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Internal Medicine > Chapter 43 - Diarrhea > Flashcards

Chapter 43 - Diarrhea Flashcards

1
Q

one of the most common causes of mortality in developing
countries, particularly among impoverished infants, accounting for
1.8 million deaths per year.

A

Acute infectious diarrhea

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2
Q

results in environmental enteropathy with long-term

impacts on physical and intellectual development.

A

Recurrent, acute diarrhea in children in

tropical countries

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3
Q

primary function of the small intestine

A

digestion and

assimilation of nutrients from food

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4
Q

function of small intestine and colon

A

regulate the secretion and
absorption of water and electrolytes, the storage and subsequent
transport of intraluminal contents aborally, and the salvage of some
nutrients

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5
Q

Alterations in motor and sensory functions of the colon result in highly
prevalent syndromes such as _______, _______, and _________

A

irritable bowel syndrome (IBS), chronic

diarrhea, and chronic constipation

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6
Q

also called the enteric nervous system, comprises

myenteric, submucosal, and mucosal neuronal layers

A

intrinsic innervation

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7
Q

regulates smooth-muscle function through intermediary pacemaker-
like cells called the interstitial cells of Cajal

A

myenteric

plexus

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8
Q

affects secretion, absorption, and mucosal blood flow

A

submucosal

plexus

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9
Q

receives input from the extrinsic nerves, but it

is capable of independent control of these functions.

A

enteric nervous system

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10
Q

innervations of the small intestine and colon are part of
the autonomic nervous system and also modulate motor and secretory
functions.

A

extrinsic innervations

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11
Q

convey visceral sensory pathways

from and excitatory pathways to the small intestine and colon

A

parasympathetic nerves

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12
Q

Parasympathetic fibers via the vagus nerve reach the small intestine
and proximal colon along the branches of the

A

superior mesenteric

artery

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13
Q

distal colon is supplied

A

sacral parasympathetic nerves

(S2–4) via the pelvic plexus

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14
Q

chief excitatory neurotransmitters

controlling motor function

A

acetylcholine and the tachykinins,

such as substance P

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15
Q

modulates motor

functions and reaches the small intestine and colon

A

sympathetic nerve supply

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16
Q

Sympathetic input to the gut is generally __________ to

sphincters and ________ to non-sphincteric muscle

A

excitatory

inhibitory

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17
Q

___ of fluid enter the GI tract, ___ of residual fluid
reaches the colon, and the stool excretion of fluid constitutes about
_____.

A

9L
~1 L
0.2 L/d

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18
Q

During the fasting period, the motility of the small intestine is characterized
by a cyclical event called the ___________),
which serves to clear nondigestible residue from the small intestine
(the intestinal “housekeeper”).

A

migrating motor complex (MMC)

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19
Q

MMC lasts for how long and occurs every???

A

lasts for 4min and occurs every 60-90min

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20
Q

acts as a reservoir, emptying intermittently by bolus
movements. This action allows time for salvage of fluids, electrolytes,
and nutrients.

A

distal ileum

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21
Q

Segmentation by ______
compartmentalizes the colon and
facilitates mixing, retention of residue,
and formation of solid stools

A

haustra

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22
Q 
The resident
microorganisms, predominantly
\_\_\_\_\_\_\_\_\_\_, in the colon are
necessary for the digestion of unabsorbed
carbohydrates that reach the
colon even in health, thereby providing
a vital source of nutrients to the
mucosa.
A

anaerobic bacteria

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23
Q

regions
of colon function as reservoirs (average
transit time,____)

A

ascending and transverse regions

15h

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24
Q

region of the colon that acts as a conduit (average transit time, ____).

A

descending colon

3h

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25
Q

efficient
at conserving sodium and water, a function that is particularly important
in sodium-depleted patients in whom the small intestine alone
is unable to maintain sodium balance

A

colon

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26
Q

result from alteration in the reservoir function of the proximal colon
or the propulsive function of the left colon.

A

Diarrhea or constipation

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27
Q

result from disturbances of the rectal or sigmoid reservoir, typically
as a result of dysfunction of the pelvic floor, the anal sphincters, the
coordination of defecation, or dehydration.

