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Maddy - GI II Exam I - some pharm > Clin - Diarrhea > Flashcards

Clin - Diarrhea Flashcards

1
Q

describe the bristol stool chart

A

1: separate hard lumps
2: sausage shaped but lumpy
3: sausage but with cracks on surface
4: sausage or snake, smooth
5: soft blobs
6: fluffy pieces w/ ragged edges
7: watery

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2
Q

duration of acute and chronic diarrhea

A

acute: less than 2 weeks
chronic: more than 4 weeks

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3
Q

compare inflammatory and non-inflammatory acute diarrhea

A

inflammatory: blood or pus, fever, invasive or toxin producing bacteria, need stool culture

non-inflammatory: watery, non bloody, mild, virus or non-invasive bacteria

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4
Q

most common cause of acute diarrhea

A

90% is infectious, 75% of that is viral

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5
Q

most common cause of noninfectious acute diarrhea

A

1) medications
- most frequently antibiotics
2) artificial sweeteners
- sorbitol, chewing gum

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6
Q

antibiotic that commonly causes antibiotic-associated diarrhea

A

amoxicillin-clavulanate (augmentin)

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7
Q

top 3 causes of chronic diarrhea

A

1) medications
2) IBS
3) lactose intolerance

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8
Q

what symptoms are inconsistent with medications causing chronic diarrhea and warrant further evaluation

A

1) nocturnal diarrhea
2) weight loss
3) anemia
4) positive fecal occult blood test

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9
Q

compare osmotic gap between osmotic diarrhea and secretory diarrhea

A

osmotic: increased stool osmotic gap (50-75)
secretory: normal stool osmotic gap

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10
Q

sx osmotic diarrhea

A

abd distention, bloating, flatulence due to increased colonic gas production

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11
Q

most common causes osmotic diarrhea

A

1) medications
2) disaccharidase deficiency (lactose intolerance)
3) laxative abuse
4) malabsorption syndromes

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12
Q

sx secretory diarrhea

A

high volume watery diarrhea (>1L day)

- hyponatemia

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13
Q

causes of secretory diarrhea

A

1) endocrine tumors (zollinger ellison, carcinoid syndrome VIPoma)
2) bile salt malabsorption (ileal resection, crohn ileitis)
3) factitious diarrhea (laxative abuse)
4) villous adenoma

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14
Q

what is the sudan stain used for

A

qualitative staining for fat to test to malabsorption disorders

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15
Q

diagnostic study for most patients with chronic persistent diarrhea

A

colonoscopy with mucosal bipsy

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16
Q

what diagnostic test is performed when suspected a small intestinal malabsorptive disorder

A

upper endoscopy with small bowel biopsy

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17
Q

what fecal elastase level indicates pancreatic insufficiency (which could be causing chronic diarrhea)

A

less than 100 mcg/g

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18
Q

what breath test is used in testing for carbohydrate malabsorption (lactase deficiency)

A

hydrogen breath test

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19
Q

what diagnostic study will localize neuroendocrine tumors if present

A

somatostatin receptor scintigraphy

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20
Q

what serology test tests for VIPoma

A

vasoactive intestinal peptide (VIP)

21
Q

what serology test tests for medullary thyroid carcinoma

A

calcitonin

22
Q

what serology test tests for zollinger ellison syndrome

A

gastrin

23
Q

what serology test tests for carcinoid tumor

A

urinary 5-hydroxyindoleacetic acid (5-HIAA)

24
Q

medications that are common offenders in mediation induced diarrhea

A

1) cholinesterase inhibitors
2) SSRIs
3) angiotensin II receptor blockers
4) PPIs
5) NSAIDs
6) metformin
7) allopurinol

25
Q

common pathophysiology of IBS

A

visceral hyperalgesia to mechanoreceptor stimuli

26
Q

what psychological disturbances are associated with IBS

A

depression, hysteria, OCD

27
Q

what are the alarm symptoms associated with IBS

A

1) acute onset of sx
2) nocturnal diarrhea
3) severe constipation or diarrhea
4) hematochezia
5) weight loss
6) fever
7) FMHx of CA

28
Q

ROME IV criteria is used to diagnose what dz

A

IBS

29
Q

diagnostic criteria for IBS

A

chronic > 6 months for diagnosis, at least 3 months for it to be on a differential

30
Q

describe the ROME IV criteria for IBS

A

recurrent abd pain, on average, at least 1 day per week in the last 3 months, associated with 2+ of the following:

1) related to defecation
2) associated w/ change in frequency of stool
3) associated with change in appearance of stool

31
Q

what is the FODMAPS diet for IBS

A

fermentable oligosaccharides, disacchardies, monosaccharides, and polyols

32
Q

what pathogens are associated with CHRONIC infectious diarrhea

A

protozoans: giardia, e. histolytica, cyclospora

intestinal nematodes: strongyloidiasis stercoralis

bacteria: c. diff

33
Q

most common antibiotics that increase risk for C. diff

A

1) ampicillin
2) clindamycin
3) 3rd gen cephalosporins
4) fluoroquinolones

34
Q

etiologic agents for microscopic colitis

A

1) NSAIDs
2) PPIs
3) low dose aspirin
4) SSRI
5) ACEI
6) beta-blockers

35
Q

characteristics of malabsorption syndromes

A

1) weight loss
2) osmotic diarrhea
3) steatorrhea
4) nutritional defiicency

36
Q

SIGNS of malabsorption

A

1) loss of muscle mass or subq fat
2) pallor due to anemia
3) vitamin K deficiency
4) hyperkeratosis
5) osteomalacia
6) neurologic signs due to vitamin B12

37
Q

sx of malabsorption

A

1) diarrhea
2) steatorrhea
3) weight loss
4) abd distension
5) weakness
6) muscle wasting

38
Q

elevated fecal fat

A

malabsorption syndrome

39
Q

extraintestinal features of celiac dz

A

1) fatigue, depression
2) iron deficiency anemia
3) osteoporosis
4) short stature
5) delayed puberty
6) amenorrhea
7) reduced fertility
8) dermatitis herpetiformis

40
Q

what scan should you do on celiac pts to screen for osteroperosis

A

dual-energy x-ray densitometry

41
Q

sx of pancreatic insufficiency causing chronic diarrhea

A

1) steatorrhea
2) weight loss
3) gaseous distention and flatulence

42
Q

causes of bile salt malabsorption

A

1) bacterial overgrowth
2) massive acid hypersecretion
3) medications that bind bile salts

43
Q

signs of bile salt malabsorption

A

1) bleeding tendencies
2) osteoporosis
3) hypocalcemia
4) watery secretory diarrhea

44
Q

periodic acid schiff (PAS) test positive for macrophages with characteristic bacillus

A

whipple dz

45
Q

what type of diarrhea is common in the elderly

A

overflow diarrhea from fecal impaction

46
Q

describe fecal incontinence

A

neuromuscular disorder or structural anorectal problems causing involuntary discharge of rectal contents

47
Q

what is pseudodiarrhea

A

frequent passage of small volumes of stool

48
Q

how to diagnose fecal impaction

A

DRE

49
Q

chronic use of laxatives can lead to what endoscopic finding

A

melanosis coli

- benign hyerpigmentation of colon

Maddy - GI II Exam I - some pharm (23 decks)

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