Patho Exam 2 Lower GI

  1. IBD is bowel inflammation with manifestations resulting in...
    • Inflammatory cells
    • Inflammatory chemical mediators
  2. What is the cause of IBD and is it familial?
    • Unknown cause b/c its autoimmune
    • Familial tendency
  3. What are the S&S of IBD?
    • Diarrhea
    • Fecal urgency
    • Weight loss
  4. Are the S&S of IBD constant and how severe are they?
    • Remission/ exacerbation patterns (come and go)
    • Systemic manifestations are mild to furminating (extreme)
  5. What are the 3 proposed causative factors of IBD?
    • Immune (autoimmune w/ no trigger or defective immunoregulation
    • Genetics (it is a familial tendency)
    • Infectious origin (something got into you somehow)

    If there is a cause... its a 2ndary disease
  6. Define Crohn's Disease (1 type of IBD)
    An inflammation of the GI tract that extends through all layers of the intestinal wall (transmural- diff from Ulcerative colitis)
  7. What group develops Crohn's Disease?
    • Young adults and adolescents
    • European origin or certain subcultures (some jews)
  8. Where does Crohn's Disease occur in lower GI tract?
    • Anywhere
    • Most commonly is proximal colon aka "ileocecal region" where the large and small bowel meet
  9. What precipitates a Crohn's attack?
  10. What do Crohn's lesions look like?
    • Cobblestone!
    • Sharply demarcated
    • Inflamed granulation tissue
    • Lesions surrounded by normal appearing tissue (skip pattern- red then damaged)
    • Deep fissures
    • Wall thickening
  11. List clinical manifestations for Crohn's Disease
    • Diarrhea
    • RLQ abdominal pain
    • Weight loss
    • Malabsorption (results in hypoalbuminemia, steatorrhea- gray fat stool, anemia)
    • Also- fever, weakness, F&E losses, bleeding
  12. What are complications of Crohn Disease?
    • Fibrosing strictures- hardening areas altering peristalsis
    • Fistulas (bowel to bladder, vagina, out of body)
    • Abscesses (perianal or peritoneal)
    • Cancer (caused by dysplasia)
  13. Define Ulcerative Colitis
    • Inflammatory disease of MUCOSA of rectum and colon
    • Superficial
    • Unlike Crohn's b/c mucosa not transmural
  14. What is the location of Ulcerative colitis?
    • Rectum or rectosigmoid
    • Rare- subtotal or total colon)
  15. List the disease features of Ulcerative colitis
    • Active inflammation
    • Ulceration- extensive
    • Continuous injury (Crohn's was cobblestone)
    • Epithelial cell changes cause cancer
  16. List clinical manifestations of Ulcerative Colitis
    • Diarrhea- severe, bloody, mucous threads
    • Pain- lower abdominal (targeted end of colon)
    • Exacerbation and remission pattern (not constant)
  17. Compare LGI types of Inflammation
    • Crohns: Granulomatous (lesions of inflammed granulated tissue)
    • Colitis: Ulcerative/ exudative
  18. Compare LGI level of injury
    • Crohns: All layers (transmural)
    • Colitis: Mucosa
  19. Compare LGI Area of Involvement
    • Crohn: ileum/ proximal colon (or anywhere)
    • Colitis: Limited to rectum and sigmoid colon
  20. Compare LGI rectal bleeding
    • Crohn: Rare
    • Colitis: Common (rectal area is only location of colitis)
  21. Compare LGI fistulas/ strictures
    • Crohn: common (transmural through tissue)
    • Colitis: rare (only affects mucosal layer)
  22. Compare LGI Cancer Development
    • Crohn: Possible
    • Colitis: Possible
  23. Compare LGI Fat/ Vitamin malabsorption
    • Crohn: Yes (in small intestines) (transmural)
    • Colitis: No (only damages mucosa)
  24. State prototype drug for Antiinflammatory drug group 5-Aminosalicylates (5-ASA)
    mesalamine (Rowasa)
  25. List indications for use mesalamine (Rowasa) 5-ASA
    • Mild to moderate IBD
    • 1st line therapy
  26. List delivery forms of mesalamine (Rowasa) 5-ASA
    • Rectal for local effect (colitis or rare crohn)
    • PO for small bowel (crohns)
  27. What does 5-ASA "prodrug" mean?
    • Chemical makeup does nothing when broken down (no systemic effects)
    • Only works when it attaches to receptor sites (locally)
  28. What does 5-ASA (Rowasa) break down into?
    • 5-ASA (active* antiiflammatory ingredient)
    • Sulfapyridine (effects unknown, responsible for adverse effects)
  29. What are the SE of 5-ASA?
    • Mesalamine (Rowasa) has less SE than other forms of 5-ASA
    • GI- abdominal discomfort, gas, nausea
    • Flu-like symptoms
    • Hematologic disorders (rare)
  30. List Pt Teaching for 5-ASA mesalamine (Rowasa)
    • Drug is photosensitive- keep in foil container until use, will stain surfaces and material
    • **Report symptoms of Acute Intolerance Syndrome- cramping, acute abdominal pain, bloody diarrhea (same as disease but more severe), May be accompanied with fever, rash, & H/A
    • Delayed therapeutic effect- 3 to 21 days!
