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\author{ksellybelly}
\pdfinfo{
  /Title (gi-iii-small-intestine-and-colon.pdf)
  /Creator (Cheatography)
  /Author (ksellybelly)
  /Subject (GI III: Small Intestine \& Colon Cheat Sheet)
}

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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{GI III: Small Intestine \& Colon Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{ksellybelly} via \textcolor{DarkBackground}{\uline{cheatography.com/19318/cs/2427/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}ksellybelly \\
  \uline{cheatography.com/ksellybelly} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 7th August, 2014.\\
   Updated 12th May, 2016.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Diarrhea}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Increased frequency or volume of stool (eg 3+ liquid/semisolid stools daily for at least 2-3 consecutive days)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Etiology} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Infections, toxic, dietary (laxative use), other GI disease} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Pertinent Patient History} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}All current meds, illnesses among others who may have shared meals with pt.} \tn 
% Row Count 10 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features: Secretory Diarrhea} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Large volume w/o inflammation (pancreativ insufficiency, ingestion of preformed bacterial toxins, laxative use)} \tn 
% Row Count 14 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features: Inflammatory Diarrhea} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Bloody diarrhea + fever (invasive organisms or IBD)} \tn 
% Row Count 17 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features: Antibiotic-Associated Diarrhea} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}{\emph{Clostridium dificile}} (causes pseudomenbranous colitis in the most severe cases)} \tn 
% Row Count 20 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}WBCs in the stool = inflammatory process, and get cultures} \tn 
% Row Count 23 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Supportive therapy, antibiotics for pts with severe diarrhea and systemic sx (C. diff, Shigella, Campylobacter)} \tn 
% Row Count 27 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Celiac Disease (celiac sprue)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Inflammation of the small bowel with the ingestion of gluten-containing foods (wheat, rye, barley) leading to malabsorption} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Multifactorial inheritance} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Among the most common genetic conditions in Europe and USA} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Presentation} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Diarrhea, steatorrhea, flatulence, weight loss, weakness, abdominal distension (infants/kids - failure to thrive) (older pts - iron deficiency, coagulopathy, hypocalcemia)} \tn 
% Row Count 12 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Diagnosis} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Serologic screening tests: IgA antiendomysial and antitisuue transglutaminase antibodies} \tn 
% Row Count 15 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}{\emph{Gluten-free dieat}}, should see nutritionist possibly lactose-free diet, supplementation, prednisone} \tn 
% Row Count 19 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{IBS (Irritable Bowel Syndrome)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}A functional disorder without a known pathology - thought to be a combination of altered motility, hypersensitivity to intestinal distention, and psychological distress, W\textgreater{}\textgreater{}M and can occur with menses/stress. A dx of exclusion.} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Most common cause of...} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}chronic or recurrent abdominal pain the the US. Usually an intermittent/lifetime problem.} \tn 
% Row Count 9 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{DDX} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Lactose intolerance, cholecystitis, chronic pancreatitis, intestinal obstruction, chronic peritonitis, carcinoma of pancreas/stomach} \tn 
% Row Count 13 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Abdominal pain (worsened with ingestion, relieved with defecation), pain may be associated with bowel distention from accumulation of gas and associated spasm of smooth muscle; postprandial urgency common, changes in stool frequency/character, dyspepsia, urinary frequency/urgency in women} \tn 
% Row Count 21 (+ 8)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Generally normal - test stool for blood, bacteria, parasites, lactose intolerance. R/O other pathology with colonoscopy/barium enema/US.CT, and endoscopic studies in pts with persisten sx or weight loss/bleeding} \tn 
% Row Count 27 (+ 6)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Avoid triggers, high-fiber diet, bulking agents, and symptom control (antispasmodics, antidiarrheals, prokinetics, antidepressants)} \tn 
% Row Count 31 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Colonic Polyps}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Fleshy growth on lining of colon/rectum; common and can be benign or malignant. Removal can reduce the occurence of colon cancer} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Familial Polyposis Syndrome} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Genetic predisposition to multiple colonic poolups with a near-100\% risk of developing colon cancer (evaluate q1-2 yrs beginning at age 10)} \tn 
% Row Count 8 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}{\emph{Asymptomatic}}, Can get contipation, flatulence, rectal bleeding, or iron deficiency anemia} \tn 
