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Gastroenterology > 16 - IBS > Flashcards

16 - IBS Flashcards

1
Q

IBS

A

functional bowel disorder
abdominal pain and discomfort
altered bowel habits

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2
Q

علائم

A 
recurrent abdominal pain and discomfort 
episodic and crampy 
با خوردن و استرس بدتر میشه 
بهبود همراه با مدفوع کردن 
شروع درد همراه با تغییر در فرکانس مدفوع 
شروع درد همراه با تغییر در شکل مدفوع 
postprandial pain 
defecation straining 
urgency 
feeling of incomplete bowel movement 
passing mucus 
bloating

علائم معمولا در بیداری
دیسفاژی
سوزش سر دل
تهوع استفراغ

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3
Q

post infectious IBS بیشتر توسط کدوم باکتری ها

A

کمپیلو باکتر
شیگلا
سالمونلا

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4
Q

کدوم فلور های نرمال کاهش کدوم ها افزایش پیدا کردن ؟

A

کاهش
genera bifidobacterium
lactobacillus

افزایش
firmicutes . bacteroidetes

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5
Q

اگر درد در اپی گاستر و اطراف ناف باشه تشخیص های افتراقی اش ؟

A

بیماری مجاری صفراوی
زخم معده
ایسکمی روده
کارسینومای معده / پانکراس

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6
Q

اگر درد بیشتر در پایین شکم باشد تشخیص های افتراقی ؟

A

دایورتیکول کولون
IBD
کارسینوما کولون

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7
Q

postprandial pain تشخیص های افتراقی

A

گاستروپارزی
انسداد مقطعی روده
عفونت روده ای با ژیاردیا

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8
Q

تشخیص های افتراقی اسهال

A 
لاکتاز کمبود 
استفاده زیاد از مسهل 
سوء جذب 
سلیاک 
هیپرتیروئیدی 
IBD
اسهال عفونی
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9
Q

یبوست تشخیص افتراقی

A

استفاده از دارو هایی مثل
انتیکولینرژیک
انتی هایپرتنسیو
ضد افسردگی

اندوکرینوپاتی
هیپوتیروئیدی
هیپوپاراتیروئیدی

acute intermittent porphyria
مسمومیت با سرب

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10
Q

تست های تشخیصی IBD

A

CBC
سیگموئیدسکوپی
کشت مدفوع برای تخم و انگل
بیوپسی سیگموئید در اسهال پرسیستنت مقاوم به درمان

ددر صورت سن بالای 40 سال:
air contrast barium enema
colonoscopy

تست هیدروژن تنفسی
3 هفته رژیم بدون لاکتوز

رژیم بدون گلوتن

upper GI radiography
در کسانی که دیس پپسی دارند

esophagogastroduedonalscopy
در کسانی که دیس پپپسی دارند

ultrasonogram of the gallbladder
در کسانی که
postprandial pain in RUQ

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11
Q

یسک فاکتور های

arterio occlussive mesentric ischemia

A

AF
recurrent myocardial infarction
valvular disease
recurrent cardiac or vascular catheterization

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12
Q

embolic clot ها در کدوم ایسکمی

A

arterio occlussive mesentric ischemia

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13
Q

gold standard تشخیص

arterio occlussive mesentric ischemia

A

angiography

laparotomy

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14
Q

intestinal angina

A

non occlussive mesentric ischemia

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15
Q

non occlussive mesentric ischemia

در ؟

A

یکهویی در سنین پیری
atherosclerotic
increased dose vasopressin
cardiogenic / septic shock cocaine overdose

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16
Q

علائم

non occlussive mesentric ischemia

A 
generalized abdominal pain 
bloody stool 
anorexia
abdominal distention 
لوکوسیتوز
اسیدوز متابولیک
افزایش امیلاز 
افزایش کراتینین فسفاتاز 
لاکتیک اسید
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17
Q

در کدوم مدل اصلا وازوکانتریکتور نباید بدیم در ایسکمی ها

A

non occlusive mesenteric ischemia

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18
Q

کدوم ارتباط بالا با ischemic colitis داره

A

non occlusive mesenteric ischemia

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19
Q

mesenteric venous thrombosis در

A 
hypercoagulative state 
(pr c , s antitrypsin 3 deficiency )

polycythemia
carcinoma

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20
Q

در کدوم ایسکمی

clot in sup. mesenteric

A

mesenteric venous thrombosis

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21
Q

gold standard تشخیصی

mesenteric venous thrombosis

A

Angiography mesenteric

22
Q

Griffiths point

A

خمیدگی اسپلنیک

مهم ترین نقاط ایسکمی

23
Q

sudech’s point

A

خمیدگی سگموئید و رکتوم

مهم ترین نقطه ایسمنی

24
Q

دو نقطه مهم ایسکمی

A

Griffiths point

sudech’s point

25
Q

SMA occlusive

A

superior mesenteric artery (SMA)
کمی پایین تر از خروج
middle colic artery

26
Q

علائم

acute mesenteric ischemia

A 
severe acute non remitting abdominal pain 
تهوع استفراغ 
اسهال موقت 
anorexia
bloody stool 
abdominal distension
hypoactive bowel sound
peritonitis
cardiovascular collapse
27
Q

early features رادیوگراقی

acute mesenteric ischemia

A

ادم دیواره bowel

thumbprinting

28
Q

ischemia of colonic mucosa is graded as :

