GI: 354 - 357 Flashcards Preview

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Flashcards in GI: 354 - 357 Deck (29):
1

What is thought to be the cause of Crohn disease vs. ulcerative colitis?

Crohn disease - disordered response to intestinal bacteria

Ulcerative colitis - autoimmune

2

What is the difference in localization of Crohn disease vs. ulcerative colitis?

Crohn disease - any portion of the GI tract; usually the terminal ileum and colon; skip lesions; rectal sparing

Ulcerative colitis - colonic inflammation that is continuous; always has rectal involvement

3

What do you see on gross morphology with Crohn disease?

Transmural inflammation - fistulas, cobblestone mucosa, creeping fat, bowel wall thickening, linear ulcers, fissures

4

What do you see on barium swallow with Crohn disease?

String sign - due to wall thickening which narrows the lumen

5

How is gross morphology of ulcerative colitis different from Crohn disease in terms of the layers affected?

Ulcerative colitis affects mucosa and submucosa vs. Crohn disease which is transmural

6

Describe what you see on gross morphology with ulcerative colitis.

Friable mucosal pseudopolyps with freely hanging mesentery

7

What do you see on imaging with ulcerative colitis and why?

Lead pipe appearance with loss of haustra

8

Contrast Crohn disease and ulcerative colitis in terms of Th1 vs. Th2 response.

Crohn disease - Th1 (noncaseating granulomas and lymphoid aggregates)

Ulcerative colitis - Th2 (crypt abscesses, ulcers, bleeding, no granulomas)

9

Strictures (leading to obstruction), fistulas, perianal disease, malabsorption, nutritional depletion, colorectal cancer, gallstones - complications of Crohn or ulcerative colitis?

Crohn

10

Malnutrition, sclerosing cholangitis, toxic megacolon, colorectal cancer - complications of Crohn or ulcerative colitis?

Ulcerative colitis

11

When do you have an increased risk of colorectal cancer with ulcerative colitis?

Worse with right-sided colitis or pancolitis

12

Is bloody diarrhea more common with Crohn disease or ulcerative colitis?

Ulcerative colitis

13

Compare and contrast the extraintestinal manifestations of Crohn disease vs. ulcerative colitis.

Both - erythema nodosum, uveitis, aphthous ulcers, ankylosing spondylitis, pyoderma gangrenosum

Crohn only - migratory polyarthritis, kidney stones

Ulcerative colitis only - primary sclerosing cholangitis

14

How do we treat Crohn disease?

Corticosteroids, azathioprine, methotrexate, infliximab, adalimumab

15

How do we treat ulcerative colitis?

ASA preparations (sulfasalazine), 6-mercaptopurine, infliximab, colectomy

16

How do we define irritable bowel syndrome?

Recurrent abdominal pain associated with at least 2 of the following:
1. Pain improves with defecation
2. Change in stool frequency
3. Change in appearance of stool

17

What are the structural abnormalities with irritable bowel syndrome?

None

18

Is irritable bowel syndrome more of an acute or chronic disease?

Chronic

19

What demographic does irritable bowel syndrome tend to affect?

Middle aged women

20

How does IBS tend to present?

Diarrhea, constipation, or alternating symptoms

21

How do we treat IBS?

Symptomatic management

22

Contrast the causes of appendicitis in children vs. adults.

Children - lymphoid hyperplasia
Adults - obstruction by fecalith

23

How does appendicitis present?

Initial diffuse periumbilical pain that migrates to McBurney point

24

Where is McBurney point?

Half the distance between anterior superior iliac spine to umbilicus

25

If an appendicitis patients has fever and nausea, what should you be concerned about?

Possible perforation

26

What might you see with perforation of the appendix?

Psoas, obturator, and Rovsing signs

27

What should be on your differential with appendicitis?

Diverticulitis (elderly), ectopic pregnancy (beta-hCG to rule out)

28

How do you treat appendicitis?

Appendectomy

29

What is the difference between a true vs. false diverticulum?

True diverticulum - all 3 gut wall layers outpouch (e.g. Meckel)