What are the most common causes of appendicitis in children and adults?
- lymphoid hyperplasia - child
2. fecalith - adults (impacted feces)
What are the usual symptoms of appendicitis?
periumbilical pain –> then localizes to RLQ
-fever, nausea, guarding and rebound tenderness
What is IBD? what do they think is the cause?
chronic relapsing inflam of bowel
abnormal immune response to enteric flora
Who is the classic patient with IBD and what are the usual symptoms?
young women - west, caucasians, eastern european
-bloody diarrhea, abdominal pain
Where does ulcerative colitis occur?
mucosal and submucosal layers
begins in rectum and can extend proximally to cecum
What are the symptoms of ulcerative colitis?
LLQ pain, bloody diarrhea, cramping, fever
What are the typical pathognomonic signs of ulcerative colitis?
crypt abscesses with neutrophils
pseudopolyps
loss of haustra “ lead pipe “ sign
What are some complications of ulcerative colitis? What is the risk based on?
toxic megacolon and carcinoma
- extent of involvement and duration
What are some systemic associations of ulcerative colitis?
Primary sclerosing cholangitis – liver disease
pANCA positivity, thromboembolism, DVTs
Arthritis, uveitis, erythema nodosum
Pyoderma gangrenosum – noninfective deep purulent ulcers - serious
Is smoking protective against ulcerative colitis or crohns disease?
ulcerative colitis
Where are the lesions found in crohns disease?
FULL THICKNESS
anywhwere from mouth to anus
terminal ileum is most common*
Are skip lesions seen in ulcerative colitis or crohn disease?
crohn disease
What are the symptoms of crohns disease?
RLQ pain
non bloody diarrhea
recurrent fever
What are the typical pathognomonic signs of crohn’s disease?
noncaseating granulomas in the submucosa cobblestone appearance submucosal fibrosis strictures - narrow lumen "creeping fat"
What are some complications of Crohns disease?
malabsorption with nutritional deficiency
calcium oxalate nephrolithiasis
Fistula formation – rupture and connection
Carcinoma – only if colonic disease is present
Liver disease – sclerosing cholangitis
amyloidosis
What are some systemic associations of crohns disease?
o Ankylosing spondylitis o Sacrolitis o Migratory polyarthritis o Erythema nodosum o Uveitis – visual disturbance
What is hirshsprungs disease?
defective relaxation and peristalsis of rectum and distal sigmoid colon
-segmental absence of ganglion cells - failure to descend from neural crest
What is hirsphrungs disease highly associated with?
down syndrome
What are some clinical features of hirshsprungs disease?
o Failure to pass meconium
o Empty rectal vault on DRE
o Massive dilation of bowel proximal to obstruction
o Inc in nonmyelinated cholinergic nerve fibers
How would you diagnose hirshsprungs disease?
rectal suction biopsy
-look for lack of ganglion cells
What is colonic diverticulosis?
outpouching of mucosa and submucosa through muscularis propria
What is believed to be the cause of colonic diverticulosis?
low fiber diet , constipation
Where do colonic diverticula typically occur?
where vasa recta traverse muscularis propria
-sigmoid colon
Although diverticula are usually asymptomatic, what are some possible complications?
Alternating Constipation and Diarrhea, colicky abdominal pain, flatulence Rectal bleeding – hematochezia Diverticulitis – appendicitis like symptoms fistula
What is angiodysplasia?
acquired malformation of mucosal and submucosal capillary beds
Where does angiodysplasia occur?
cecum and right colon due to high wall tension
What is the presentation of angiodysplasia?
hematochezia in an older adult
What are hemorrhoids?
dilated venous channels of hemorrhoidal plexus
Where would atherosclerosis affect the colon?
the SMA - splenic flexure is typically affected
How does ischemic colitis present?
postprandial pain
digestion requires inc blood
What is IBS?
relapsing abd pain with bloating and flatulence
- change in bowel habits
- improves with defecation
- related to disturbed intestinal motility
