Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

411 > W13 lower GI > Flashcards

W13 lower GI Flashcards

(161 cards)

Start Studying
1
Q

what 3 things contribute to the etiology of IBD?

A

genetic predisposition
mucosal immune system
environmental triggers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the Rome IV criteria for IBS ?

A

recurrent abdominal pain at least 1 day/week in the last 3 months associatedwith 2 or more:
- related to defecation
- onset associated with a change in frequency of stool
- onset associated with a change in form (apperance of stool)
symptom onset at least 6 months prior to diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

red flags in history that point away from IBS

A

unintended weight loss
onset after 50
family history of: Colorectal cancer, IBD, celiac
joint pain, skin rashes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

red flags in physical that point away from IBS

A

malnourished, anemic
mass, obstruction
FOBT (fetal occult blood test) positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

red flags in investigations that point away from IBS

A

abnormal CBC
elevated CRP/ESR
altered biochemistry
abnormal thyroid testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

match the following symptoms with either ulcerative colitis or Crohn disease:
crampy lower abdominal pain: relieved by bowel movement
vs
constant RLQ pain not relived by BM

A

UC

CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

match the following symptoms with either ulcerative colitis or Crohn disease:

not bloody stool
vs
bloody stool

A

CD

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

match the following symptoms with either ulcerative colitis or Crohn disease:
mass in RLQ
vs.
no mass

A

CD

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

match the following symptoms with either ulcerative colitis or Crohn disease:
mucosal
vs. transmural

A

UC

CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

match the following symptoms with either ulcerative colitis or Crohn disease:
continous from rectum with no granulomas
vs
skip lesions with granulomas

A

UC

CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

which extraintestinal manifestations are more common in Crohn disease than UC?

A

arthritis
uveitis
aphthous stomatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most common phenotype of Crohn disease?

A

L1

in the terminal ileum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is fecal calprotectin?

A

cytosolic protein derived from dead neutrophils
stable for 7 days
correlates with active IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what treatment is used for patients with mild Crohn disease ?

A

topical:
budesonide
aminosalicylates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what treatment is used for patients with moderate Crohn disease?

A

infliximab
systemic corticosteroids
oral steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what treatmentis used for patients with severe Crohn disease?

A

surgery
infliximab
other biologics
anti-TNFs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the most common biologic used to treat Crohn disease?

A

anti-TNF:

infliximab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the characteristics that place a Crohn disease patient in the high risk for progression category?

A
  • young age at onset <18
  • non-inflammatory disease behaviour
  • extensive disease
  • early steroid need
  • extra intestinal manifestations
  • active smoker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the first line treatment in patients with Crohn disease with high risk for progression?

A

steroids: budesonide/corticosteroids
+
immune suppresant: AZA or MTX

smoking cessation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is often the first pharmacologic therapy used in CD?

A

5-aminosalicylic acid (5-ASA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the two 5-ASA compounds that are avaliable?

A

sulfasalazine

mesalamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are some of the short term side effects of corticosteroids?

A

night sweats
increased appetite
adrenal insufficiency
impaired glucose metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are some of the long term effects of corticosteroids?

A 
abnormal fat deposition 
excessive hair growth 
cataracts
glaucoma
osteoporosis 
hypertension 
aseptic bone necrosis of the hip
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are some key actions attributed to TNF?

A

macrophages: increase proinflammatory cytokines, increased chemokines –> increased inflammation
endothelium: increased adhesion molecules –> increased cell infiltration

fibroblasts: increased acute phase response –> increased CRP
increased metalloproteinase synthesis and decreased collagen production –> tissue remodeling

