Podcast
Questions and Answers
What is a common treatment for ulcerative colitis during an acute flare-up?
What is a common treatment for ulcerative colitis during an acute flare-up?
Which of the following is NOT a characteristic of Crohn's Disease?
Which of the following is NOT a characteristic of Crohn's Disease?
What is a hallmark symptom of ulcerative colitis?
What is a hallmark symptom of ulcerative colitis?
What procedure involves the transfer of fecal material from a healthy person to treat resistant colonization?
What procedure involves the transfer of fecal material from a healthy person to treat resistant colonization?
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What is a potential risk associated with long-term ulcerative colitis?
What is a potential risk associated with long-term ulcerative colitis?
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Which medication is typically NOT used for severe cases of Crohn's Disease?
Which medication is typically NOT used for severe cases of Crohn's Disease?
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What type of surgical intervention may be required for patients with extensive Crohn's Disease?
What type of surgical intervention may be required for patients with extensive Crohn's Disease?
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What is the primary goal of dietary modifications for individuals with inflammatory bowel disease?
What is the primary goal of dietary modifications for individuals with inflammatory bowel disease?
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What is the primary cause of toxic megacolon?
What is the primary cause of toxic megacolon?
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What condition is characterized by alternating diarrhea and constipation with abdominal cramping pain?
What condition is characterized by alternating diarrhea and constipation with abdominal cramping pain?
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What surgical complication is indicated by a silent abdomen after bowel surgery?
What surgical complication is indicated by a silent abdomen after bowel surgery?
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What is the main concern with untreated toxic megacolon?
What is the main concern with untreated toxic megacolon?
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Which of the following is a common symptom of diverticulitis?
Which of the following is a common symptom of diverticulitis?
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Which treatment is considered palliative for Irritable Bowel Syndrome (IBS)?
Which treatment is considered palliative for Irritable Bowel Syndrome (IBS)?
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What differentiates diverticulosis from diverticulitis?
What differentiates diverticulosis from diverticulitis?
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Which alternative therapy may help relieve symptoms of Irritable Bowel Syndrome?
Which alternative therapy may help relieve symptoms of Irritable Bowel Syndrome?
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Which of the following is a clinical manifestation of lower gastrointestinal dysfunction?
Which of the following is a clinical manifestation of lower gastrointestinal dysfunction?
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What is the definition of constipation in relation to bowel movements?
What is the definition of constipation in relation to bowel movements?
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Which of the following treatment options is non-surgical for lower GI dysfunction?
Which of the following treatment options is non-surgical for lower GI dysfunction?
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What is the role of adsorbents in treating diarrhea?
What is the role of adsorbents in treating diarrhea?
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Which type of medication decreases intestinal muscle tone and peristalsis in the GI tract?
Which type of medication decreases intestinal muscle tone and peristalsis in the GI tract?
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What is a common dietary factor that can contribute to constipation?
What is a common dietary factor that can contribute to constipation?
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What is the purpose of probiotics in the management of lower GI issues?
What is the purpose of probiotics in the management of lower GI issues?
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Which of the following is a potential side effect that should be monitored when using antidiarrheal medications?
Which of the following is a potential side effect that should be monitored when using antidiarrheal medications?
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What is the primary function of the gallbladder?
What is the primary function of the gallbladder?
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Which vitamin is NOT stored by the liver?
Which vitamin is NOT stored by the liver?
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What is a common cause of acute pancreatitis?
What is a common cause of acute pancreatitis?
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Which enzyme does the pancreas release for carbohydrate digestion?
Which enzyme does the pancreas release for carbohydrate digestion?
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What is a symptom of cholangitis?
What is a symptom of cholangitis?
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Which treatment is the gold standard for biliary decompression in acute cholangitis?
Which treatment is the gold standard for biliary decompression in acute cholangitis?
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What is a notable consequence of chronic pancreatitis?
What is a notable consequence of chronic pancreatitis?
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Which hormone is released by the pancreas to stimulate glycogenesis?
Which hormone is released by the pancreas to stimulate glycogenesis?
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Which complication is NOT associated with Crohn's disease?
Which complication is NOT associated with Crohn's disease?
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What is the primary risk factor for developing colon cancer?
What is the primary risk factor for developing colon cancer?