% Row Count 11 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Heme-positive stool, detected by colonoscopy, and must get histologic evaluation to determine dysplasia} \tn 
% Row Count 15 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Removal and FU} \tn 
% Row Count 17 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Constipation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}A decrease in stool volume and increase in stool firmness accompanied by straining (normal BM ranges 3/day-3/wk)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Red Flag} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Patients \textgreater{}50 yo with new-onset constipation -{}-\textgreater{} evaluate for colon cancer!} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Basic Treatment/Lifestyle modifications} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Increase fiber (10-20g/day), increase fluid intake (1.5-2L/day), increased exercise} \tn 
% Row Count 10 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment if constipation lasts \textgreater{} 2wks or if refractory to lifestyle modifications} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Investigate and treat underlying cause} \tn 
% Row Count 13 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Bowel Obstruction}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Etiology: small bowel obstruction (SBO)} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}{\emph{Adhesions or hernias}}, neoplasm, IBD, volvulus} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Etiology: large bowel obstruction} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}{\emph{Neoplasm}}, strictures, hernias, volvulus, intussusception, fecal impaction} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Complete strangulation of bowel tissue can lead to} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Infarction, necrosis, peritonitis, death} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Andominal pain, distention, vomiting, obstipation, high-pitched/rushing bowel sounds, more severe cases pts can be febrile/tachycardic, in shock} \tn 
% Row Count 12 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Dehydration, electrolyte imbalance, upright radiographs showing air-fluid levels} \tn 
% Row Count 15 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}NPO, NG suctioning, IV fluids, monitoring (surgery likely, esp. with large bowel obstruction)} \tn 
% Row Count 18 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Crohn's Disease (aka regional enteritis)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}An IBD for which there is some genetic predisposition, but the cause is unknown. Must be differentiated from ulcerative colitis (other IBD)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Anatomical Involvement} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}{\emph{Skip lesions}}, {\emph{Terminal ileum and right colon}} most common, can also be in small and large bowels, mouth, esophagus, stomach (rectum frequently spared)} \tn 
% Row Count 9 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Complications} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Fistula, abscesses, aphthous ulcers, renal stones, predisposition to colonic cancer} \tn 
% Row Count 12 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Abdominal cramps and diarrhea in pts \textless{}40yo (can also get low-grade fever, polyarthralgia, anemia, fatigue, bloody stool)} \tn 
% Row Count 16 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Colonoscopy, bx to reveal involvement (will often see granulomas), blood tests (anemia, decreased ESR, electrolyte imbalances)} \tn 
% Row Count 20 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Acute tx: Prednisone +/e aminosalicylates (add metronidazole or cipro if perianal dz/fissures/fistula. Chronic management: Mesalamine, also smoking cessation} \tn 
% Row Count 25 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Intussusception}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}The invagination of a proximal segment of bowel into the portion just distal to it (95\% of the time occurs in {\emph{children}}, following a viral infx. If in adults d/t neoplasm)} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Severe colicky pain, stool will contain mucus/blod ({\emph{currant jelly stools}}), and sausage-shaped mass felt on palpation} \tn 
% Row Count 9 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Barium or air enema - diagnostic and therapeutic (plain-films, CT, surgery for adults)} \tn 
% Row Count 12 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Hospitalization, and barium/air enema for kids (surgery if that doesn't help or for all adults)} \tn 
% Row Count 16 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Toxic Megacolon}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Extreme dilatation and immobility of the colon, {\emph{Emergency}}!} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Etiology: Newborn} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Hirschsprung's Disease = Congenital aganglionosis of the colon, leading to functional obstruction in the neworn} \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Etiology: Adults} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Occurs as a complication of UC, Crohn's colitis, pseudomenbranous colitis, and specific infectious causes (Shigella, C. diff)} \tn 
% Row Count 11 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Fever, prostration, severe cramps, abdominal distension, and rigid abdomen and abdominal tenderness on exam} \tn 
% Row Count 15 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Abdominal plain films will show colonic dilatation} \tn 
% Row Count 18 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Decompression (sometimes colostomy  or complete colonic resection may be necessary)} \tn 
% Row Count 21 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Volvulos}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}The twisting of any portion of bowel on itself (most commonly the sigmoid or cecal area)-{}-\textgreater{}requires emergent decompression to avoid ischemic injury!} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Cramping abdominal pai, distention, N/V, obstipation} \tn 