epithelium: increased ion transport and permeability –> compromised barrier function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
risks of anti-TNF-a
``` drug induced lupus injection site reactions non-Hodgkin lymphoma serious infections opportunistic infections demyelination (don't use with MS patients) ```
26
what is the goal of surgery in patients with Crohn disease?
relieve symptoms | reilieve complications
27
indications for surgery in patients with CD
``` failure of medical therapy cancer risk perforation haemorrhage stricture ```
28
risks for colorectal cancer in patients with UC
``` duration of colitis extent of colitis primary sclerosing cholangitis family history of CRC development of dysplasia endoscopic apperance severity of inflammation at surveillance colonoscopy ```
29
Where does lower GI bleed occur?
Colon or rectum
30
What is hematochezia?
Passage of red blood or maroon coloured stools
31
What is melena?
Dark tarry stools
32
Anatomic causes of lower GI bleeding?
Diverticulosis | Outlet bleeding
33
Vascular cause of lower GI bleeding?
Angiodysplasia
34
Inflammatory cause of lower GI bleeding
Colitis
35
C-HAND
``` Colitis: ischemic, inflammatory infectious Haemorrhoids Angiodysplasia Neoplastic Diverticulosis ```
36
What is the dentate line and what is its clinical significance?
Separates rectum and colon | Above this line haemorrhoids won’t hurt, but below this line they will
37
What is the most common cause of GI bleeding in patients under 50?
Hemorrhoid
38
How are haemorrhoids diagnosed?
History Digital rectal exam Endoscopy
39
Medications used to treat haemorrhoids/fissures
Hydrocortisone based ointments Suppositories Sitz baths Fissures: Topical nitroglycerin, nifedipine, or diltiazem ointments
40
What is diverticulosis?
Sac like protrusions of the colon wall
41
Where is diverticulosis most commonly found?
Sigmoid colon
42
What is the clinical presentation of diverticulosis?
Bleeding in large volumes Painless Majority of the time bleeding stops spontaneously
43
What is the clinical presentation of diverticulitis?
Pain Fever High WBC Not typically bleeding
44
What is the course of management in diverticulosis?
``` ABCs Colonoscopy Angiography Surgery: segmental resection - persistent, recurrent, unstable ```
45
What is the classic presentation of IBD?
Chronic diarrhea Rectal bleeding Weight loss Pain
46
What are the possible causes of ischemic colitis?
Non-occlusive colonic ischemia Embolic occlusion Mesenteric vein thrombosis
47
Clinical manifestations of ischemic colitis
Acute abdominal pain followed by diarrhea and mild rectal bleeding
48
Diagnosis of ischemic colitis
Labs: anemia, high serum lactate, high WBC CT scan Colonoscopy
49
Treatment of ischemic colitis
Most improve spontaneously Antibiotics in severe cases Treat underlying cardiovascular risk factors
50
Common causes of infectious colitis in developed countries
Shigella Campylobacter Salmonella Enterohemorrhagic E.coli From contaminated food and water
51
Clinical manifestations of infectious colitis
Acute onset diarrhea Nausea Vomiting Fever
52
Antibiotics that can be used to treat severe infectious colitis
Ciprofloxacin | Azithromycin
53
Where is angiodysplasia frequently located and what is it commonly associated with?
Cecum and right colon | End stage renal disease, aortic stenosis, old age
54
What type of bleeding is seen with angiodysplasia?
Occult
55
Treatment for angiodysplasia
Endoscopic with argon plasma coagulation therapy
56
Clinical presentation of colon cancer
Bright red blood and/or maroon stools/melena Occult iron deficiency Altered bowel movements Possible bowel obstruction
57
Management of colon cancer
Surgery
58
What is the 30-20-10 rule used to assess orthostatic hypotension
Decrease of 30 in HR Decrease of 20 in systolic BP Decrease of 10 in diastolic BP
59
How much blood loss is typically seen with supine hypotension
>40%
60
What are the high risk features of lower GI bleed?