A

constipation

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28
Q

associated with mass movements through the colon and
normally occur approximately five times per day, usually on awakening
in the morning and postprandially

A

short duration or phasic contractions

high-amplitude (>75 mmHg) propagated contractions (HAPCs)

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29
Q

refers to the background contractility upon which

phasic contractile activity (typically contractions lasting <15 s) is superimposed

A

Colonic tone

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30
Q

After meal ingestion, colonic phasic and tonic contractility increases for
a period of ____

A

~2 h

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31
Q

The initial phase (~10 min) is mediated by the ______ in response to mechanical distention of the stomach

A

vagus nerve

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32
Q

Tonic contraction of the ____________, which forms a sling

around the rectoanal junction, is important to maintain continence

A

puborectalis muscle

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33
Q

during defecation, ______________ relax this muscle,

facilitating the straightening of the rectoanal angle

A

sacral parasympathetic nerves

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34
Q

Distention
of the rectum results in transient relaxation of the internal anal
sphincter via _______________.

A

intrinsic and reflex sympathetic innervation

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35
Q

loosely defined as passage of abnormally liquid or

unformed stools at an increased frequency

A

Diarrhea

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36
Q

diarrhea in adults

A

typical

Western diet, stool weight >200 g/d

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37
Q

acute diarrhea

A

<2 weeks

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38
Q

persistent diarrhea

A

2-4 weeks

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39
Q

chronic diarrhea

A

> 4 weeks

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40
Q

frequent
passage of small volumes of stool, is often associated with rectal
urgency, tenesmus, or a feeling of incomplete evacuation, and accompanies
IBS or proctitis

A

Pseudodiarrhea

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41
Q

involuntary discharge of
rectal contents and is most often caused by neuromuscular disorders
or structural anorectal problems

A

Fecal incontinence

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42
Q

may occur in nursing
home patients due to fecal impaction that is readily detectable by rectal
examination.

A

Overflow diarrhea

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43
Q

More than 90% of cases of acute diarrhea are caused by ______________

A

infectious

agents

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44
Q

acute diarrhea is accompanied by_________

A

vomiting, fever, and

abdominal pain

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45
Q

Disturbances of flora by antibiotics can lead to diarrhea
by reducing the digestive function or by allowing the overgrowth of
pathogens, such as ____________

A

Clostridium difficile

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46
Q

five high-risk groups in US

A
  • Travelers
  • Consumers of certain foods
  • Immunodeficient persons
  • Daycare attendees and their family members
  • Institutionalized persons
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47
Q

Nearly 40% of tourists to endemic regions of Latin America,
Africa, and Asia develop so-called traveler’s diarrhea, most commonly
due to __________

A

enterotoxigenic or enteroaggregative Escherichia coli as
well as to Campylobacter, Shigella, Aeromonas, norovirus, Coronavirus,
and Salmonella

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48
Q

Visitors to Russia (especially St. Petersburg) may

have increased risk of _________

A

Giardia-associated diarrhea

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49
Q

Campers, backpackers, and swimmers in

wilderness areas may become infected with __________

A

Giardia

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50
Q

Cruise ships
may be affected by outbreaks of gastroenteritis caused by agents
such as ______

A

norovirus

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51
Q

chicken

A

Salmonella, Campylobacter, or Shigella

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52
Q

undercooked hamburger

A

enterohemorrhagic

E. coli (O157:H7)

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53
Q

fried rice or other reheated food

A

Bacillus cereus

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54
Q

mayonnaise or creams

A

Staphylococcus aureus or

Salmonella

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55
Q

eggs

A

Salmonella

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56
Q

fresh or frozen uncooked foods or soft cheeses

A

Listeria

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57
Q

seafood

A

Vibrio species,

Salmonella, or acute hepatitis A

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58
Q

primary immunodeficiency

A

IgA deficiency,
common variable hypogammaglobulinemia, chronic granulomatous
disease

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59
Q

secondary immunodeficiency

states

A

AIDS, senescence, pharmacologic suppression

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60
Q

In patients with AIDS, agents
transmitted venereally per rectum or by extension from vaginal
infection (e.g., Neisseria gonorrhoeae, Treponema pallidum, Chlamydia)
may contribute to ________

A

proctocolitis

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61
Q

most common microorganism in institutionalized persons

A

C. difficile

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62
Q

Profuse, watery diarrhea secondary to small-bowel hypersecretion
occurs with _____________, _______________, ____________

