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Lecture 6- GI Flashcards

1
Q

what two syndromes make up inflammatory bowel disease?

A

Crohn’s disease

Ulcerative colitis

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2
Q

What causes Crohn’s disease?

A

Genetic + Environmental factors

strong twin concordance

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3
Q

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

A

Northern European

Ashkenazi Jewish

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4
Q

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

A

bimodal

fTeens to 30’s and 50’s

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5
Q

What is SBFT?

A

Small Bowel Follow Through study

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6
Q

What does the SBFT show on Crohn’s?

A

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

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7
Q

Where does Crohn’s disease occur?

A

Anywhere in the GI tract (pharynx to anus)

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8
Q

How is inflammation of Crohn’s described?

A

transmural-cobblestoning

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9
Q

where is Crohn’s disease rarely found?

A

Esophagus
Stomach
Duodenum

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10
Q

List the three patterns of dz distribution of Crohn’s

A

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

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11
Q

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

A

Skips lesions (normal sections bordered by abnormal sections)

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12
Q

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

A

Malabsorption of VIt B 12

Iron deficiency or pernicious anemia

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13
Q

What cancers can commonly occur with Crohn’s dz?

A

colon cancer
Small bowel carcinoma
lymphoma

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14
Q

Where can you get fistulas with Crohn’s dz?

A

Enteric (between 2 loops of bowel)
Bladder
Skin
Vaginal

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15
Q

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

A

bleeding

not absorbing iron

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16
Q

Why can renal stones develop with Crohn’s dz?

A

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

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17
Q

People who _____ have less frequency of what?

A

Ulcerative colitis

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18
Q

Does ulcerative colitis skip sections or is it contiguous?

A

Contiguous

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19
Q

Is the rectum involved in UC?

A

Yes- always

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20
Q

What is the presentation with UC?

A 
Pain
Diarrhea
Urgency
Bleeding
Mucus analysis
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21
Q

If UC is severe what might be required?

A

Colectomy

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22
Q

Where does UC often start then go?

A

Rectum then creeps proximal

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23
Q

why is there mucus with UC?

A

Mucosa is inflamed

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24
Q

What are some complications with UC?

A

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

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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)

Old DOOS (21 decks)

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