A

mild اریتم کم موکوس
moderate pale mucosal ulceration . تهاجم به لایه ماهیچه ای

severe : ischemic colitis + severe ulceration ( frank necrosis)

29
Q

بهترین پروگنوز بین همه این ایمسکمی ها

A

mesenteric venous insufficiency

30
Q

علائم

chronic intestinal ischemia

A 
weight loss حتمی 
chronic diarrhea
intestinal angina 
postprandial abdominal pain 
درد کرمپی بعد از خوردن غذا
31
Q

یافته های بالینی در

chronic intestinal ischemia

A

malnourished patient
abdominal bruit
atherosclerosis

32
Q

Acute mesenteric ischemia (AMI) is

A

a syndrome in which there is acute onset of inadequate blood flow through the mesenteric vessels, which commonly results from occlusion or hypoperfusion to the vessels.

33
Q

Common causes of acute mesenteric ischemia include:

A

Arterial thrombus due to atherosclerosis (most common)
Venous thrombus due to hypercoagulable states (polycythemia vera, pregnancy, protein C and S deficiency, etc)
Arterial occlusion due to emboli from arrhythmia or post-cardiac catheterization
Hypoperfusion due to blood loss or CHF

34
Q

Chronic mesenteric ischemia (CMI) is

A

ischemia of the bowel due to long-standing atherosclerotic disease of 2 or more mesenteric vessels. Vasculitides may also cause chronic mesenteric ischemia.

35
Q

The three vessels that may be affected in chronic mesenteric ischemia are

A

celiac trunk,
superior mesenteric artery,
inferior mesenteric artery.

36
Q

In patients with acute mesenteric ischemia, symptoms may include:

A

Non-localized, diffuse, and constant abdominal pain
Nausea
Vomiting
Bloody diarrhea

37
Q

In chronic mesenteric ischemia, patients present with:

A 
Postprandial pain (epigastric or periumbilical)
Fear of eating (sitophobia)
Weight loss
History of vascular disease
Nausea, vomiting, diarrhea
38
Q

On physical exam, patients with acute mesenteric ischemia may have the following:

A 
Pain disproportionate to physical exam findings
Abdominal distention
Fever
Hypotension
Tachycardia
Altered mental status
Positive fecal occult blood
39
Q

On physical exam Patients with chronic mesenteric ischemia may have the following:

A

Pain disproportionate to physical exam findings
Abdominal bruit
Decreased peripheral pulses​
Signs of weight loss

40
Q

The gold standard for diagnosis of acute or chronic mesenteric ischemia is

A

CT angiography.

41
Q

In both acute and chronic mesenteric ischemia, laboratory studies are typically non-specific, but may include:

A

Elevated WBC count with left shift
Increased lactate dehydrogenase
Elevated amylase
Metabolic acidosis
Elevated hematocrit due to hemoconcentration
Prothrombin time, activated partial thromboplastin time, and international normalized ratio abnormalities

42
Q

in chronic mesenteric ischemia, the following may be found:

A

Anemia, leukopenia, lymphopenia due to chronic malnourishment
Hypoalbuminemia due to malnourishment
Electrolyte abnormalities due to vomiting, diarrhea, or malnutrition

43
Q

Acute mesenteric ischemia may result in:

A 
Bowel necrosis
Perforation
Peritonitis
Sepsis
Death
44
Q

Ischemic colitis is

A

ischemia and necrosis of the large intestine secondary to vascular compromise.

45
Q

There are 3 degrees of infarction:

A

Mucosal infarction
Mural (submucosal infarction)
Transmural infarction

46
Q

Mucosal and mural infarctions are generally due to

A

hypoperfusion.

47
Q

Acute transmural infarction may present with:

A 
Sudden severe abdominal pain
Abdominal muscular rigidity
Nausea
Vomiting
Bloody diarrhea
Melena
48
Q

risk factors include:

A 
older patients with concomitant cardiac or valvular disease
Diabetes mellitus
Atherosclerosis
Congestive heart failure
Peripheral vascular disease
Lupus
49
Q

Chronic ischemia may closely mimic

A

inflammatory bowel disease.

50
Q

Diagnosis may be done by:

A

Colonoscopy: may see bloody and edematous mucosa

CT scan: may show air within bowel, bowel wall thickening, or thumb-printing (see image)

51
Q

Complications of ischemic colitis include:

A

Bowel tissue death
Perforation
Bowel inflammation
Bowel obstruction (strictures)

52
Q

Treatment consists of: ischemic colitis

A

Bowel rest
IV fluids
IV antibiotics

Gastroenterology (16 decks)

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