A

ingestion of preformed bacterial toxins

enterotoxin-
producing bacteria

enteroadherent pathogens

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63
Q

Diarrhea
associated with marked vomiting and minimal or no fever may occur
abruptly within a few hours

A

ingestion of preformed bacterial toxins

enterotoxin-
producing bacteria

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64
Q

vomiting is usually less, abdominal cramping or bloating is greater,
and fever is higher

A

enteroadherent pathogens

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65
Q

cause high fever and abdominal pain

A

Cytotoxin-producing and invasive

microorganisms

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66
Q

cause bloody diarrhea

A

Invasive

bacteria and Entamoeba histolytica

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67
Q

bloody diarrhea

A

dysentery

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68
Q

invades the terminal ileal and proximal colon
mucosa and may cause especially severe abdominal pain with tenderness
mimicking acute appendicitis

A

Yersinia

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69
Q

Reactive arthritis (formerly known as Reiter’s syndrome),
arthritis, urethritis, and conjunctivitis may accompany or follow infections
by _______, ____________, ________, _______.

A

Salmonella, Campylobacter, Shigella, and Yersinia

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70
Q

may

also lead to an autoimmune-type thyroiditis, pericarditis, and glomerulonephritis.

A

Yersiniosis

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71
Q

can
lead to the hemolytic-uremic syndrome with an attendant high mortality
rate

A

enterohemorrhagic E. coli (O157:H7) and Shigella

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72
Q

recognized as

a complication of infectious diarrhea

A

postinfectious IBS

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73
Q

may precede the diagnosis of celiac disease or Crohn’s disease

A

acute gastroenteritis

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74
Q

most
common noninfectious causes of acute diarrhea, and etiology may be
suggested by a temporal association between use and symptom onset

A

Side effects from medications

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75
Q

frequently incriminated medications that may produce diarrhea

A

antibiotics, cardiac antidysrhythmics,
antihypertensives, nonsteroidal anti-inflammatory drugs
(NSAIDs), certain antidepressants, chemotherapeutic agents, bronchodilators,
antacids, and laxatives

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76
Q

typically occurs in persons aged >50 years; often presents as
acute lower abdominal pain preceding watery, then bloody diarrhea;
and generally results in acute inflammatory changes in the sigmoid or
left colon while sparing the rectum

A

Occlusive or nonocclusive ischemic

colitis

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77
Q

Indications for evaluation in acute diarrhea

A

profuse diarrhea with
dehydration,
grossly bloody stools,
fever ≥38.5°C (≥101°F)
duration
>48 h without improvement, recent antibiotic use, new community
outbreaks, associated severe abdominal pain in patients aged
>50 years, and elderly (≥70 years) or immunocompromised patients

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78
Q

cornerstone of diagnosis in those suspected of severe acute

infectious diarrhea

A

microbiologic analysis of the stool

79
Q

Workup

included in microbiologic analysis of the stool

A

cultures for bacterial and viral pathogens; direct inspection
for ova and parasites; and immunoassays for certain bacterial toxins
(C. difficile), viral antigens (rotavirus), and protozoal antigens (Giardia,
E. histolytica)

80
Q

Persistent diarrhea is commonly due to _____ (Chap. 218),
but additional causative organisms that should be considered
include _____ (especially if antibiotics had been administered),
E. histolytica, Cryptosporidium, Campylobacter

A

Giardia

C. difficile

81
Q

If stool
studies are unrevealing, _________ with biopsies and
________ with duodenal aspirates and biopsies may be
indicated

A

flexible sigmoidoscopy

upper endoscopy

82
Q

abrupt-onset diarrhea that persists for at least
4 weeks, but may last 1–3 years, and is thought to be of infectious
origin

A

Brainerd diarrhea

83
Q

appropriate in patients with uncharacterized
persistent diarrhea to exclude IBD or as an initial approach in patients
with suspected noninfectious acute diarrhea such as might be caused
by ischemic colitis, diverticulitis, or partial bowel obstruction

A

Structural examination by sigmoidoscopy, colonoscopy, or

abdominal computed tomography (CT) scanning

84
Q

central importance to

all forms of acute diarrhea

A

Fluid and electrolyte replacement

85
Q

should be instituted promptly
with severe diarrhea to limit dehydration, which is the major cause
of death

A

Oral sugar-electrolyte solutions (iso-osmolar sport

drinks or designed formulations)

86
Q

group of people that needs IV rehydration during acute diarrhea

A

Profoundly dehydrated patients, especially infants and the

elderly

87
Q

In moderately severe nonfebrile and nonbloody diarrhea,
antimotility and antisecretory agents such as _______ can be
useful adjuncts to control symptoms

A

loperamide

88
Q

loperamide should be avoided with _______, which may be exacerbated or prolonged by
them.

