Term
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Definition
| - rapid (within 1 to a couple days) total or segmental nonobstructive colonic dilation with systemic toxicity |
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Term
| causes of toxic megacolon: |
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Definition
- IBD (more commonly Ulcerative Colitis, but Crohn's can also cause it)
- Pseudomembranous colitis Pfrom C. diff
- Ischemic colitis
- Volvulus
- Diverticulitis
- Obstructive colon cancer |
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Term
| Precipitating factors (drugs) that may lead to toxic megacolon: |
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Definition
- Opiates
- Anti-motiliy agents (Loperamide)
- Anticholinergics
- Antidepressants |
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Term
| MC symptom of toxic megacolon: |
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Definition
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Term
| symptoms of toxic megacolon: |
|
Definition
- severe bloody diarrhea
- malaise
- abdominal pain
- distention |
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Term
| PE findings of toxic megacolon: |
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Definition
- fever
- tachycardia
- hypotention
- abdominal tenderness/distention
- peritoneal signs +/- |
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Term
| Criteria for dx of Toxic Megacolon: |
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Definition
- Must have radiographic evidence of colonic distention
- 3 of the following (FHAN): Fever greater than 38C, Heart rate > 120 bmp, Anemia, Neutrophillic leukocytosis > 10,500 microL
- PLUS one of the following (HADE): hypotension, altered sensorium, dehydration, electrolyte disturbance |
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Term
| Common lab findings of toxic megacolon: |
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Definition
- Anemia
- Leukocytosis
- Electrolyte abnormalities
- Hypoalbuminemia
- Increased ESR/CRP
- Plain film: dilation nof > 6 cm, usually in transverese or right colon |
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Term
| Test to assess extent of ulcerative colitis: |
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Definition
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Term
| Test to evaluate for perfoartion and rule out other possible causes of obstruction with toxic megacolon: |
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Definition
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Term
| Toxic megacolon management: |
|
Definition
- Admit to ICU
- Check CBC, CMP, and abdominal xray every 12 hours until improvement, and then every 24 hours
- Bowel rest with NG tube- start enteral nutrtion once stabilized
- Discontinue all antimotility agents
- Broad spectrum antibiotics: Gentamycin, Ampicillin, and Metronidazole or 3rd generation Cephalosporin and Metronidazole
- Steroids
- Start Sulfasalazine/5-ASA compounds after improvement
- Surgery if free perforation, massive blood loss, or failure to imporove after 2-3 d/therapy (usually subtotal colectomy) |
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Term
| What broad spectrum antibiotics do you use for toxic megacolon? |
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Definition
- Gentamycin, Ampicillin, and Metronidazole
OR
- Metronidazole plus a 3rd generation Cephalosporin |
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Term
| Internal hemorrhoids are above the __ __, originate from the __ __ __, are __ innervated and thus are __ __. |
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Definition
- above the dentate ilne
- from the superior hemorrhoidal plexus
- viscerally innervaed and thus are NOT painful |
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Term
| External hemorrhoids are below the __ __, arise from the __ __ plexus, and are __ innervated and are thus ___. |
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Definition
- below the dentate line
- inferior hemorrhoidal plexus
- somatically innervated
- painful |
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Term
| Both internal and external hemorrhoids have venous drainage to the __ __ __, which then drain into the __ __ _. |
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Definition
- internal pudendal vein
- inferior vena cava |
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Term
| conservative management for hemorrhoids: |
|
Definition
- increase fiber and water
- stool softeners
- for ithcing: preparation H, hydrocortisone suppositories, Sitz bath |
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Term
| Definition of constipation: |
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Definition
- Hard stools, incomplete evacuation, straining, or sense of blockage at least 25% of time
- Manual maneuvers to have BM at least 25% of time
- Less than 3 BMs/week
- Patient does not meet criteria for IBS |
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Term
| 3 types of Idiopathic Constipation: |
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Definition
1. Normal Colonic Transit
2. Colonic Inertia
3. Pelvic Floor Dysfunction |
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Term
| Secondary Causes of Constipation: |
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Definition
- Dietary
- Immobility
- Medication induced: opiates, anticholinergics, antidepressants, NSAIDs
- Hirschsprung's Disease
- Neuro diseases: stroke, MS, Parkinson's, DM autonomic neuropathy
- Metabolic and Connective tissue diseases: hypothyroidism, hypercaclemia, scerloderma
- Pregnancy
- Colorectal cancer |
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Term
| colonic transit studies that may be done if pt fails to respond to conservative tmt for constipation: |
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Definition
- radiopaque marker study
- wireless motility capsule
- defecography |
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Term
| motility study for constipation: |
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Definition
|
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Term
| if you suspect obstruction with constipation,what studies can be done? |
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Definition
colonscopy
flexible sigmoidoscopy |
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Term
| Prescription meds for constipation: |
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Definition
- Lubipristone
- Misoprostol
- Linaclotide |
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Term
| A prescription constipation drug that activates chlorid channels causing increased chloride rich intestinal fluid secretion: |
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Definition
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Term
| Anti-constipation prescription medication that is a prostaglandin analoge: |
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Definition
|
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Term
| Anit-constipation prescriptin medication that increaes fluid secretion and transit: |
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Definition
|
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Term
|
Definition
- fecal incontinence
- with impaction, caused by liquid stools passing around the hard bulky mass |
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Term
| Presentation of fecal impaction: |
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Definition
- long history of constipation
- anticholinergics or opiates
- abdominal bloating/cramping
- rectal bleeding
- limited mobility |
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Term
|
Definition
- Enemas or supositories of mineral oil or soap suds
- Laxatives: magnesium sulfate or polyethelene glycol
- If all else fails> disimpaction |
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Term
| Prevention of further fecal impaction: |
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Definition
- more fiber
- more water
- stop offending meds (narcotics, opiates, anticholinergics)
- avoid stimulant laxatives, but can use polyethelene glycol (Miralax) since non-habit forming |
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Term
| Initial management of toxic megacolon: |
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Definition
- Admit to ICU
- Serial CBC, CMP, and abdominal plain films
- Antibiotics
- Steroids
- Bowel rest |
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Term
| Long term management of toxic megacolon: |
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Definition
- Sulfasalazine of 5-ASA
- Colectomy |
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