)

19

ischemic colitis locations

watershed vascular areas: splenic flexure, rectosigmoid

20

Ischemic colitis presentation

•Abrupt-onset, crampy, lower abdominal pain. Urgent need to defecate. Mild diarrhea and/or hematochezia.
•Abrupt-onset, crampy, lower abdominal pain. Urgent need to defecate. Mild diarrhea and/or hematochezia.

21

ischemic colitis endoscopic findings

edema, ulceration +/- bleeding confined to vascular region

22

ischemic colitis recovery time

1-2 weeks

23

Ischemic colitis diagnosis:

Colonoscopy or flexible sigmoidoscopy with biopsy are gold standard. A KUB x ray may show thumbprinting of colon mucosa, but not sensitive. Also, contrast CT may show colon wall thickening, pericolonic inflammation or decreased perfusion

24

Less common causes of ischemic colitis

vasculitis (lupus), substance abuse, meds (estrogen), protein C/ S deficiency, Factor V leiden deficiency, marathon running

25

ischemic colitis treatment

support, antibiotics, volume support

26

Symptoms of infectious colitis

•Inflammatory diarrhea +/- hematochezia. Short duration, recent travel/sick contacts, Abx use,

27

Risk factors for diverticulosis

western countires (low fiber diets, increased intracolonic pressure), >50% are in elderly

28

Symptoms and cause of diverticular hemorrhage

usually in right colon, vasa recta withing dome of diverticulum. Causes painless Painless hematochezia, often heavy, typically stops w/in 2-3 days. Does NOT occur with diverticulitis

29

What is acute diverticulitis

Fecolith obstructs diverticulum causing distension from bacterial gas and neutrophils, microperforation, abscess, macroperforation with peritonitis.

30

Acute diverticulitis symptoms

LLQ pain, nausea, fever

31

Diverticulitis management

Diagnose with CT or MRI. Treat with oral/ IV antibiotics, abscess drainage and/or surgery. Strictures may require dilation or resection

32

Etiologies of lower GI bleeding

diverticulosis, arteriovenous malformations, colitis, neoplasm, radiation colitis, post-polypectomy or biopsy, internal hemorrhoids, rectal ulcer, anal fissure,

33

Causes of colonic obstruction

adenocarcinoma of colon or rectum (90%), volvulus, benign strictures from acute divertiulitis.

34

Obstructive colon cancer prodrome

change in stool frequency or caliber

35

Volvulus

typically involves the cecum or sigmoid colon, where a colonic loop twists around on its mesentery, resulting in strangulation and luminal obstruction

36

colonic obstruction presentation

diffuse or upper abdominal discomfort, distension, and nausea/vomiting. The emesis may be feculent. Absence of stool passage (obstipation)

37

How is colonic obstruction treated

surgical resection or metal stent