A

febrile dysentery

89
Q

may reduce symptoms of vomiting
and diarrhea but should not be used to treat immunocompromised
patients or those with renal impairment because of the risk of
bismuth encephalopathy.

A

Bismuth subsalicylate

90
Q

Many physicians treat moderately to severely ill patients with
febrile dysentery empirically without diagnostic evaluation using a
quinolone, such as _______________

A

ciprofloxacin (500 mg bid for 3–5 d).

91
Q

Empirical

treatment can also be considered for suspected giardiasis with ______________.

A

metronidazole

250 mg qid for 7 d

92
Q

Because of resistance to first-line treatments, newer agents
such as ________ may be required for Giardia and Cryptosporidium
infections.

A

nitazoxanide

93
Q

may reduce the frequency of traveler’s

diarrhea

A

Bismuth subsalicylate

94
Q

Antibiotic prophylaxis is only indicated for certain patients
traveling to high-risk countries in whom the likelihood or seriousness
of acquired diarrhea would be especially high, including those with
_____________

A

immunocompromise, IBD, hemochromatosis, or gastric achlorhydria

95
Q

may reduce bacterial

diarrhea in such travelers by 90%

A

ciprofloxacin, azithromycin, or rifaximin

96
Q

is not suitable for
invasive disease but rather as treatment for uncomplicated traveler’s
diarrhea.

A

rifaximin

97
Q

most of the causes

of chronic diarrhea are ________.

A

noninfectious

98
Q

are due to derangements

in fluid and electrolyte transport across the enterocolonic mucosa

A

Secretory diarrheas

99
Q

They are characterized clinically by watery, large-volume fecal outputs
that are typically painless and persist with fasting

A

Secretory diarrheas

100
Q

are the most common secretory causes of chronic diarrhea

A

Side effects from regular ingestion of drugs and toxins

101
Q

may cause a secretory-type diarrhea due to enterocyte
injury with impaired sodium and water absorption as well as rapid
transit and other alterations

A

Chronic ethanol

consumption

102
Q

is associated with diarrhea due to sprue-like

enteropathy

A

oral angiotensin-receptor

blocker, olmesartan

103
Q

These
conditions may result in a secretory-type diarrhea because of inadequate
surface for reabsorption of secreted fluids and electrolytes

A

BOWEL RESECTION, MUCOSAL DISEASE, OR ENTEROCOLIC FISTULA

104
Q

this subset of conditions tends to

worsen with eating

A

BOWEL RESECTION, MUCOSAL DISEASE, OR ENTEROCOLIC FISTULA

105
Q

bile acids are functionally malabsorbed from a

normal-appearing terminal ileum

A

idiopathic secretory diarrhea or bile acid diarrhea

BAD

106
Q

diseases that are present with bile acid diarrhea

A

Crohn’s ileitis or resection of

<100 cm of terminal ileum

107
Q

may

paradoxically lead to increased fecal output due to fluid hypersecretion

A

Partial bowel obstruction, ostomy stricture, or fecal impaction

108
Q

may produce
watery diarrhea alone or as part of the carcinoid syndrome that comprises
episodic flushing, wheezing, dyspnea, and right-sided valvular
heart disease.

A

Metastatic gastrointestinal

carcinoid tumors or, rarely, primary bronchial carcinoids

109
Q

Diarrhea is due to the release into the circulation of

potent intestinal secretagogues including ____________

A

serotonin, histamine, prostaglandins,
and various kinins

SHPK

110
Q

one of the most common neuroendocrine tumors, most typically
presents with refractory peptic ulcers, but diarrhea occurs in up
to one-third of cases and may be the only clinical manifestation in 10%

A

Gastrinoma

111
Q

While other secretagogues released with gastrin may play a role, the
diarrhea most often results from ___________ by low intraduodenal pH

A

fat maldigestion owing to pancreatic

enzyme inactivation

112
Q

watery diarrhea

hypokalemia achlorhydria syndrome

A

pancreatic cholera

113
Q

non-β cell pancreatic adenoma

A

VIPoma

114
Q

secretory diarrhea in pancreatic cholera is often massive
with stool volumes ____; daily volumes as high as ____ have been
reported.