    • Monitor CBC
  31. What is the prototype drug for Glucocorticoids?
  32. List the uses and delivery of Glucocorticoid Budesonide
    • Symptom relief
    • Induction of remission
    • Short term relief (never long term- think steroid adverse effects "olive" look)
    • Give PO or IV (broken down by liver- generally local)
  33. State the prototype drug for Immunomodulator therapy
    • infliximab (Remicade)
    • -ab = antibody
  34. What is the MOA of infliximab (Remicade)?
    • Monoclonal (designer- target specific things) antibody
    • Binds with and inactivates TNF-alpha (proinflammatory) - Tumor necrosis factor
  35. What is the indication for use of infliximab (Remicade)?
    • Mod to severe Crohn dx or ulcerative colitis
    • only used when conventional/ modern does not work
  36. What is the mode of delivery of infliximab (Remicade)?
    • IV
    • Induction regimen (intermittent for 6 weeks)
    • Maintenance infusions
    • can significantly reduce exacerbation
  37. List SE of infliximab (Remicade)
    • Infections
    • Infusion reactions (fever, chills, urticaria, cardiopulmonary rxns)
    • Increased risk for lymphoma
    • (not 1st line therapy)
  38. List prototype immunosuppresant agents
    • azathioprine (Imuran)
    • mercaptopuring (Purinethol)
  39. State indications for use and delivery of Imuran and Purinethol
    • Induce/ maintain remission (not acute, takes 6 months)
    • Second-line adjunct therapy (take with mainstream drug)- (toxic, kept as backup)
    • not approved for IBD but commonly used
  40. List SE of immunosuppressants Imuran and Purinethol
    • Bone marrow suppression
    • Pancreatitis
  41. List Nsg implications for immunosuppressants (Imuran and Purinethol)
    • Pt teaching- S&S of infection, anemia, bleeding
    • Monitor CBC for bone marrow depression
    • Monitor pancreatic enzymes
  42. Define Diverticulosis
    Condition in small pouches in lining of colon that bulge outward through weak spots
  43. State location and incidence of Diverticulosis
    • Location: Sigmoid colon
    • Incidence: 30% people over 60 yrs and 80% people over 80 yrs
  44. List contributing factors of Diverticulosis
    • Dietary factors- not enough fiber
    • Physical Activity- sedentary
    • Bowel habits- constipation
    • Effects of aging- weakness
  45. State manifestations and complications of Diverticulosis
    • Asymptomatic
    • Inflammation leads to perforation, rupture, and absesses leading to peritonitis (rare)
  46. What causes Diverticulitis manifestations?
    • Perforation
    • Abcess formation
  47. List common complaints and duration of Diverticulitis manifestations
    • Pain- severe lower abdominal
    • Systemic fever and chills
    • Duration: days then goes away
  48. State complications and tx of Diverticulitis
    • Peritonitis- e. coli
    • Hemorrhage- vessel bursts
    • Bowel obstruction
    • Fistula formation- bursts then attaches
      : broad spectrum antibiotic therapy
  49. Define Peritonitis
    Inflammatory response of serous membrane that lines abdominal cavity and covers visceral organs
  50. What is the common cause of Peritonitis?
    • Perforation!
    • Break in the system causing death of bowel and bacteria escaping into the peritoneum
    • Trauma- stab or gun shot wound
  51. How does bacteria access peritoneal cavity causing peritonitis?
    • It escapes from the bowel through fissure, rupture (diverticulitis), or trauma
    • Historical: common cause of death in war
  52. What are common conditions that cause Peritonitis?
    • Perforated peptic ulcer
    • Ruptured appendix
    • Perforated diverticulum
    • Gangrenous (dead) bowel
    • Pelvic inflammatory disease (PID)
    • Gangrenous gallbladder (dead tissue)
  53. What are the local manifestations of Peritonitis?
    • Translocation of ECF (extra cellular fluid) in peritoneal cavity
    • N&V
    • Pain
    • Rigid "board-like" abdomen- from tense internal infection
  54. What are the systemic manifestations of Peritonitis?
    • Fever
    • elevated WBC
    • tachycardia
    • hypotension
    • (starts to look shocky)
  55. What are the late manifestations of Peritonitis?
    • Toxemia
    • Shock- inflammation causes edema causing a large shift of fluids (ECF in peritoneum) leading to shock
    • Death
  56. What are the complications of Peritonitis?
    • Adhesions (attaches elsewhere causes dec. peristalsis and discomfort)
    • Sepsis
    • Multiorgan failure (resulting from shock)
Card Set
Patho Exam 2 Lower GI
IBD: Crohn's Disease and Ulcerative colitis. Other lower GI problems