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GIR Test 2 > B5-020 Diarrhea > Flashcards

B5-020 Diarrhea Flashcards

1
Q

the colon takes up approximately […]% of the fluid presented to it

A

90

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2
Q

when the large reserve capacity of the small intestine and colon is exceeded or impaired […] manifests

A

diarrhea

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3
Q

the site for intestinal fluid movement is the

A

epithelial lining

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4
Q

has specialized properties for fluid movement

A

epithelial lining

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5
Q

restrict passive flow of solutes once secreted or absorbed

A

tight junctions

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6
Q

normal crypt to villi ratio

A

2 villi to one crypt

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7
Q

movement of solutes and water through tight junctions

A

paracellular trans epithelial transport

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8
Q

dictated primarily by electrochemical gradient

A

paracellular trans-epithelial transport

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9
Q

requires membrane transport proteins to drive the transcellular transport of ions

A

trans-epithelial transport

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10
Q

transport of ions sets up the electrochemical gradient

A

trans-epithelial transport

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11
Q

electrochemical gradients allow […] transport of fluid through tight junctions

A

paracellular

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12
Q

primary function is nutrient absorption

A

villi

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13
Q

primary function is secretion

A

crypt

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14
Q

primarily depends on Na+ transport

A

villi absorption

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15
Q

primarily follows Cl- and bicarbonate

A

crypt secretion

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16
Q
  • bricarbonate secretion
  • electroneutral NaCl absoprtion
  • chloride secretion

occurs where

A

small intestine

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17
Q

chloride secretion mainly occurs where in GI tract?

A

colon

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18
Q

calcium and iron absorption occur where

A

small intestine

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19
Q

what transporter is responsible for sodium glucose reabsorption?

A

SGLT1

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20
Q

what transporter allows for the secretion of Cl-

A

CFTR

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21
Q
  • solute driven water losses
  • more prominent in the colon
A

osmotic diarrhea

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22
Q

crypt secretion leads to more prominent small intestinal losses

A

secretory diarrhea

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23
Q

normal osmotic gap

A

50-100

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24
Q

calculation for osmotic gap

A

290-2 x (Na + K)

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25
Q

osmotic gap > 100 mosm/kg

A

osmotic diarrhea

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26
Q

osmotic gap <50 mosm/kg

A

secretory diarrhea

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27
Q

frequent, small volume bloody stool

A

inflammatory diarrhea

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28
Q

fundamentally indicates disrupted and inflamed mucosa

A

inflammory diarrhea

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29
Q

caused by:
* infectious processes
* IBD
* ischemic colitis

A

inflammatory diarrhea

`

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30
Q
  • greasy, bulky stools
  • weight loss
  • floating feces
A

fatty diarrhea

osmotic diarrhea, but with fat content

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31
Q

celiac disease causes what type of diarrhea?

A

fatty diarrhea

fat malabsorption

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32
Q

loss of large volumes without inflammation of enterocytes

A

osmotic diarrhea

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33
Q

stool volume decreases with fasting

A

osmotic diarrhea

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34
Q

stool pH <5.3

acidic

normal is 6.6

A

osmotic diarrhea

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35
Q

caused by:
* giardiasis
* osmotic laxatives
* lactose intolerance

A

osmotic diarrhea

36
Q

osmotic laxatives

5

A
  • MiraLax
  • milk of mag
  • sorbitol
  • lactulose
  • PEG
37
Q

caused by an osmotically active substance drawing hypotonic solution into lumen

A

osmotic diarrhea

38
Q

caused by ingestion of poorly absorbed sugars or ions

A

osmotic diarrhea

39
Q

loss of large volumes of isotonic watery diarrhea without inflammation

A

secretory diarrhea

40
Q

stool volume continues unabated by fasting

A

secretory diarrhea

41
Q

stool pH usually 6.6

normal or close to normal

A

secretory diarrhea

42
Q

caused by increased Cl- channel activation via increased cAMP

A

secretory diarrhea

43
Q

is further workup necessary for acute diarrhea?