A

> 3 L/d

20 L

115
Q

may present with watery diarrhea caused by

calcitonin, other secretory peptides, or prostaglandins

A

Medullary

carcinoma of the thyroid

116
Q

may be associated with the skin lesion urticaria pigmentosa, may cause diarrhea that is either secretory and
mediated by histamine or inflammatory due to intestinal infiltration
by mast cells

A

Systemic mastocytosis

117
Q

may rarely be associated
with a secretory diarrhea that may cause hypokalemia, can be inhibited
by NSAIDs, and are apparently mediated by prostaglandins

A

colorectal villous adenomas

118
Q

defective Cl−/HCO3

− exchange with alkalosis

A

congenital

chloridorrhea

119
Q

defective Na+/H+ exchange

A

congenital sodium diarrhea

120
Q

Some hormone deficiencies may be associated with watery diarrhea,
such as occurs with _________
that may be accompanied by skin hyperpigmentation

A

adrenocortical insufficiency (Addison’s disease)

121
Q

occurs when ingested, poorly
absorbable, osmotically active solutes draw enough fluid into the
lumen to exceed the reabsorptive capacity of the colon

ceases with fasting or with discontinuation of the
causative agent

A

Osmotic diarrhea

122
Q

Ingestion of ________ may induce osmotic diarrhea typified

by a stool osmotic gap

A

magnesium-containing antacids,

health supplements, or laxatives

123
Q

One of the
most common causes of chronic diarrhea in adults is _________,
which affects three-fourths of nonwhites worldwide and 5–30% of
persons in the United States; the total lactose load at any one time
influences the symptoms experienced.

A

lactase deficiency

124
Q

are frequently malabsorbed,
and diarrhea ensues with ingestion of medications, gum, or
candies sweetened with these poorly or incompletely absorbed sugars

A

sorbitol, lactulose, or fructose

125
Q

osmotic diarrhea with a low pH

A

Carbohydrate malabsorption

126
Q

recognized as symptoms of non-celiac gluten intolerance
(which is associated with impaired intestinal or colonic barrier
function) and intolerance of fermentable oligosaccharides, disaccharides,
monosaccharides, and polyols (FODMAPs).

A

Chronic diarrhea, bloating, and

abdominal pain

127
Q

may lead to greasy,
foul-smelling, difficult-to-flush diarrhea often associated with weight
loss and nutritional deficiencies due to concomitant malabsorption
of amino acids and vitamins.

A

Fat malabsorption

128
Q

steatorrhea

A

stool fat exceeding the normal 7 g/d

129
Q

rapid-transit diarrhea

A

fecal fat up to 14 g/d

130
Q

average daily fecal fat of small-intestinal diseases

A

15–25 g

131
Q

average daily fecal fat of pancreatic exocrine

insufficiency

A

> 32 g

132
Q

these diseases may produce steatorrhea

A

Intraluminal maldigestion, mucosal malabsorption, or

lymphatic obstruction

133
Q

This condition most commonly results
from pancreatic exocrine insufficiency, which occurs when >90% of
pancreatic secretory function is lost

A

INTRALUMINAL MALDIGESTION

134
Q

usually a

sequel of ethanol abuse, most frequently causes pancreatic insufficiency.

A

Chronic pancreatitis

135
Q

this may deconjugate bile acids and alter micelle formation, impairing fat
digestion

A

Bacterial overgrowth

136
Q

Bacterial overgrowth in the small intestine occurs with _____

A

blind-loop, small-bowel diverticulum

or dysmotility and is especially likely in the elderly

137
Q

mucosal malabsorption most commonly occurs from ______

A

celiac disease

138
Q

gluten-sensitive enteropathy affects all ages and is characterized by
villous atrophy and crypt hyperplasia in the proximal small bowel and
can present with fatty diarrhea associated with multiple nutritional deficiencies
of varying severity