% Row Count 8 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Ischemia from volvulus can lead to} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Gangrene, peritonitis, sepsis} \tn 
% Row Count 10 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Signs/symptoms of Bowel Ischemia} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Abdominal tympany, tachycardia, fever, severe pain} \tn 
% Row Count 13 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Diagnosis confirmed by} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Abdominal plain film-{}-\textgreater{}showing colonic distention} \tn 
% Row Count 16 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Endoscopic decompression, surgery if unresolved by non-surgical means} \tn 
% Row Count 19 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Malabsorption}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}May involve a single nutrient (like Vit B12 in pernicious anemia) or lactase deficiency (lactose), or it may be global (celiac disease, AIDS)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Etiology} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Problems in digestion, absorption, impaired blood/lymph flow} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Diarrhea +/- bloating and discomfort, weight loss, edema, steatorrhea (othersL bone demineralization, tetany, bleeding, anemia)} \tn 
% Row Count 11 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}If 72-hr fecal fat test is normal, consider specific defects (ie pancreatic insufficiency), and specific tests can detect deficiencies like B12/calciu/albumin} \tn 
% Row Count 16 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Therapeutic trials to help in dx/tx} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Lactose-free diet, gluten-free diet, pancreatic enzyme, antibiotics in certain cases} \tn 
% Row Count 19 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Ulcerative Colitis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}An IBD with ulcerated lesions in the colon, starts distally at the rectum and progresses proximally, continuous (NO skip lesions)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features - most common} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}{\emph{Tenesmus (feeling of constantly needing to pass BM despite empty colon) and bloody/pus-filled diarrhea}}} \tn 
% Row Count 8 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Less common features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}LLQ pain, weight loss, malaise, fevere, might see toxic megacolon and malignancy seen more in UC than Crohn's (smoking actually protective in UC)} \tn 
% Row Count 13 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Anemia, increased ESR, decreased serum albumin, abdominal plain film-{}-\textgreater{}colonic distension. Sigmoidoscopy or colonoscopy best to establish diagnosis} \tn 
% Row Count 18 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{What to AVOID in pts with possible acute UC} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Colonoscopy and barium enema - risk of perforation and toxic megacolon!} \tn 
% Row Count 21 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Aminosalicyates + Corticosteroids (surgery can be curative, total protocolectomy most common type)} \tn 
% Row Count 25 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Diverticular Disease}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Diverticulosis (def.)} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Large outpouchings of the mucosa of the colon} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Diverticulitis (def.)} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Inflammation of the diverticula caused by obstructing matter} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{In pts. with diverticulosis, can prevent diverticulitis with...} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}High-fiber diet and avoidance of obstructing/constipating foods (seeds, etc.)} \tn 
% Row Count 9 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features (diverticulitis)} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Sudden-onset LLQ/suprapubic pain +/- fever, altered BM, N/V} \tn 
% Row Count 12 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Diverticular bleeding presentation} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Sudden-onset, large-volume hematochezia (resolves spontaneously)} \tn 
% Row Count 15 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Plain films + Ct: to r/o other causes of abdominal pain or tos how areas of edema/dilatation. Colonoscopy: best to evaluate for ischemia,} \tn 
% Row Count 19 (+ 4)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Surgical revascularization (+ hydration)} \tn 
% Row Count 21 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Colorectal Cancer}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Risk Factors} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Hereditary nonpolyposis colorectal cancer} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{General} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}3rd leading cause of cancer death in USA, \textgreater{}50yo, good prognosis if caught early} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}{\emph{Slow growing and no sx at first}}, Abdominal pain, change in bowel habits, occult bleeding, intestinal obstruction, anemia (fatigue, weakness), frank blood in stool, change in stool size/shape.} \tn 
% Row Count 11 (+ 6)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Findings} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Occult blood in stool, colonoscopy} \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Surgical resection + chemo (stage III and higher)} \tn 
% Row Count 16 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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% That's all folks
\end{multicols*}

\end{document}