Patho Exam 2 Lower GI

• Inflammatory cells
• Inflammatory chemical mediators

• Unknown cause b/c its autoimmune
• Familial tendency

• Diarrhea
• Fecal urgency
• Weight loss

• Remission/ exacerbation patterns (come and go)
• Systemic manifestations are mild to furminating (extreme)

• 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

An inflammation of the GI tract that extends through all layers of the intestinal wall (transmural- diff from Ulcerative colitis)

• Young adults and adolescents
• European origin or certain subcultures (some jews)

• Anywhere
• Most commonly is proximal colon aka "ileocecal region" where the large and small bowel meet

Stress

• Cobblestone!
• Sharply demarcated
• Inflamed granulation tissue
• Lesions surrounded by normal appearing tissue (skip pattern- red then damaged)
• Deep fissures
• Wall thickening

• Diarrhea
• RLQ abdominal pain
• Weight loss
• Malabsorption (results in hypoalbuminemia, steatorrhea- gray fat stool, anemia)
• Also- fever, weakness, F&E losses, bleeding

• Fibrosing strictures- hardening areas altering peristalsis
• Fistulas (bowel to bladder, vagina, out of body)
• Abscesses (perianal or peritoneal)
• Cancer (caused by dysplasia)

• Inflammatory disease of MUCOSA of rectum and colon
• Superficial
• Unlike Crohn's b/c mucosa not transmural

• Rectum or rectosigmoid
• Rare- subtotal or total colon)

• Active inflammation
• Ulceration- extensive
• Continuous injury (Crohn's was cobblestone)
• Epithelial cell changes cause cancer

• Diarrhea- severe, bloody, mucous threads
• Pain- lower abdominal (targeted end of colon)
• Exacerbation and remission pattern (not constant)

• Crohns: Granulomatous (lesions of inflammed granulated tissue)
• Colitis: Ulcerative/ exudative

• Crohns: All layers (transmural)
• Colitis: Mucosa

• Crohn: ileum/ proximal colon (or anywhere)
• Colitis: Limited to rectum and sigmoid colon

• Crohn: Rare
• Colitis: Common (rectal area is only location of colitis)

• Crohn: common (transmural through tissue)
• Colitis: rare (only affects mucosal layer)

• Crohn: Possible
• Colitis: Possible

• Crohn: Yes (in small intestines) (transmural)
• Colitis: No (only damages mucosa)

mesalamine (Rowasa)

• Mild to moderate IBD
• 1st line therapy

• Rectal for local effect (colitis or rare crohn)
• PO for small bowel (crohns)

• Chemical makeup does nothing when broken down (no systemic effects)
• Only works when it attaches to receptor sites (locally)

• 5-ASA (active* antiiflammatory ingredient)
• Sulfapyridine (effects unknown, responsible for adverse effects)

• Mesalamine (Rowasa) has less SE than other forms of 5-ASA
• GI- abdominal discomfort, gas, nausea
• Flu-like symptoms
• Hematologic disorders (rare)

• 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

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)

• infliximab (Remicade)
• -ab = antibody

• Monoclonal (designer- target specific things) antibody
• Binds with and inactivates TNF-alpha (proinflammatory) - Tumor necrosis factor

• Mod to severe Crohn dx or ulcerative colitis
• only used when conventional/ modern does not work

• IV
• Induction regimen (intermittent for 6 weeks)
• Maintenance infusions
• can significantly reduce exacerbation

• Infections
• Infusion reactions (fever, chills, urticaria, cardiopulmonary rxns)
• Increased risk for lymphoma
• (not 1st line therapy)

• azathioprine (Imuran)
• mercaptopuring (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
  PO

• Bone marrow suppression
• Pancreatitis

• Pt teaching- S&S of infection, anemia, bleeding
• Monitor CBC for bone marrow depression
• Monitor pancreatic enzymes

Condition in small pouches in lining of colon that bulge outward through weak spots

• Location: Sigmoid colon
• Incidence: 30% people over 60 yrs and 80% people over 80 yrs

• Dietary factors- not enough fiber
• Physical Activity- sedentary
• Bowel habits- constipation
• Effects of aging- weakness

• Asymptomatic
• Inflammation leads to perforation, rupture, and absesses leading to peritonitis (rare)

• Perforation
• Abcess formation

• Pain- severe lower abdominal
• Systemic fever and chills
• Duration: days then goes away

• Peritonitis- e. coli
• Hemorrhage- vessel bursts
• Bowel obstruction
• Fistula formation- bursts then attaches
  Treatment: broad spectrum antibiotic therapy

Inflammatory response of serous membrane that lines abdominal cavity and covers visceral organs

• Perforation!
• Break in the system causing death of bowel and bacteria escaping into the peritoneum
• Trauma- stab or gun shot wound

• It escapes from the bowel through fissure, rupture (diverticulitis), or trauma
• Historical: common cause of death in war

• Perforated peptic ulcer
• Ruptured appendix
• Perforated diverticulum
• Gangrenous (dead) bowel
• Pelvic inflammatory disease (PID)
• Gangrenous gallbladder (dead tissue)

• Translocation of ECF (extra cellular fluid) in peritoneal cavity
• N&V
• Pain
• Rigid "board-like" abdomen- from tense internal infection

• Fever
• elevated WBC
• tachycardia
• hypotension
• (starts to look shocky)

• Toxemia
• Shock- inflammation causes edema causing a large shift of fluids (ECF in peritoneum) leading to shock
• Death

• Adhesions (attaches elsewhere causes dec. peristalsis and discomfort)
• Sepsis
• Multiorgan failure (resulting from shock)