A

celiac disease

139
Q

frequently presents
without steatorrhea, can mimic IBS, and has many other GI and extraintestinal
manifestations

A

celiac disease

140
Q

may produce a similar histologic
and clinical syndrome with celiac disease but occurs in residents of or travelers to tropical
climates;

abrupt onset and response to antibiotics suggest an infectious
etiology

A

Tropical sprue

141
Q

due to the bacillus Tropheryma whipplei and
histiocytic infiltration of the small-bowel mucosa, is a less common
cause of steatorrhea that most typically occurs in young or middle-aged
men;

it is frequently associated with arthralgias, fever, lymphadenopathy,
and extreme fatigue, and it may affect the CNS and endocardium

A

Whipple’s disease

142
Q

a rare defect of chylomicron formation and fat malabsorption in
children, associated with acanthocytic erythrocytes, ataxia, and retinitis
pigmentosa.

A

Abetalipoproteinemia

143
Q

unique constellation of fat malabsorption
with enteric losses of protein (often causing edema) and lymphocytopenia.
Carbohydrate and amino acid absorption are preserved

A

POSTMUCOSAL LYMPHATIC OBSTRUCTION

144
Q

POSTMUCOSAL LYMPHATIC OBSTRUCTION is due to ________

A

rare congenital intestinal lymphangiectasia
or to acquired lymphatic obstruction secondary to trauma, tumor, cardiac
disease or infection

145
Q

generally
accompanied by pain, fever, bleeding, or other manifestations of
inflammation.

A

Inflammatory diarrheas

146
Q

unifying feature on stool analysis of inflammatory diarrhea

A

presence of leukocytes or

leukocyte-derived proteins such as calprotectin

147
Q

generalized edema

A

anasarca

148
Q

among the most common organic causes of chronic diarrhea in adults
and range in severity from mild to fulminant and life-threatening under idiopathic inflammatory bowel disease

A

Crohn’s disease and chronic ulcerative colitis

149
Q

They may be associated with uveitis, polyarthralgias, cholestatic liver
disease (primary sclerosing cholangitis), and skin lesions (erythema
nodosum, pyoderma gangrenosum)

A

Crohn’s disease and chronic ulcerative colitis

150
Q

cholestatic liver

disease

A

primary sclerosing cholangitis

151
Q

skin lesions in Crohn’s disease and chronic ulcerative colitis

A

erythema

nodosum, pyoderma gangrenosum

152
Q

an increasingly recognized cause
of chronic watery diarrhea, especially in middle-aged women and
those on NSAIDs, statins, proton pump inhibitors (PPIs), and selective
serotonin reuptake inhibitors (SSRIs

biopsy of a normal-appearing
colon is required for histologic diagnosis.

typically responds well to anti-inflammatory drugs (e.g., bismuth),
the opioid agonist loperamide, or to budesonide

A

Microscopic colitis, including both

lymphocytic and collagenous colitis

153
Q

diarrhea that is
particularly prevalent and often the result of giardiasis, bacterial overgrowth,
or sprue

A

selective IgA

deficiency or common variable hypogammaglobulinemia

154
Q

disease that presents diarrhea, pain, vomitting, or ascites

A

EOSINOPHILIC GASTROENTERITIS

hx of atopy, charcot-leyden crystals

155
Q

may accompany many diarrheas
as a secondary or contributing phenomenon, but primary dysmotility
is an unusual etiology of true diarrhea

A

Rapid transit

156
Q

stool features of rapid transit

A

secretory diarrhea

157
Q

may produce hypermotility with resultant

diarrhea

A

Hyperthyroidism, carcinoid syndrome, and certain drugs (e.g., prostaglandins,
prokinetic agents)

158
Q

may lead to stasis with secondary bacterial

overgrowth causing diarrhea

A

Primary visceral neuromyopathies or idiopathic acquired

intestinal pseudoobstruction

159
Q

often accompanied
by peripheral and generalized autonomic neuropathies, may occur in
part because of intestinal dysmotility.

A

Diabetic diarrhea

160
Q

characterized by disturbed intestinal and colonic motor
and sensory responses to various stimuli.

Symptoms of stool frequency
typically cease at night, alternate with periods of constipation, are
accompanied by abdominal pain relieved with defecation, and rarely
result in weight loss.