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What type of intestinal polyp has a narrow stalk?
What type of intestinal polyp has a narrow stalk?
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Celiac disease primarily leads to an impairment in nutrient absorption due to inflammation of what?
Celiac disease primarily leads to an impairment in nutrient absorption due to inflammation of what?
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What is the recommended colon cancer screening method for individuals over 50?
What is the recommended colon cancer screening method for individuals over 50?
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Which of the following is a clinical manifestation of celiac disease?
Which of the following is a clinical manifestation of celiac disease?
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Which treatment is recommended for managing short-gut syndrome?
Which treatment is recommended for managing short-gut syndrome?
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What type of polyp is typically associated with a higher risk of malignancy?
What type of polyp is typically associated with a higher risk of malignancy?
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What is a common treatment strategy for intestinal polyps?
What is a common treatment strategy for intestinal polyps?
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What complication can arise from short-gut syndrome?
What complication can arise from short-gut syndrome?
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Study Notes
Toxic Megacolon
- Massive dilation of the colon
- Cause: prolonged constipation
- Complication of Inflammatory Bowel Disease, intestinal obstruction, or bowel infection (e.g. C. difficile)
- Pseudomembranous colitis may result in acute megacolon: surgical emergency.
- Huge dilated loops of the large bowel are visible on plain abdominal x-ray (KUB)
- May resolve within the first 24 hours with decompression, but many patients will require a colectomy
- Fatal if untreated
Irritable Bowel Syndrome (IBS)
- Alternating diarrhea and constipation accompanied by abdominal cramping pain with no identifiable pathologic process in the GI tract
- Also called spastic colitis or irritable colon syndrome
- Idiopathic
- Normal peristalsis wave is interrupted by irregular spasms
- Clinical presentation: Diarrhea, constipation, or alternating pattern of both; Abdominal cramping pain; Mucus in stool
Diverticular Disease
- Presence of diverticula in the colon
- Micro-herniations in mucosa
- Genetic predisposition
Diverticulosis vs Diverticulitis
- Diverticulosis: Asymptomatic, chronic condition
- Diverticulitis: Acute inflammation, causes diarrhea, constipation, distention, fever, acute lower abdominal pain, elevated WBCs (leukocytosis)
- Diverticulitis complications: Abscess formation or perforation (serious complication!!)
Ulcerative Colitis
- Chronic inflammatory disease of the mucosa & submucosa of the rectum and colon
- The most common form of inflammatory bowel disease worldwide
- Idiopathic, yet noted hereditary pattern
- Large ulcers form in the mucosal layer of the colon and rectum
- Begins as inflammation at the base of the crypts of Lieberkühn → damage results → abscess formation in crypts → abscesses begin to coalesce → large ulcerations develop in epithelium
- Hallmark clinical manifestations are bloody diarrhea and lower abdominal pain
- Have exacerbations and remissions
- Associated with increased cancer risk after 7 to 10 years of disease
Crohn’s Disease
- Chronic inflammation of all layers of intestinal wall resulting from blockage and inflammation of lymphatic vessels
- Affects proximal portion of the colon or terminal ileum
- Suggestive findings are ulcerations, strictures, fibrosis, and fistulas
- Clinical manifestations: Intermittent bouts of fever and diarrhea; May include hematochezia but, not as severe as ulcerative colitis; Constant, chronic RLQ pain; May have RLQ mass, tenderness
Intestinal Polyps
- Any tissue protrusion into the GI lumen
- Sessile polyp: raised protuberance with a broad base
- Pedunculated polyp: attached to bowel wall by a stalk that is narrower than the body of the polyp
- Benign or malignant
- Major precursor lesion in development of colon cancer
- Clinical manifestations: Usually none, May cause occult or gross bleeding, Abdominal pain
- Treatment: Varies according to size, type, and location, Usually removed through scope
Colon Cancer