A

no

44
Q
  • CRP and ESR elevated
  • low serum albumin
A

inflammatory diarrhea

45
Q

curved rods
gram negative

2

A

c. jejuni
vibrio

46
Q
  • common in southern states
  • through summer (May-Aug)
  • found in oysters
A

vibrio parahaemolyticus

47
Q

improves with fasting

A

osmotic diarrhea

48
Q

osmotic gap >125 mosm/kg

A

osmotic diarrhea

49
Q

what does a high magnesium output indicate?

A

laxative abuse
inadvertent digestion

50
Q
  • associated with laxative abuse
  • damaged cells express pigmentation
A

melanosis coli

51
Q

sorbitol should be limited to

A

10 g/day

52
Q

what kind of laxative is Senna?

A

stimulant

53
Q

stimulant laxatives increase

2 things

A

motility and secretions

54
Q

stimulant laxatives cause […] diarrhea

A

secretory

55
Q

absorbed carbohydrates and sugar alcohols intaken orally in large quantities cause

A

osmotic diarrhea

56
Q

do enzymes help digest polyol/sugar alcohols?

A

no

57
Q

measures anaerobic bacteria production of hydrogen from undigested sugars

A

hydrogen breath test

58
Q

osmotic gap <50

A

secretory diarrhea

59
Q

what additional test may you want in the setting of secretory diarrhea?

A

colonoscopy
sigmoidoscopy
CT scan

60
Q

indomethacin inhibits […]

A

prostaglandins

reduces Cl- pumped into lumen

61
Q

how does an adenoma cause secretory diarrhea?

A
  1. adenoma secretes PGE2
  2. PGE2 stimulates increased intracellular cAMP
  3. cAMP phosphorylates CTFR
  4. CTFR allows Cl- movement into small intestine. water follows -> secretory diarrhea
62
Q

villous adenomas secrete electrolytes and mucin causing secretory diarrhea and dehydration

A

McKittrick Wheelock syndrome

63
Q

pre-renal acute kidney injury
* hyponatremia
* hypokalemia
* elevated creatine

A

McKittrick Wheelock syndrome

64
Q

treatment for secretory diarrhea caused by adenoma

A

NSAIDs can be supportive but must be resected

65
Q
  • reduced duodenal folds
  • no duodenal villi
  • increased intra-epithelial lymphocytes
  • no villi
A

celiac

66
Q

anti-TTG IgA
anti-gliadin IgA

are markers for

A

celiac

67
Q

what kind of diarrhea does celiac disease cause?

A

osmotic

unabsorbed nutrients pull fluid into the lumen

68
Q

how does celiac cause issues with bone health?

A
  1. decreased Ca+ absorption in small intestine
  2. decreased serum calcium signals thyroid to release PTH
  3. PTH signals for increased calcium uptake from bones and kidneys
69
Q

autoimmune disease where consumption of gluten will lead to damage of small intestine

A

celiac

70
Q

associated with bone health issues

A

celiac

71
Q

treatment for celiac

A

strict gluten free diet

72
Q

dermatitis herpetiformis is associated with

A

celiac

73
Q

decreased stool pH is associated with

A

lactose intolerance

74
Q

what kind of diarrhea does lactase insufficiency result in?

A

osmotic

75
Q

T. whippelii presents with

4

A
  • fever
  • steatorrhea
  • joint pain
  • fatigue
76
Q

celiac can lead to decreased […], resulting in edema

A

albumin

77
Q

usually experiences some benefit with loperamide and diet change

A

IBS

78
Q

pancreatic exocrine insufficiency causes

A

frequent loose, foul smelling stools (steatorrhea)

79
Q
  • bloody stools
  • abdominal pain
  • fever
  • elevated CRP
  • low Hb
  • low albumin
A

UC

80
Q

frequent watery, non-bloody diarrhea and abdominal cramping

A

collagenous collitis

81
Q

gram negative non-motile rods in a stool sample can belong to which two genera?

A

campylobacter and vibrio

82
Q

continue to grow at 4 degrees C

2

A
  • yersinia
  • listeria
83
Q

causes issues with refrigerated blood supplies

A

yersinia

84
Q

causes issues with refrigerated foods

A

listeria

85
Q

thiosulfate citrate bile salts sucrose agar is selective for

A

vibrio

GIR Test 2 (18 decks)

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