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Clin Med - GI > diseases of intestine > Flashcards

diseases of intestine Flashcards

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1
Q

what portion of the GI tract can Crohns disease affect

A

any portion mouth to anus
50% include terminal ilium and colon
30% with terminal ilium only
20% with colon only
<5% with upper GI tract involvement

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2
Q

what id dysbiosis

A

alternation in normal flora of the gut

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3
Q

how do you describe inflammation with Crohns

A

tranmural - aka full thickness
‘cobblestoning’ or ‘skip lesions’

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4
Q

what is the presentation of Crohns

A

variable - depending on location and severity of dz
many have RUQ pain + diarrhea
+/- systemic symptoms (fever, weight loss, fatigue)
may present with obstruction from strictures, parianal or other GI tract manifestations or extra-intestinal manifestations

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5
Q

what is the workup for crohns disease

A

no lab testing specific for Crohns
stool studies to r/o other causes of diarrhea
+/- elevated ERC/CRP and evidence of malabsorption
Mainstay of dx is colonoscopy with biopsy

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6
Q

what is ulcerative colitis

A

like crohns, inflammatory condition but pathogenesis unknown
hereditary risk, environmental risk

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7
Q

what can lower the severity of UC

A

smoking

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8
Q

where is UC located in the GI tract

A

confined to colon
25% isolated to recosigmoid region
50% have disease extending to splenic flexure
25% have disease extending more proximally

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9
Q

what is inflammation confied to the mucosa

A

ulcerative colitis

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10
Q

what is the presentation of UC

A

variable based on location and severity of dz
-MOST with bloody diarrhea +/- mucus
LLQ, abdominal cramping, fecal urgency, tenesmus
+/- fever, weight loss
+/- extraintestinal manifestations

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11
Q

what is the workup for UC

A

mainstay of dx is colonoscopy with biopsy

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12
Q

when is colonoscopy with biopsy contraindicated

A

acute disease - risk for bowel perforation

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13
Q

What is the pharmacologic treatments of crohns and UC

A

5-aminosalicylates: (5ASA; sulfasalazine, mensalamine, balsalazide)
Corticosteroids
Immunomodulators (Mercaptopurine, azathioprine, methotrexate)
Biologic agents: TNF inhibitors, Anti-integrins, anti-IL antibody

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14
Q

what is the treatment of acute crohns

A

ensure adequate nutrition
antidiarrheal agents (loperamide)
pharmacotherapy:
mensalamine
+/- oral abx
corticosterioids (budesonide first line)

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15
Q

what is maintenance therapy for crohns

A

pts usually on zathioprine or mercaptopurine + infliximab

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16
Q

what is the treatment of acute UC

A

normal oral intake if mild/moderate
AVOID anti-diarrhea (loperamide)
pharmacologic:
topical mesalamine (first line: suppository or enema)

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17
Q

what is fulminant UC disease

A

severe, rapidly progressive (1-2 weeks) and toxic
fever, hypovolemia, hemorrhage, abdominal distension and tenderness
risk for bowl perforation and toxic megacolon

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18
Q

what is the treatment of fulminant UC disease

A

NPO 24-48 hours
resuscitation: fluid, blood products, correct electrolytes
topical hydrocortison -> infliximab +/- cyclosporine
R/o Toxic Megacolon with abd xr

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19
Q

what is the first line maintenance tx of UC

A

continue 5-ASA agent: topical or oral
if no improvement in 4-8 weeks: add pred or methylpred

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20
Q

when is surgical intervention recommended for UC/Crohn’s

A

refractory UC/Crohns

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21
Q

what are the indications for bowel resection with crohn’s and UC

A

refractory
hemorrhage
abscess
obstruction
fistulas
bowel perforation
fulminant colitis
toxic megacolon
carcinoma

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22
Q

what is an immunogenic response to gluten

A

celiac disease

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23
Q

what are gene associations with celiac disease

A

HLA-DQ2 gene

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24
Q

what is the result of the antibodies with celiac disease

A

damage to intestinal mucosa (villi)
tissue transflutaminase (tTG) antibodies
anti-gliadin antibodies
anti-endomysial antibodies (EMA)