- Second only to lung cancer as a cause of cancer deaths
- Risk factors: Increased after age 40, High-fat, low-fiber diet, Polyps, Chronic irritation or inflammation, Hereditary patterns
- Guidelines for colon cancer screening via colonoscopy: Every 10 years starting at age 50y for average risk individual; May need to be more frequent in higher risk individuals
- Important hereditary condition: Familial adenomatous polyposis (FAP)
- At least three close relatives with colorectal cancer, colorectal cancer involving at least two generations, and one or more cases of colorectal cancer occurring before age 50 years
Celiac Disease
- Inherited autoimmune disorder associated with consumption of gluten
- Protein found in wheat, rye, and barley
- Ingestion of gluten triggers inflammation and atrophy of the villi in the small intestine
- Reduced mucosal surface area
- Decreased brush border enzymes
- Leads to Impaired nutrient absorption
- Increased risk for intestinal malignancy
- Clinical manifestations: Diarrhea, Abdominal pain, Constipation, Bloating, Conditions associated with deficiencies (anemias, delayed clotting, Rickets)
Short-Gut Syndrome
- Complication related to surgical removal of large portions of the small intestine
- Rapid transit time and reduced surface area for absorption (if ileocecal valve removed)
- Reduced ability to absorb nutrients
- Clinical manifestations: Diarrhea and malabsorption
- Treatment: Gradual increase in oral intake; Temporary or indefinite intravenous nutritional support
Liver
- Largest gland of the body
- Very vascular organ: Portal vein & hepatic artery
- Functions:
- Glucose metabolism
- Ammonia conversion
- Protein metabolism
- Fat metabolism
- Vitamin and iron storage (D, K, B12)
- Bile formation
- Bilirubin excretion
- Drug metabolism
Gallbladder
- Storage container for bile produced by hepatocytes
- Communicates with duodenum via common bile duct & sphincter of Oddi
- Bile: Emulsifies fat → Promotes intestinal absorption of fatty acids, cholesterol, lipids
- Cholangitis: Inflammation of the bile duct system; Often d/t gallstone obstruction; Can lead to infection; S/S include: fever, RUQ pain, jaundice, AMS, SIRS; Tx includes: hydration, Abx; ERCP: gold standard for biliary decompression if needed
Pancreas
- Exocrine Function: Digestive enzymes enter duodenum via biliary tract (Amylase, Trypsin, Lipase, Secretin)
- Endocrine Function: Hormones released into blood stream (Insulin: promotes CHO metabolism; Glucagon: stimulates hepatic glycogenesis)
Pancreatitis
- Types: Acute (pancreatic duct becomes obstructed, enzymes back up causing autodigestion and inflammation of the pancreas); Chronic (progressive inflammatory disorder with destruction of the pancreas, cells are replaced by fibrous tissue, pressure within the pancreas increases, obstructing the pancreatic and common bile ducts)
- Common Causes: ETOH use, Biliary tract obstruction, Neoplasms, Trauma, Medications
- Clinical Findings: Pain, N/V, Abd distention, Decreased BS, Abnormal VS (Fever, tachycardia), Abnormal Labs (Elevated amylase & lipase, Elevated WBCs)
Lower GI Dysfunction: Clinical Manifestations
- Abdominal discomfort: Pain, Pressure, Cramping, Distention
- Diarrhea
- Constipation
- Melena
- Hematochezia
Constipation
- Abnormally infrequent (<3x/day)
- May be Acute or Chronic
- Loose or liquid stool
- Treatment options: Nonsurgical (Dietary, Behavioral, Pharmacologic); Surgical (Bowel resection)
Antidiarrheals
- Adsorbents: Coat the walls of the GI tract, Binds to the causative bacteria or toxin, which is then eliminated through the stool (Ex: bismuth subsalicylate (Pepto-Bismol), activated charcoal)
- Anticholinergics: Decrease intestinal muscle tone and peristalsis of GI tract, Slows movement of fecal matter through the GI tract (Ex: belladonna alkaloids)
- Opiates: Decrease motility and reduce pain by relief of rectal spasms, Allow more time for water and electrolytes to be absorbed (Ex: paregoric, opium tincture, codeine, over-the-counter (OTC) loperamide, diphenoxylate)
- Probiotics: Supply missing bacteria to the GI tract and suppress growth of diarrhea-causing bacteria (Ex: Lactobacillus acidophilus (Bacid))
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Description
This quiz covers key gastrointestinal disorders including Toxic Megacolon, Irritable Bowel Syndrome (IBS), and Diverticular Disease. It highlights causes, symptoms, complications, and treatment options related to these conditions. Test your understanding of these critical health issues.