``` Hemodynamic instability Known diverticulosis Profound anemia Significant comorbid illness Blood thinnners Altered mental status Advanced age Persistent bleeding New bleeding in hospitalized patient Elevated urea ```
61
Labs commonly ordered with lower GI bleed
``` CBC Electrolytes Creatinine BUN INR Liver enzymes ```
62
Imaging for assessing lower GI bleeding
CT angiogram Angiogram RBC scan
63
What patients could CT angiography negatively impact?
Patients with active kidney disease
64
What classifies as diarrhea on the Bristol stool chart?
6+7
65
What are the two main types of diarrhea that are due to there being more fluid secreted into the lumen than the gut can absorb ?
Secretory | Osmotic
66
Characteristics of secretory diarrhea
Watery Minimal fever Continues with fasting or diet changes
67
Characteristics of osmotic diarrhea?
Due to overingestion of osmotic agents
68
Characteristics of malabsorptive diarrhea
Foul smell/gas | And/or greasy stools
69
Characteristics of inflammatory diarrhea
Fever, bloody stool, WBCs in stool
70
Characteristics of acute diarrhea
<14 days Often underlying illness Might be inflammatory
71
Characteristics of chronic diarrhea
>14 days Often accompanied by weight loss Secretory or malabsorptive Often immune compromised
72
What is secretory infectious diarrhea?
Caused by bacteria: adhere to small intestinal epithelium without causing damage Secrete toxins —> fluid secretion Ex. Choleratoxin Trouble absorbing fluid
73
What is the appropriate management of watery diarrhea?
Volume repletion !! Antibiotics (with cholera will shorten duration) All infections are self limited
74
Pathology of malabsorptive diarrheal infections
Villus blunting Inflammation Damaged villi
75
What is inflammatory enterocolitis?
Bacteria that attach to and invade the small and/or large intestinal epithelia
76
Symptoms of inflammatory enterocolitis
Diarrhea with blood and/or pus Fever Cramps Prostration
77
What is dystentery ?
A disease characterized by severe diarrhea with passage of mucus and blood and usually caused by infection
78
What are some common causes of dysentery?
``` Non-typhoidal salmonella Campylobacter jejuni Shigella spp. Entamoeba histolytica C. Diff ```
79
How is dysentery transmitted?
Food/water Fomites Direct person to person
80
Characteristics of Shigella
Gram negative rod 4 subspecies Invades epithelial cells directly Causes bacillary dysentery
81
Characteristics of non-typhoidal salmonella
Gram negative rod One species (enterica) Frequent colonizer of poultry and meats Self limited
82
Characteristics of campylobacter jejuni
Gram negative gull wing rod Colonizer of poultry Almost never fatal
83
Characteristics of entamoeba histolytica
Very infectious —> protozoan epidemic in developing countries Fever, bloody diarrhea, tenesmus but can be non specific
84
How is dysentery diagnosed?
``` Blood in stool Fever (>38) Mucus/pus in stool Fecal WBCs Fecal calprotectin and lactoferin Do Stool Culture! ```
85
Differential diagnosis of dysentery
UC/CD Infectious proctitis Hemorrhagic colitis C. Diff colitis
86
Characteristics of infectious proctitis
Sexually transmitted Itching, discharge Generally treated like other STIs
87
Characteristics of hemorrhagic colitis
Caused by EHEC or STEC Afebrile, bloody diarrhea, severe abdominal pain Hemolytic-uraemic syndrome is severe complication Diarrhea self limited
88
Hemolytic-uraemc syndrome
``` Caused by systemic Stx2>Stx1 Triad of: Intravascular hemolysis Acute kidney injury Thrombocytopenia Neurological sequela may occur Permanent renal damage common ```
89
Treatment of hemorrhagic colitis
Avoid anti-peristaltic against Supportive care Monitoring for HUS
90
C. Diff characteristics
``` Gram+ Spore forming Anaerobe Colonized in farm animals, survives in meat Leading cause of nosocomial infection ```
91
Characteristics of C. Diff infections
After antibiotic exposure in hospital Produces 2 large toxins: TcdA, TcdB Mild diarrhea to fatal colitis with shock
92
Treatment of C. Diff infection
Vancomycin Mild: metronidazole Usually resolves in 4-7 Relapse common
93
Diagnostic tests for infectious diarrhea
