Inflammatory Bowel diseases Flashcards Preview

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Flashcards in Inflammatory Bowel diseases Deck (45):
1

Inflammatory bowel disease includes

ulcerative colitis and crohn's

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differences of ulcerative colitis and crohn's onset

C-gradual, UC- sudden or gradual

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differences of ulcerative colitis and crohn's distribution

C-mouth to anus, skip areas, UC- distal to proximal, no skip

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differences of ulcerative colitis and crohn's depth of lesion

C- trasmural, UC- mucosal

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differences of ulcerative colitis and crohn's symptoms

C- diarrhea/pain, UC- bloody, pus, diarrhea, tenesmus

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differences of ulcerative colitis and crohn's complications

C-fistulas, toxic megacolon, colon CA, UC: toxic megacolon and colon cancer

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Ulcerative cholitis

chronic recurrent disease, starts at rectum and moves proximally, contained within colon, toxic megacolon and malignancy are more likely in UC than C, smoking is protective

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Symptoms of UC

inflammatory diarrhea, tenesmus, pain in LLQ (rare), weight loss, malaise, fever

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Diagnosis of UC

CBC: anemia, ESR: increased, Albumin: decreased, Xray will show colonic dilatation, diagnostic is colonoscopy (avoid in severe) or sigmoidoscopy

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Treatment of UC

topical or oral aminosalicylates, corticosteroids, immunomodulators, surgery can be curative

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Crohn's disease

cause is unknown, genetic predispostion, involves: s/l colon, mouth, esophagus, stomach, but mostly terminal ileum and r colon, not usually rectum, has skip areas

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Symptoms of Crohn's

abdominal cramps, chronic diarrhea,

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Diagnosis of crohn's

anemia, increased ESR, electrolyte imbalances colonoscopy, biopsy, granuloma common

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Treatment of Crohn's

acute: oral corticosteroids, Maintenance: mesalamine, MTX, smoking cessation, B12, folate, Vit D, surgery is not curative

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Toxic megacolon

Emergency, extreme dilatation and immobility of colon, Hirschsprung's disease, ulcerative colitis, Crohn's. and infectious causes

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Symptoms of toxic megacolon

fever, prostration, severe cramps, abd distention

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Diagnosis of Toxic megacolon

rigid abd, rebound tenderness, xray shows colon dilatation

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Treatment of Toxic megacolon

Decompression of the colon, fluid and electrolyte balances

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Ischemic bowel disease

Acute or chronic, >50 yo, intestinal infarction is more common in the small bowel than large, shock is common

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Acute mesenteric ischemia

emergency, high mortality, arterial embolus/thrombus, venous thrombosis, sudden onset of severe abd pain

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Chronic mesenteric ischemia

blood supply is present but insufficient, abd angina and pain 10-30 min after eating, relieved by squatting or lying down

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Diagnosis of ischemic bowel

Ct to rule out other abd causes, diagnostic is colonoscopy

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Treatment of ischemic bowel disease

surgery to revascularize intestine, hydration

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Intussusception

invagination of proximal segment of bowel into portion distal to it, most common in children

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Symptoms of intussusception

children: colick, stoll will contain blood and mucus (jelly stool), abd pain, sausage like mass adults: crampy, no blood, abd pain, mass is rare

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Diagnosing intussusception

children:barium or air filled most diagnostic, adult: barium enema should not be used, Xray is not specific, CT best, usually found in surgery

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Treatment of intussusception

hospitalized, air or barium enema may be curative, surgery or resection

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Common small bowel obstruction

adhesions, hernias, neoplasm, inflammatory bowel disease, volvulus

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Common large bowel obstruction

neoplasm, strictures, hernias, volvulus, intussusception, fecal impaction

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Symptoms of small bowel obstruction

abd pain, distention, vomiting of partially digested food, opstipation, high pitched bowel sounds, later bowel is silent

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Symptoms of large bowel obstruction

distention and pain, may be febrile, tachy, shock

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Diagnosing bowel obstruction

CMP: decreased electrolytes, upright CT shows air fluid levels

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Treatment of bowel obstruction

NPO, NG, IV fluids, monitoring, surgery likely with large intestine

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Volvulus

emergency, twisting of bowel on self, sigmoid or cecal area, ischemia can lead to gnagrene, peritonitis and sepsis

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Symptoms of bowel volvulus

Cramping abd pain and distention, tachy, nausea, vomiting, obstipation, fever, severe pain

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Diagnosing Volvulus

xray shows colonic distension

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Treatment of volvulus

immediate decompression to avoid ischemia, endoscopic depression with surgeon stand by

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Diverticular disease

Diverticulosis are pocket formations, diferticulitis is infection, >60% >60 have, 20% are asymptomatic, 20% have acute

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Symptoms of diverticular disease

sudden onset in LLQ, fever, nausea, diarrhea, blood

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Diagnosing diverticular disease

occult blood, elevated WBC, X ray to rule out free air, CT if pt does not respond to therapy, barium enema avoided

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Treatment diverticular disease

antibiotic treatment (Cipro, flagyl), pt education on diet, and meds

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Treatment of severe diverticulitis

hospitalization, IV antibiotics, NPO, NG tube, surgical management

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Appendicitis

obstruction of appendix leads to inflammation and infection, commonest cause of fecalith and ER surgery, 10-30 yo, 10% of pop, 20% of pt develop peritonitis and perforation

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Symptoms of appendicitis

progressive, intermittent periumbical pain, than RLQ localization, nausea and anorexia, vomiting/diarrhea, low grade temp

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Diagnosis of appendicitis

increased WBC, blood and leukocytes in UA, abdominal CT w/ contrast