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Flashcards in Lecture 6- GI Deck (75):
1

what two syndromes make up inflammatory bowel disease?

Crohn's disease
Ulcerative colitis

2

What causes Crohn's disease?

Genetic + Environmental factors
strong twin concordance

3

Most people with Crohn's and UC are of what two ancestries?

Northern European
Ashkenazi Jewish

4

Crohn's and UC disease has a _____ distribution of age of presentation

bimodal
fTeens to 30's and 50's

5

What is SBFT?

Small Bowel Follow Through study

6

What does the SBFT show on Crohn's?

Narrowing, irregularity, and ulceration in the distal ileum (String sign)

7

Where does Crohn's disease occur?

Anywhere in the GI tract (pharynx to anus)

8

How is inflammation of Crohn's described?

transmural-cobblestoning

9

where is Crohn's disease rarely found?

Esophagus
Stomach
Duodenum

10

List the three patterns of dz distribution of Crohn's

Ileocecal- distal SB and proximal colon (most common)
Terminal ileum- fistulas common
colon only with +/- rectal sparing

11

Is Crohn's disease contiguous or does it skip lesions?

Skips lesions (normal sections bordered by abnormal sections)

12

What are some deficiencies that are common with Crohn's?

Malabsorption of VIt B 12
Iron deficiency or pernicious anemia

13

What cancers can commonly occur with Crohn's dz?

colon cancer
Small bowel carcinoma
lymphoma

14

Where can you get fistulas with Crohn's dz?

Enteric (between 2 loops of bowel)
Bladder
Skin
Vaginal

15

why may you have iron deficiency with Crohn's dz?

bleeding
not absorbing iron

16

Why can renal stones develop with Crohn's dz?

calcium oxalate
Free fatty acid binding
also with dehydration and volume depletion

17

People who _____ have less frequency of what?

Ulcerative colitis

18

Does ulcerative colitis skip sections or is it contiguous?

Contiguous

19

Is the rectum involved in UC?

Yes- always

20

What is the presentation with UC?

Pain
Diarrhea
Urgency
Bleeding
Mucus analysis

21

If UC is severe what might be required?

Colectomy

22

Where does UC often start then go?

Rectum then creeps proximal

23

why is there mucus with UC?

Mucosa is inflamed

24

What are some complications with UC?

Megacolon- fever, pain, bloody diarrhea
Perf from over dilation (<15 cm)
Anemia- Fe defieincy
Bone marrow supression

25

What cancer are you more at risk for with UC?

adenocarcinoma (10-20 fold increase after 10 years)

26

What usually has a worse prognosis- UC or Crohn's?

Crohn's

27

Why do you bone marrow suppression from UC potentially?

Body can't tend to normal things when it is stressed
energy is fighting off the infection from UC

28

What should you rule out for IBD?

infectious etiologies of diarrhea, pain
assess extra-intesitnal manifestations of IBD

29

what are skin extra-intestinal manifesetations of IBD?

E. Nodosum (red nodules on lower legs)
Pyoderma Gangrenosum (inflamed, ulcerated skin)

30

What are hepatobiliary signs of IBD?

Autoimmune Hepatitis
GB stones
Primary Sclerosing Cholangitis

31

Musculoskeletal manifestations of IBD

Seronegative arthritis
Ankylosing Spondylitis
Sacroiliitis

32

Ocular manifestations of IBD

Uveitis
Episcleritis

33

Misc extra-intestinal manifestations of IBD

Hypercoag
AutoImHemolytic Anemia
Amyloidosis (amyloid deposited everywhere)

34

How do you manage mild UC?

5-ASA PO or per rectum

35

How do you manage moderate UC?

5-ASA
Steroids
Azathioprine
Sulfasala > Mesalamine
Rowasa
Canasa

36

How do you manage severe UC?

IV steroid
Azathioprine
Cyclosporine
Surgery

37

How do you treat mild Crohn's?

5-ASA
Elemental diet
Antibiotics

38

How do you treat moderate Crohn's?