``` Stool culture: routine bacterial pathogens Stool O&P: - microscopic exam with special stains - molecular testing available Don’t order on inpatients Stool for C diff ```
94
What pathogen should you suspect with undercooked poultry
Campy or salmonella
95
What pathogen should you expect with raw eggs
Salmonella
96
What pathogen should you expect with recent hospitalization
C. Diff
97
What pathogens are common in day care outbreaks, MSM and tropical travel?
Shigella | E. Histolytica
98
What pathogen should you suspect with oysters/sushi?
Vibrio
99
What pathogens should you suspect with drinking from lakes or streams?
Giardia | Cryptosporidium
100
When is stool testing most valuable
Outbreaks Immune compromised Bloody stools CDI suspected
101
Which pathogens need to be treated?
Shigella - little evidence for Campylobacter: immune compromised and severe cases SAlmonella: immune compromised, can help others but increase relapse E. Histolytica: beneficial but difficult
102
What are the most common sites of enteric infection
Small and large intestine
103
What are the 6 main steps in outbreak management?
1. Confirm the existence of an outbreak 2. Define and identify cases 3. Formulate hypothesis & implement initial control measures 4. Test hypothesis 5. Readjust hypothesis and control measures 6. Plan for long term prevention and control
104
Outbreak definition
Disease in excess of what would normally be expected in a defined community, geographical region, or season
105
Endemic definition
Constant presence of a disease within an area or population
106
Epidemic definition
Increased occurrence of disease in excess of normal expectation (longer and larger than outbreak)
107
Pandemic definition
Epidemic spread across a large region
108
What is active surveillance ?
Case finding through proactive investigation, employing data from health care providers and centres, health records, lab data, public surveys - detect cases that would otherwise be unreported
109
What is passive surveillance?
Cases identified through routine reporting
110
What is a vector ?
Animal carrying an infectious pathogen to a human host
111
What is a fomite?
An object that can become contaminated with and transmit an infectious pathogen
112
What is a reservoir?
Habitat where a pathogen lives and multiplies
113
What is the incubation period?
Period after exposure to a pathogen and before the first clinical manifestation
114
What is the latent period?
Period after exposure to a pathogen and before the onset of transmissibility to others
115
What is the period of communicability?
Period during which a pathogen can be transmitted from an infected individual to an uninflected individual
116
What is isolation?
Separation of an infected individual from others for the period of communicability
117
What is quarantine?
Separation of an exposed individual for the latent period or incubation period
118
Difference between a point source and a continuous source
Time limited vs ongoing
119
What does it mean if a disease is spread through propagation?
Person to person spread
120
Terms ~ equivalent to IBS
Mucous colitis Spastic colitis Nervous bowel Functional bowel disease
121
IBS definition from Rome IV criteria
Continuous or recurrent symptoms for more than 3 months of: 1. Abdominal pain 2. Disordered defecation 3. Bloating and distension
122
Gynaecological manifestations of IBS
Dysmenorrhea | Dyspareunia
123
Urologic manifestations of IBS
Dysuria
124
Musculoskeletal manifestations of IBS
Fibromyalgia
125
Psychological manifestations of IBS
Depression Anxiety Abuse
126
IBS pathophysiology
Motility disturbance Or Visceral hypersensitivity
127
Describe IBS diagnosis
``` Symptom assessment Physical exam Limited screen for organic disease Identify subgroup - constipation predominant - diarrhea predominant - pain, gas, bloating ```
128
Rome IV criteria for IBS diagnosis
Recurrent abdominal pain at least 1 day/week in the last 3 months with >=2 of the following: - defecation - change in stool frequency - change in form Symptom on set >6 month prior to diagnosis, symptoms for >3 months
