Flashcards in Lecture 6- GI Deck (75):
what two syndromes make up inflammatory bowel disease?
What causes Crohn's disease?
Genetic + Environmental factors
strong twin concordance
Most people with Crohn's and UC are of what two ancestries?
Crohn's and UC disease has a _____ distribution of age of presentation
fTeens to 30's and 50's
What is SBFT?
Small Bowel Follow Through study
What does the SBFT show on Crohn's?
Narrowing, irregularity, and ulceration in the distal ileum (String sign)
Where does Crohn's disease occur?
Anywhere in the GI tract (pharynx to anus)
How is inflammation of Crohn's described?
where is Crohn's disease rarely found?
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
Is Crohn's disease contiguous or does it skip lesions?
Skips lesions (normal sections bordered by abnormal sections)
What are some deficiencies that are common with Crohn's?
Malabsorption of VIt B 12
Iron deficiency or pernicious anemia
What cancers can commonly occur with Crohn's dz?
Small bowel carcinoma
Where can you get fistulas with Crohn's dz?
Enteric (between 2 loops of bowel)
why may you have iron deficiency with Crohn's dz?
not absorbing iron
Why can renal stones develop with Crohn's dz?
Free fatty acid binding
also with dehydration and volume depletion
People who _____ have less frequency of what?
Does ulcerative colitis skip sections or is it contiguous?
Is the rectum involved in UC?
What is the presentation with UC?
If UC is severe what might be required?
Where does UC often start then go?
Rectum then creeps proximal
why is there mucus with UC?
Mucosa is inflamed
What are some complications with UC?
Megacolon- fever, pain, bloody diarrhea
Perf from over dilation (<15 cm)
Anemia- Fe defieincy
Bone marrow supression
What cancer are you more at risk for with UC?
adenocarcinoma (10-20 fold increase after 10 years)
What usually has a worse prognosis- UC or Crohn's?
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
What should you rule out for IBD?
infectious etiologies of diarrhea, pain
assess extra-intesitnal manifestations of IBD
what are skin extra-intestinal manifesetations of IBD?
E. Nodosum (red nodules on lower legs)
Pyoderma Gangrenosum (inflamed, ulcerated skin)
What are hepatobiliary signs of IBD?
Primary Sclerosing Cholangitis
Musculoskeletal manifestations of IBD
Ocular manifestations of IBD
Misc extra-intestinal manifestations of IBD
Amyloidosis (amyloid deposited everywhere)
How do you manage mild UC?
5-ASA PO or per rectum
How do you manage moderate UC?
Sulfasala > Mesalamine
How do you manage severe UC?
How do you treat mild Crohn's?
How do you treat moderate Crohn's?
How do you treat severe Crohn's?
Infliximab/ Rituximab (lessens autoimmune, $$$)
Are any IBD cured?
No, they are controlled
Is there an identifiable pathology in IBS?
What is IBS frequently associated with?
History of sexual abuse of childhood molestation
what are some symptoms of IBS?
abdominal distention and pain
Aggravated by stress, travel, change in diet
What are some red flag symptoms of IBS that can indicate something more severe? (6 of them)
Nocturnal symptoms (Celiac dz)
onset after age 50
What criteria is used for IBS?
Rome I criteria & Manning criteria
How do you measure IBS?
Serial weight record
Basic lab and stool studies
Endoscopy with appropriate biopsies
should you start people with IBS on narcotics?
What should you do for someone with IBS?
history and physical
basic lab and GI workup
What meds can help someone with IBS?
increase dietary fiber
acid suppression (if also have reflex)
What is a non medication way to help someone with IBS?
counseling and antidepressants
what is the hallmark of depression?
What are bacteria that commonly cause intestinal infection
What does inflammatory diarrhea have?
White cells and red cells
What 2 types of diarrhea are watery?
What are viruses that commonly cause infections of the intestines?
What are parasites/ protozoa that can cause intestinal infections?
What are some food products that can cause infections of the intestines
What things in the immunosupression category of causing infections of the intestines.
Cryptosporidium, Isospora, Cyclospora
What is caused by the overgrowth of C. Diff?
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
(toxin elaborating) – colonize small bowel, enterotoxin causes hypersecretion of isotonic fluid-Vibrio chol
elaborating-destroy mucosal epithelial cells (C. dificile)
elaborating-one cause of food poisoning & vomiting (Staph A)
pathogens-inflammatory damage (Salmonella, Norwalk Virus., Entamoeba )
How do you treat GI disease?
fluid resuscitation/ simple carbs (BRAT)
What does BRAT stand for?
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
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
Do most people w/ divertic have symptoms?
what can perforation of the colon lead to?
Peritonitis (silent bowel sounds, rebound)
What can cause profuse passing of blood?
Diverticula or internal hemorrhoid
what labs should you get with diverticular dz?
Fecal studies (WBC, RBC, mucus)
pain films (flat, upright)
Barium enema (unprepped)
colonoscopy, GI capsule camera
How can you treat diverticular dz?
Bulk or fiber laxative (psyllium)
If someone has a bout of diverticulitis what should you do?
bowel rest (NPO or clear liquids or IV)
IV fluids w/ appropriate electrolytes