Week 6 - Lower GI Inflammatory Disorders Flashcards
(49 cards)
1
Q
list 3 inflammatory disorders of the lower GI system
A
- appendicitis
- peritonitis
- gastroenteritis
2
Q
what is appendicitis
A
- inflammation of the vermiform appendix
3
Q
what is the appendix
A
- narrow tube-like structure emerging from the cecum (beginning of the large intestine)
4
Q
what commonly causes appendicitis (2)
A
- obstruction of the appendix by fecalith or foreign material (bc it is a hollow tube)
- twisting of the appendix
5
Q
what is fecalith
A
- stone or hard piece of feces
6
Q
what does obstruction or twisting of the appendix & inflammation lead to? (5)
A
- 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
7
Q
how does inflammation effect the permeability of the appendix? what does this cause?
A
- increases the permeability = intestinal bacteria leaks into the peritoneal cavity
= localized peritonitis
8
Q
list the manifestations of appendicitis (6)
A
- pain
- NV
- fever
- leukocytosis
- general signs & symptoms of peritonitis
9
Q
what kind of pain is associated with appendicitis? what causes it?
A
- 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
10
Q
what is peritonitis
A
- inflammation of the peritoneal membranes
11
Q
what can cause peritonitis (2)
A
- chemical irritation
- bacterial infection
12
Q
peritonitis due to chemical irritation can cause _____, leading to…
A
- inflammation = increased permeability of the intestinal wall
- this leads to bacteria leaking into the peritoneal cavity & bacterial peritonitis
13
Q
how long could it take for chemical peritontits to become bacterial peritonitis
A
- can occur in a # of hours
14
Q
list common causes of peritonitis (7)
A
- perforated ulcer
- ruptured gallbladder
- pancreatitis
- ruptured spleen
- hemorrhage
- perforated appendix
- intestinal obstruction
15
Q
list manifestations of peritonitis (9)
A
- generalized abdominal pain
- NV (due to inflammation)
- rigid abdomen
- rebound tenderness
- septicemia
- hypovolemic shock with tachy
- paralytic ileus
- fever
- leukocytosis
16
Q
what is meant by rebound tenderness
A
- pain when let go from palpating
17
Q
what causes hypovolemic shock with peritonitis
A
- the inflammation causes formation of exudate
- inflammation = increased permeability of vessels = causes fluid shift from peritoneal and intestinal blood vessels = 3rd spacing
18
Q
how does paralytic ileus effect bowel sounds?
A
- causes absent bowel sounds
19
Q
what causes fever & leukocytosis during peritonitis
A
- sign of inflammation & infection (from the bacteria)
20
Q
what causes a rigid abdomen in peritonitis
A
- the pain leads to reflex contraction of abdominal muscle
21
Q
what causes paralytic ileus during peritonitis
A
- inflammation of the peritoneal membrane = impaired nerve transmission
- this causes decreased peristalsis
= paralytic ileus (obstruction)
22
Q
what are 2 types of inflammatory bowel disease
A
- crohn’s disease
- ulcerative colitis (UC)
23
Q
what type of diseases are crohn’s disease and UC?
A
- chronic inflammatory bowel disorders
- autoimmune in nature
24
Q
what % of pts have both crohn’s and UC
A
- 10%
25
where does crohn's effect?
- can effect anywhere along the GI tract
| - but most commonly effects the ileum
26
what is crohn's characterized by?
- ulcerative "skip lesions" that involve the entire thickness of the GI wall
- creation of nodules or a "cobblestone" appearance to the mucosa
27
what is meant by skip lesions
- distribution of affected segments alternating with normal segments of bowel
28
what contributes to the development of crohn's
- strong family history & genetic component
29
when does crohn's disease often develop
- childhood or adolescence
30
list manifestations of crohn's (6)
- right lower quad pain & distension
- diarrhea
- fistulas
- intestinal obstruction
- exacerbations & remissions
- weight loss
31
what causes intestinal obstruction in crohn's
- 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
32
what causes diarrhea in crohn's (2)
- damage to the mucosa prevent absorption
| - inflammation can increase motility
33
what is a fistula
- an abnormal connection between 2 hollow spaces
34
what causes fistulas in crohn's
- inflammation of the affected bowel can create ulcers may penetrate the GI wall to create an abcess or fistula between adjacent structures
35
what are the characteristics of exacerbations in crohn's
- diarrhea
- cramping
- melena
36
what can induce remissions of crohn's
- anti inflammatory drugs
37
list indications for surgical therapy of crohn's
- 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
38
where does ulcerative colitis effect?
- begins at the rectum and progresses proximally thru the large intestine
39
what layers of the GI tract does ulcerative colitis effect?
- mucosa & submucosa
40
describe the onset of ulcerative colitis
- adulthood
41
describe epidemiology of ulcerative colitis
- similar to crohn's
| - family history & genetic components involved
42
describe manifestations of ulcerative colitis (5)
- rectal bleeding
- blood loss
- diarrhea
- tenemus --> painful spasms of the rectal sphincter = LLQ pain
- colon obstruction & dilation
43
what causes rectal bleeding in ulceratitive colitis
- the submucosa contains blood vessels
| - ulceration is more continuous
44
what can rectal bleeding result in?
- blood loss anemia
45
what causes diarrhea in ulceratitive colitis
- tissue destruction interferes w absorption in the large
| = small volume diarrhea
46
what is diarrhea often accompanied by in UC
- tenesmus
47
what is tenesmus
- painful spasms of the rectal sphincter
48
what causes colon obstruction & dilation in ulcerative colitis
- inflammation impairs peristalsis = functional obstruction & filation
= toxic megacolon
49
outline the main differences between crohn's and ulcerative colitis
- 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