129
What are some IBS alarm symptoms?
``` New onset >50 Weight loss GI bleeding Fever Nocturnal bowel movements ```
130
What are the diet guidelines for IBS?
``` Regular meals Taking time to eat Limit high fat foods Fluid intake, avoid fizz and caffeine Limit sugar free sweets and sorbitol Limit fruit to 3 portions per day ```
131
What are FODMAPs
``` Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols ```
132
IBS drug therapy options
``` Fibre Antidiarrheals Antispasmodic Motility regulators Peppermint oil Choleystyramine Antidepressants Probiotics ```
133
Drugs used to treat diarrhea in IBS
Absorbants | GI relaxants
134
Drugs used to treat constipation in IBS
``` Fibre supplements Osmotic laxatives Prokinetics GI stimulants Pro-secretory ```
135
Drugs used to treat pain/bloating in IBS
``` Anxiolytics Antispasmodic Anti-gas SSRIs TCAs ```
136
Muscle relaxants used in IBS
``` Benzodiazepines Librax Pinaverium Trimebutine Hyoscine ```
137
Antidiarrheal medications
Imodium | Choleystyramine
138
Antispasmodic medications
Buscopan | Peppermint oil
139
How does info about pain travel?
In the spinothalamic tract to reach the contra lateral cortex
140
What is the sympathetic innevation of the foregut
Greater and lesser splanchnic nerves | T5-T12
141
What is the sympathetic innervation of the midgut ?
Less splanchnic nerve t5-t12
142
What is the sympathetic innervation of the kidneys?
Least splanchnic nerve T12
143
What is the sympathetic innervation of the hindgut?
Splanchnic lumbar nerves | Sacral splanchnic nerves L1/2
144
Function of sympathetic innervation of the abdomen
Controls arterial blood flow through vasoconstriction Tonic inhibitory influence on mucosal secretion Inhibitory on smooth muscle
145
Where do pain fibres travel along to reach the spinal cord ?
Sympathetic fibres
146
Referred pain definition
Pain is perceived in regions innervated by nerves other than those that innervate the site of noxious stimulation
147
What is projected pain?
Stimulation of a sensory nerve along its path may induce pain that is projected to the tissue by the stimulated nerve
148
How is somatic pain characterized?
By the activation of peripheral nociceptors without actual damage to nerves
149
Inflammation of the gut causing pain of the dermatomes on the abdomen is an example of what referred pain?
Referred pain from visceral nerve to somatic area (dermatome)
150
What type of referred pain is it when irritation of the diaphragm causes shoulder pain?
Somatic nerve to somatic area (dermatome)
151
What causes visceral pain?
Stretching, distension, ischemia
152
Problems with what are felt as upper abdominal to epigastric pain?
Stomach, duodenum, hepatobiliary, pancreas
153
Problems with what are felt as mid abdominal or periumbilical pain?
Jejunum, ileum, appendix, proximal colon
154
Problems with what are felt as pain in the lower abdomen or hypo gastric area?
Colon, bladder, uterus, adnexa
155
How does pain in appendicitis change as it progresses?
Starts as visceral pain in mid abdomen, feels like gas —> | Migrates to RLQ and os appreciated as somatic pain (McBurney’s point)
156
What is Rovsing’s sign?
Pain in RLQ during left sided pressure suggests appendicitis
157
Physical exam signs of appendicitis ?
``` Direct tenderness of RLQ parietal peritoneum and somatic pain sensation Rebound tenderness Referred rebound tenderness Rovsing;s sign Psoas and obturator signs Cutaneous hyperesthesia Guarding Rigidity ```
158
What is sympathetic innervation of appendix and where does pain initial localize to ?
Lesser splanchnic nerve (T10/11) | Dermatome T10/11
159
What is Valentino’s syndrome?
Perforated ulcer masquerading clinically as appendicitis
160
What is Murphy’s sign?
As gallbladder becomes inflamed somatic pain is perceived in the RUQ with tenderness on deep inspiration
161
What is Kehr’s sign?
Left shoulder pain in splenic ruptures?

411 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions