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Outpatient Medicine > IBD and Colitis > Flashcards

IBD and Colitis Flashcards

1
Q

What 2 areas of the abdomen cause lower abdominal pain?

A
  1. Hindgut

2. Genitourinary

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2
Q

67 yr old is on day 3 of treatment of pneumonia with fluids and antibiotics and develops sudden onset acute abdominal pain rated 10/10 with hypertension and tachycardia. What happened?

A

Diverticular rupture (perforation)

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3
Q

Rome III criteria for IBS

A

2/3 sx for 3 months over 12 months period:

  1. Abdominal pain relieved by defecation
  2. Change in stool frequency
  3. Change in stool consistency

also:

  • Recurrent abdominal pain for 6 months
  • Marked change in bowel habit for 6 months
  • Symptoms 3 days/month for 3 month
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4
Q

What is the PPV of the Rome III symptom criteria for IBS?

A

98%

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5
Q

What are alarm indicators for IBS symptoms?

A

Male, old age, nocturnal awakening, rectal bleeding, weight loss, fever, FH of colon cancer

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6
Q

What are the classic symptoms of ischemic colitis?

A

Crampy abdominal pain with rectal bleeding or bloody diarrhea within 24 hours after that in an elderly person with athersclerotic disease. Usually blood is not a huge amount, unlike diverticulosis

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7
Q

What is the triad for diverticulitis?

A
  1. LLQ pain
  2. Fever
  3. Leukocytosis
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8
Q

How do you evaluate diverticulitis?

A

Contrast enhanced CT of abdomen and pelvis. It can confirm the diagnosis and check for perforation, abscess, obstruction, fistula at the same time.

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9
Q

What are symptoms of radiation proctitis?

A

Diarrhea and tenesmus within 6 weeks of radiation therapy

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10
Q

How is radiation proctitis diagnosed and evaluated?

A

Biopsy. Must see submucosal fibrosis and arteriole endarteritis (sigmoidoscopy or endoscopy necessary)

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11
Q

Difference between ischemic colitis and acute mesenteric ischemia?

A

ISCHEMIC COLITIS: Bloody stool, mild abdominal tenderness. Colonscopy can sometimes show segmental hemorrhagic nodules, ulcers, gangerene. Much more common than AMI.

ACUTE MESENTERIC ISCHEMIA: Usually +FOBT but no overt blood in the stool. Pain out of proportion to examination.

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12
Q

What can precipitate ischemic colitis?

A
  • Long distance running
  • Cardiac surgery
  • Oral contraceptives
  • Cocaine
  • Hypercoagulable states
  • Age>60
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13
Q

What do you treat ischemic colitis?

A
  1. IV fluids

2. Broad spectrum antibiotics (less evidence for this. Not really an infection, more of a preemptive thing)

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14
Q

How do symptoms of diverticulosis differ from diverticulitis?

A

DIVERTICULOSIS: Massive painless bleeding

DIVERTICULITIS: Pain in the LLQ, fever, leukocytosis. Usually no overt rectal bleeding.

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15
Q

What are the most common causes of painless lower GI bleeding?

A

DiverticulOSIS and vascular ectasia

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16
Q

How do you manage painless lower GI bleeding? List tx steps in order

A
  1. Hemodynamic stabilization (I think this means RBC and NS)

2. Nasogastric tube aspirate, gastric lavage, or something to distinguish upper from lower source

17
Q

What are the symptoms of erythema nodosum?

A
  • Small, very tender nodules on the anterior tibial surface. Usually you can feel them better than you can see them. May look ecchymotic as they age.
  • Often occurs with Crohn disease
  • Usually preceded by joint pain, fever, malaise
18
Q

What are the most common skin manifestations in Crohn disease? In UC?

A

Crohn: Erythema nodosum (tender nodules on shins)

UC: Pyoderma gangrenosum (small ulcers that at first look like bug-bites or pustules, and then can get really big and painful. Pretty uncommon.)

19
Q

How do you treat erythema nodosum?

A

Usually treat the underlying Crohn disease

20
Q

What is dermatitis herpetiformis?

A

Grouped vesicles that look like herpes that often occur on the extensor surfaces and extremely closely associated with celiac disease. However, only 25% of these patients will have SYMPTOMATIC celiac disease!

21
Q

Which disease weirdly gets worse when you stop smoking?

A

ulcerative colitis

*memory: U for Upside-down-thinking and Ulcerative-colitis

22
Q

What is microscopic colitis?

A

Colon disease where you get non-bloody diarrhea and colonoscopy shows normal mucosa, but histology shows increased lymphocytes or collagen. Need multiple biopsies to diagnose it.

23
Q

Does Crohn or UC more often cause bleeding?

A

ulcerative colitis (think of it like Crohns is higher up so the blood doesn’t make it all the way down… idk)

24
Q

Can crypt abscesses be seen in infectious colitis?

A

No, this is usually a chronic change seen in IBD

25
Q

Does ischemic colitis typically involve the rectum?

A

No because the rectum has dual blood supply

26
Q

What area is typically spared by crohn disease?

A

The rectum (but the colon is fair game)

27
Q

How do you treat ulcerative colitis?

A

Mesalamine/Mesalazine/5-ASA (all the same thing)

It’s an anti-inflammatory drug that acts locally in the gut

28
Q

How do you treat distal ulcerative colitis?

A

Topical therapy is better, so suppositories (mesalamine or steroids) or enema (mesalamine or hydrocortisone)

29
Q

When is oral prednisone used to treat UC?

A

When symptoms don’t response to 5-ASA (like mesalamine, sulfasalazine)

30
Q

If prednisone and 5-ASAs don’t work for patients with UC, what other drugs can you try?

A

Azathioprine or 6-mercaptopurine. Usually given at the same time as a 3-4 month course of prendisone because they have delayed onset of action

Also, infliximab (antibody to TNF alpha)

31
Q

What age patients usually get microscopic colitis?

A

Collagenous type: 50-60

Lymphocytic type: 60-70

32
Q

How do you treat microscopic colitis?

A
  • Loperamide (Imodium)
  • Diphenoxylate
  • Bismuth subsalicylate
33
Q

What are the symptoms of toxic megacolon?

A

Dilation of trasnverse and descending colon. Pt may have IBD or C Diff. Fever, tachycardia, abdominal tenderness. May have bloody diarrhea.

34
Q

What are the msot common cauess of ischemic small bowel?

A
  1. Mesenteric arterial embolism from the heart (50%)
  2. Mesenteric arterial thrombus (25%)
  3. Mesenteric venous thrombosis (10%)

Outpatient Medicine (16 decks)

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