5-ASA
Antibiotics
Steroids
Azathiop
Methotrexate (treatogenic)

39

How do you treat severe Crohn's?

IV steroid
Infliximab/ Rituximab (lessens autoimmune, $$$)
Azathiop
Surgery

40

Are any IBD cured?

No, they are controlled

41

Is there an identifiable pathology in IBS?

No

42

What is IBS frequently associated with?

History of sexual abuse of childhood molestation

43

what are some symptoms of IBS?

abdominal distention and pain
Flatulence
Constipation/ Diarrhea
Aggravated by stress, travel, change in diet

44

What are some red flag symptoms of IBS that can indicate something more severe? (6 of them)

Weight loss
Anemia
Nocturnal symptoms (Celiac dz)
steatorrhea
onset after age 50

45

What criteria is used for IBS?

Rome I criteria & Manning criteria

46

How do you measure IBS?

Serial weight record
Dietary history
Basic lab and stool studies
Endoscopy with appropriate biopsies

47

should you start people with IBS on narcotics?

no

48

What should you do for someone with IBS?

history and physical
basic lab and GI workup

49

What meds can help someone with IBS?

increase dietary fiber
anticholinergics (cramping)
acid suppression (if also have reflex)
motility agents
pain management

50

What is a non medication way to help someone with IBS?

counseling and antidepressants

51

what is the hallmark of depression?

Sleep disorder

52

What are bacteria that commonly cause intestinal infection

shigella
salmonella
E. Coli

53

What does inflammatory diarrhea have?

White cells and red cells

54

What 2 types of diarrhea are watery?

secretory
osmotic

55

What are viruses that commonly cause infections of the intestines?

Norwalk virus
Rotavirus

56

What are parasites/ protozoa that can cause intestinal infections?

Giardia
AMoeba

57

What are some food products that can cause infections of the intestines

dairy
poultry
meat
fruit

58

What things in the immunosupression category of causing infections of the intestines.

Cryptosporidium, Isospora, Cyclospora

59

What is caused by the overgrowth of C. Diff?

Pseudomembranous Colitis

60

what is one way to prevent the reoccurance of C. Diff?

Transplantation of stool from healthy individuals to patients with recurrent C. difficile restores these strains and breaks the cycle of recurrence

61

(toxin elaborating) – colonize small bowel, enterotoxin causes hypersecretion of isotonic fluid-Vibrio chol

Secretory infections

62

elaborating-destroy mucosal epithelial cells (C. dificile)

Cytotoxin

63

elaborating-one cause of food poisoning & vomiting (Staph A)

Neurotoxin

64

pathogens-inflammatory damage (Salmonella, Norwalk Virus., Entamoeba )

Invasive pathogens

65

How do you treat GI disease?

Hemodynamic assessment
fluid resuscitation/ simple carbs (BRAT)
stool exam

66

What does BRAT stand for?

Bananas
Rice
Applesauce
Tea/Toast

67

Villi with enzymes on them for proteins, fats, carbs. Complex enzymes at top. When you have diarrhea what happens?

Microvilli get shaved off
Only still have the enzyme that has carbs otherwise the food will go right on through and make the diarrhea worse

68

Should you give people who are naseau and vomiting water?

No, it will come right back up
give them ginger-ale/ 7-Up, tea with sugar

69

Do most people w/ divertic have symptoms?

no

70

what can perforation of the colon lead to?

Peritonitis (silent bowel sounds, rebound)

71

What can cause profuse passing of blood?

Diverticula or internal hemorrhoid

72

what labs should you get with diverticular dz?

WBC, differential
Fecal studies (WBC, RBC, mucus)
pain films (flat, upright)
Barium enema (unprepped)
colonoscopy, GI capsule camera
Abdominal CT
Arteriography

73

How can you treat diverticular dz?

Dietary management
Bulk or fiber laxative (psyllium)

74

If someone has a bout of diverticulitis what should you do?

bowel rest (NPO or clear liquids or IV)
IV fluids w/ appropriate electrolytes

75

If someone is spetic of febrile with diverticulitis what should you do?

Antibiotics (febrile or septic)