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Differential for diahrrhea
Infectious; malabsorption; inflamatory bowel disease; ischemic colitis; IBS (functional diarrhea).
defnition of acute and chronic diahrrea
acute = 14 days; chronic decrease in consistancy and increase in frequency for greater than 4 wks
blood and mucus in stool suggests; vs oily foul smelling stools
Infections/inflamatory vs fat malabsorption/maldigestion
Compare contast ulcerative colitis and Crohn disease interms of path; GI distribution; physical findings.
CROHN: transmucosal; any where in GI and skips; blood diahrrea not so common; fissures fistulas; stricutres seen (outside of anus). ------------UC: mucosa and submcosa confined; large bowl; continuous; bloody mucus filled diarrhea. All crampy abd pain and diarrhea.
Rome III criteria for irritable bowel syndrome; functional diarrhea.
abd discomfort 3 days per month for three months. AND relief upon defecation; pain associated with change in stool apperance; or pain associated with frequency of stool
Typical presentation of ischemic colitis
elderly with cardiovascular disease presents with unilateral abdominal pain followed by bloody stools.
Important history in diabetic diarrhea
Etiologic agents of Iflamatory Bowel disease
Genetic predisposition leading to dysregulation (agressive) immune response in GI
Effect of smoking on ulcerative colitis and Crohn's
Protective in UC and more severe in Crohn's
Ulcerative colitis pathogenesis. Where does it start?
Chronic inflamation of mucosal surface starting with proctitis (rectum) and extens continuously through the colon.
Clinical symptoms of ulcerative colitis
diarrhea; abd pain; urgency to defecate; rectal bleeding; passage of mucus per rectum.
megacolon; perforation; anemia; colonic adenocarcinoma
Crohn's disease; what does it look like?
Transmural inflamation. Walls can be thickened; fibrotic; or strictured. Cobble stoning with linear ulcrations.
Major sites of Crohn's disease
Ileocecal (lower quadrant pain; fever; weight loss). Small intestine (fistulas). Colon (perianal involvment fissures fistulas abscesses).
Major complications of Crohn's disease.
Stenosis of tract (obstruction). Extensive Ileal mucosal disease (can't absorb B12-megaloblastic anema) and malabsorption of bile salts. Fistulas; calcium oxalate stones (cholesterol malabsorption displaces oxalate from Ca; oxalate is absorbed causing stone formation); colon cancer.
Dx: Labs elevated in ulcerative colitis and/or crohn's disease.
Perinuclear antineutrophil cytoplastmic antibod (p-ANCA) elevated in UC. Anti saccharomyces cerevisiae (ASCA) in Crohn's disease.
Dx: colonoscopy differences between Ulcerative colitis and Crohn's disease.
UC: erythemaatous friable and superficial ulceration. Crohn's: aphthoid-deep ulcers and cobblestoning.
Dx: radiologic differences between UC and Crohn's
UC: tubular from loss of haustra. Crohn's: strings sign; masses fistulas abscesses
Dx: histological differences between UC and Crohn's
UC mucosa only; crohn transmural
Extraintestinal manifestation of IBD: skin; hepatobiliary; muscoskeletal; ocular; misc
Pyoderma gangenosum; erythemanodosom. Primary sclerosing cholangitis; cholethiasis; hepatitis. SN arthritis; ankylosing spondylitis; sacroilitis. uveitis; episceritis. hypercoagulable state; autoimmune hemolytic anemia; amyloidosis.
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