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25
what is the presentation of celiac disease
classic symptoms: chronic diarrhea, dyspepsia, flatulence +/- steatorrhea malabsorption: weight loss, abdominal distention, weakness, muscle wasting, delayed growth
26
what is the workup for celiac disease
first line for dx testing is serology
27
what is the most specific and sensitive test for celiac disease
serology - IgA tissue transgluraminase (IgAtTG)
28
what is the definitive diagnostic test for celiac disease
mucosal biopsy -atrophy or scalloping of duodenum, blunting of intestinal villi, hypertrophic of intestinal crypts, lymphocytes in lamina propria
29
what is the tx of celiac disease
TRUE gluten free diet (lifestyle modification)
30
what is a herniation of the intestinal mucosa and submucosa through the muscularis
diverticulum
31
what is the presence of diverticula
diverticulosis
32
what is inflammation and/or infection or the diverticula
diverticulitis
33
what are diet and lifestyle factors that contribute to inflammation with diverticulitis
high fat, high protein, refined grain diet (western diet) red meat consumption eating nuts and seeds obesity smoking immunosuppression NSAID use
34
what is the presentation of diverticulitis
acute ssx LLQ or suprapubic abdominal pain +/- palpable mass abdominal tenderness N/V fever change in bowel habits etc
35
what is the workup for diverticulitis
CBC ABD CT is test of choice after resolution of acute episode - colonoscopy, barium enema or CT colonography
36
what are complications of diverticulitis
abscess formation ruptured diverticulum fistula hemorrhage
37
what is the tx of diverticulitis
mild: rest and liquid diet, abx no necessary mod/complicated/comorbidities: NPO plus oral abx (metronidazole + fluoroquinolone preferred) if severe: admit and IV abx large abscess: drainage perforation: surgical intervention
38
what is the most common cause of an acute surgical abdomen
appendicitis
39
if appendicitis is left untreated, within 24-36 hours what does it lead to
perforation gangrene abscess
40
what is the presentation of appendicitis
acute onset constant and worsening abd pain other non-specific symptoms: dyspepsia, N/v, anorexia, diarrhea, constipation, low grade fever
41
what is suggestive of perforation, abscess or gangrene with appendicitis
peritoneal signs, fever, tachy or other signs of sepsis
42
what is seen on PE with appendicitis
guarding and rigidity tendernss at McBurneys point rebound tenderness Rovsing's sign Psoas sing Obturator sign
43
what is the diagnostic test of choice for appendicitis
CT scan for adults
44
What is the tx of appendicitis
laparaoscopic appendectomy abx
45
what is the inability of contents to pass through the bowels
bowel obstruction
46
where are bowel obstructions more common
small bowel obstruction
47
what are risk factors for bowel obsturctions
prior abdominal surgery malignancy IBD hernias radiation to the area mostly things that increase risk for adhesions, strictures
48
what can the accumulation of contents within the bowel cause
increase in intraluminal pressure and dilation
49
what is the presentation of small bowel obstruction (SBO)
hx abd surgery or hernia crampy, intermittent abd pain periumbilical or diffuse abd pain vomiting, early onset, that is bilious no BM or flatusus abdominal distenstion
50
what is the presentation of LBO
+/- hx of CA (caricnoma #1) crampy, intermittened abd pain hypogastric abd pain vomiting, late onset, that is later feculent No BM or flatus abdominal distention
51
what is seen on PE with bowel obsturction
abdominal distention abdominal tenderness tympanic to percussion decreased BS high pitched BS +/- peritoneal signs
52
what is the first diagnostic tests run for concern with bowel obstruction
abdominal x-ray -absence of air or stool in rectal vault, bowel distention, air-fluid levels
53
what is the test of choice for bowel obstruction
abdominal CT (confirms obstruction and location)
54
what is the initial treatment for bowel obstruction
NPO fluid resuscitation electrolyte management NG tube insertion for decompression pain management anti-emetics +/- prophylactic abx
55
what is the definitive treatment for bowel obstruction