A

IBS

161
Q

accounts for up to 15% of unexplained

diarrheas referred to tertiary care centers.

A

Factitial diarrhea

162
Q

deception or self-injury for secondary gain

A

Munchausen syndrome

163
Q

causes of factitial diarrhea

A

Munchausen syndrome
eating disorders, some patients covertly self-administer laxatives alone
or in combination with other medications (e.g., diuretics) or surreptitiously
add water or urine to stool sent for analysis

164
Q

_______ and ________

are common co-presenting features in factitial diarrhea

A

hypotension and hypokalemia

165
Q

Measuring IgA

tissue transglutaminase antibodies may help detect _______

A

celiac disease

166
Q

confirmed by a scintigraphic radiolabeled bile

acid retention test

A

Bile acid diarrhea

167
Q

chronic watery diarrhea, which

ceases with fasting in an otherwise healthy young adult, may justify a trial of a ___________

A

lactose-restricted diet

168
Q

bloating and diarrhea persisting
since a mountain backpacking trip may warrant a trial of ________
for likely giardiasis

A

metronidazole

169
Q

postprandial diarrhea persisting
following resection of terminal ileum might be due to bile acid
malabsorption and be treated with __________
before further evaluation.

A

cholestyramine or colesevelam

170
Q

Patients suspected of
having IBS should be initially evaluated with __________
with colorectal biopsies to exclude IBD, or particularly microscopic
colitis

A

flexible sigmoidoscopy

171
Q

Any patient
who presents with chronic diarrhea and hematochezia should be
evaluated with _______________

A

stool microbiologic studies and colonoscopy.

172
Q

If stool weight is _______, additional stool analyses
should be performed that might include electrolyte concentration,
pH, occult blood testing, leukocyte inspection (or leukocyte protein
assay), fat quantitation, and laxative screens

A

> 200 g/d

173
Q

the most sensitive test for giardiasis

A

Giardia antigen

assay

174
Q

two most common

causes of osmotic diarrhea

A

lactose intolerance and magnesium ingestion

175
Q

Low fecal pH suggests _______

A

carbohydrate malabsorption

176
Q

can be confirmed by lactose breath testing or by a
therapeutic trial with lactose exclusion and observation of the effect
of lactose challenge (e.g., a liter of milk).

A

lactose

malabsorption

177
Q

should be suspected by the

presence of blood or leukocytes in the stool

A

Chronic inflammatory-type diarrheas

178
Q

Whipple’s disease or tropical sprue treatment

A

antibiotic administration

179
Q

trmt for lactase deficiency

A

elimination of dietary lactose

180
Q

trmt for celiac sprue

A

elimination of gluten

181
Q

trmt for idiopathic IBDs

A

use of glucocorticoids or other anti-inflammatory agents

182
Q

trmt for bile acid malabsorption

A

use of bile acid sequestrants

183
Q

trmt for gastric hypersecretion of gastrinomas

A

PPIs

184
Q

trmt for malignant carcinoid

syndrome

A

somatostatin analogues such as octreotide

185
Q

trmt for medullary

carcinoma of the thyroid

A

prostaglandin inhibitors such as indomethacin

186
Q

trmt for pancreatic insufficiency

A

pancreatic enzyme replacement

187
Q

often

helpful in mild or moderate watery diarrhea

A

Mild opiates, such as diphenoxylate or loperamide

188
Q

trmt for those with more

severe diarrhea, _______ may be beneficial

A

codeine or tincture of opium

189
Q

should be avoided with severe IBD, because toxic

megacolon may be precipitated

A

antimotility agents

190
Q

may allow control of diabetic diarrhea, although the medication
may be poorly tolerated because it causes postural hypotension

A

Clonidine, an α2-adrenergic agonist

191
Q

may relieve

diarrhea and urgency in patients with IBS diarrhea

A

5-HT3 receptor antagonists (e.g., alosetron, ondansetron

192
Q

may induce sphincter of Oddi spasm and subsequent

acute pancreatitis, usually in patients with prior cholecystectomy

A

eluxadoline

193
Q

For all patients with chronic diarrhea, ___________

is an important component of management

A

fluid and electrolyte repletion

194
Q

___________ may also be necessary

in patients with chronic steatorrhea

A

Replacement of fat-soluble vitamins

Internal Medicine (3 decks)

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