Week 6 - Lower GI Inflammatory Disorders

Question 1

list 3 inflammatory disorders of the lower GI system

Answer 1

• appendicitis
• peritonitis
• gastroenteritis

Question 2

what is appendicitis

Answer 2

• inflammation of the vermiform appendix

Question 3

what is the appendix

Answer 3

• narrow tube-like structure emerging from the cecum (beginning of the large intestine)

Question 4

what commonly causes appendicitis (2)

Answer 4

• obstruction of the appendix by fecalith or foreign material (bc it is a hollow tube)
• twisting of the appendix

Question 5

what is fecalith

Answer 5

• stone or hard piece of feces

Question 6

what does obstruction or twisting of the appendix & inflammation lead to? (5)

Answer 6

• now the mucus being released from the intestinal lumen is trapped
• trapped bacteria
• increased pressure –> compresses the blood vessels –> ischemia –> necrosis
• increased pressure may also cause the appendix to perforate or rupture = generalized peritonitis
• compresses nerves = pain

Question 7

how does inflammation effect the permeability of the appendix? what does this cause?

Answer 7

• increases the permeability = intestinal bacteria leaks into the peritoneal cavity
  = localized peritonitis

Question 8

list the manifestations of appendicitis (6)

Answer 8

• pain
• NV
• fever
• leukocytosis
• general signs & symptoms of peritonitis

Question 9

what kind of pain is associated with appendicitis? what causes it?

Answer 9

• starts periumbilical
• followed by localized lower right quadrant pain as the appendix becomes permeable and localized peritonitis occurs
• if the appendix ruptures, get generalized peritonitis = whole abdomen tender

Question 10

what is peritonitis

Answer 10

• inflammation of the peritoneal membranes

Question 11

what can cause peritonitis (2)

Answer 11

• chemical irritation

- bacterial infection

Question 12

peritonitis due to chemical irritation can cause _____, leading to…

Answer 12

• inflammation = increased permeability of the intestinal wall
• this leads to bacteria leaking into the peritoneal cavity & bacterial peritonitis

Question 13

how long could it take for chemical peritontits to become bacterial peritonitis

Answer 13

• can occur in a # of hours

Question 14

list common causes of peritonitis (7)

Answer 14

• perforated ulcer
• ruptured gallbladder
• pancreatitis
• ruptured spleen
• hemorrhage
• perforated appendix
• intestinal obstruction

Question 15

list manifestations of peritonitis (9)

Answer 15

• generalized abdominal pain
• NV (due to inflammation)
• rigid abdomen
• rebound tenderness
• septicemia
• hypovolemic shock with tachy
• paralytic ileus
• fever
• leukocytosis

Question 16

what is meant by rebound tenderness

Answer 16

• pain when let go from palpating

Question 17

what causes hypovolemic shock with peritonitis

Answer 17

• the inflammation causes formation of exudate
• inflammation = increased permeability of vessels = causes fluid shift from peritoneal and intestinal blood vessels = 3rd spacing

Question 18

how does paralytic ileus effect bowel sounds?

Answer 18

• causes absent bowel sounds

Question 19

what causes fever & leukocytosis during peritonitis

Answer 19

• sign of inflammation & infection (from the bacteria)

Question 20

what causes a rigid abdomen in peritonitis

Answer 20

• the pain leads to reflex contraction of abdominal muscle

Question 21

what causes paralytic ileus during peritonitis

Answer 21

• inflammation of the peritoneal membrane = impaired nerve transmission
• this causes decreased peristalsis
  = paralytic ileus (obstruction)

Question 22

what are 2 types of inflammatory bowel disease

Answer 22

• crohn’s disease

- ulcerative colitis (UC)

Question 23

what type of diseases are crohn’s disease and UC?

Answer 23

• chronic inflammatory bowel disorders

- autoimmune in nature

Question 24

what % of pts have both crohn’s and UC

Answer 24

• 10%

Question 25

where does crohn's effect?

Answer 25

- can effect anywhere along the GI tract | - but most commonly effects the ileum

Question 26

what is crohn's characterized by?

Answer 26

- ulcerative "skip lesions" that involve the entire thickness of the GI wall - creation of nodules or a "cobblestone" appearance to the mucosa

Question 27

what is meant by skip lesions

Answer 27

- distribution of affected segments alternating with normal segments of bowel

Question 28

what contributes to the development of crohn's

Answer 28

- strong family history & genetic component

Question 29

when does crohn's disease often develop

Answer 29

- childhood or adolescence

Question 30

list manifestations of crohn's (6)

Answer 30

- right lower quad pain & distension - diarrhea - fistulas - intestinal obstruction - exacerbations & remissions - weight loss

Question 31

what causes intestinal obstruction in crohn's

Answer 31

- the inflammation leads to fibrosis which affects all layers of the GI tract - this leads to a thick, rigid wall (stricture) which predisposes to obstruction

Question 32

what causes diarrhea in crohn's (2)

Answer 32

- damage to the mucosa prevent absorption | - inflammation can increase motility

Question 33

what is a fistula

Answer 33

- an abnormal connection between 2 hollow spaces

Question 34

what causes fistulas in crohn's

Answer 34

- inflammation of the affected bowel can create ulcers may penetrate the GI wall to create an abcess or fistula between adjacent structures

Question 35

what are the characteristics of exacerbations in crohn's

Answer 35

- diarrhea - cramping - melena

Question 36

what can induce remissions of crohn's

Answer 36

- anti inflammatory drugs

Question 37

list indications for surgical therapy of crohn's

Answer 37

- drainage of abdominal abscess - failure to respond to conservative therapy (such as corticosteroids) - fistulas - inability to decrease corticosteroids - intestinal osbtruction - massive hemorrhage - perforation - secondary hydronephrosis - severe anorectal disease - suspicion of carcinoma

Question 38

where does ulcerative colitis effect?

Answer 38

- begins at the rectum and progresses proximally thru the large intestine

Question 39

what layers of the GI tract does ulcerative colitis effect?

Answer 39

- mucosa & submucosa

Question 40

describe the onset of ulcerative colitis

Answer 40

- adulthood

Question 41

describe epidemiology of ulcerative colitis

Answer 41

- similar to crohn's | - family history & genetic components involved

Question 42

describe manifestations of ulcerative colitis (5)

Answer 42

- rectal bleeding - blood loss - diarrhea - tenemus --> painful spasms of the rectal sphincter = LLQ pain - colon obstruction & dilation

Question 43

what causes rectal bleeding in ulceratitive colitis

Answer 43

- the submucosa contains blood vessels | - ulceration is more continuous

Question 44

what can rectal bleeding result in?

Answer 44

- blood loss anemia

Question 45

what causes diarrhea in ulceratitive colitis

Answer 45

- tissue destruction interferes w absorption in the large | = small volume diarrhea

Question 46

what is diarrhea often accompanied by in UC

Answer 46

- tenesmus

Question 47

what is tenesmus

Answer 47

- painful spasms of the rectal sphincter

Question 48

what causes colon obstruction & dilation in ulcerative colitis

Answer 48

- inflammation impairs peristalsis = functional obstruction & filation = toxic megacolon

Question 49

outline the main differences between crohn's and ulcerative colitis

Answer 49

- crohn's = skip lesions & UC = starts in rectum and is continuous - crohn's = all 4 layers & UC = only mucosa & submucosa - crohn's first systemic effect = weight loss & UC = anemia - differences in S&S