treat the underlying cause if partial obstruction or SBO without complications: NG decompression Next step if no perf: endo/colonoscopic decompression if unstable or perf: surgical management, exlap with bowel resection
56
what occurs when the bowel twists on itself anc causes strangulation
volvulus
57
where is vulvulus most common
sigmoid colon: elderly males, pts with chronic constipation Cecum is second most common: young females in kids: small intestines
58
what is the presentation of vulvulus
most with acute onset of symptoms abdominal pain/distention vomiting constipation/obstipation hematochezia hemodynamic instability
59
if the patient has an associated perforation with volvulus what is this presentation
abdominal tenderness rigidity guarding
60
what is the initial study of choice for vulvulus
abdominal x-ray: characteristic coffee bean appearance
61
what will be seen on a barium enema with volvulus
birds beak appearance
62
what can be diagnostic and therapeutic for vulvulus
flexible sigmoidoscopy
63
what is the initial treatment of volvulus
sigmoidoscopy: insufflation at site of rotation, decompression with rectal tube
64
what is the refractory treatment of volvulus
surgical management - bowel resection due to risk for recurrence
65
what is the most common cause of bowel obstruction in young children
intussesception
66
what is telescoping of the intestines
intussesception
67
what is the presentation of intussesception
sudden onset colicky abdominal pain: reoccurs every 15-20 min abdominal pain later becomes constant vomiting bloody stools; 'currant jelly' colored lethargy palpable mass: "sausage shaped"
68
what is the test of choice for intussusception
US
69
what is seen on US with intussesception
'target sign'
70
what test can be diagnostic and therapeutic for intussesception
barium enema - risk for peritonitis if performation present
71
what is the treatment of intussusception
air or barium enema is the tx of choice if air enema is unsuccessful: surgical reduction
72
what is ischemic colitis
hypo-perfusion through the IMA - sloughing of the intestinal mucosa
73
who is at a increased risk of ischemic colitis
IBS or COPD 2-4x increased risk more common in pts with pre-existing cardiac or peripheral vascular disease or coagulopathy
74
what is the presentation of ischemic ocolitis
LLQ abdominal pain abdominal tenderness abdominal cramping diarrhea, usually bloody low grade fever
75
what is the first line for assessing ischemic colitis
Ct scan
76
what is the tx of ischemic colitis
tx underlying cause main adequate BP IV fluids prophylactic abx bowel rest (NPO except clear liquids) in full thickness necrosis - surgical intervention
77
if there is a bleed proximal to the ligament of treitz it is what type of bleed
Upper GI bleed
78
if there is a bleed distal to the ligament of treitz it is what type of bleed
lower IG bleed
79
what is occult
often asymptomatic, no visible blood
80
who is at an increased risk of mortality with GI bleeding?
patients over 60 and hospitalized patients
81
what can cause UGI bleeding
PUD portal HTN (varices) mallory-weiss tear vascular anomalies gastric/esophageal CA erosive gastritis/esophagitis hiatal hernia coagulopathy
82
what can cause LGI bleeding
diverticulosis vascular anomalies (angioectasias) colonic/anal CA IBD anorectal disease ischemic colitis inflammatory diarrhea hemorrhoids lower abdominal or anorectal trauma
83
what is the presentation of UGI bleed
anemia hematemesis melena +/- hematochezia +/- hemodynamic instability
84
what is the presentation of LGI bleed
anemia +/- melena hematochezia +/- hemodynamic instability
85
what are the diagnostic tests that can be done for GI bleeding
endoscopy /colonoscopy nuclear scans angiography capsule imaging
86
what is the treatment for GI bleeding
endoscopic tx pharmacologic options: IV or oral PPI, octreotide if liver disease intra-arterial embolization surgical management TIPS for variceal bleeds
87
what are common causes of occult GI bleeding
neoplasms angiogenectasis PUD infection meds IBD
88
what are the diagnostic tests of choice for occult bleeding
Fecal occult blood test (FOBT) fecal immunochemical test (FIT; cologuard) if FOBT or FIT positive -> colonoscopy and EGD

Clin Med - GI (11 decks)

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