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Gastrointestinal > Clinic-Diarrhea > Flashcards

Clinic-Diarrhea Flashcards

1
Q

diarrhea symptoms vary dramatically, but diarrhea as a diagnostic SIGN is defined as?

A

stool weight >150-200 grams per 24 hours

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2
Q

chronic diarrhea lasts more than ____ weeks and is (more/less) likely to be infectious in etiology

A

3; less

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3
Q

acute diarrhea is usually caused by _______ and lasts less than?

A

self-limiting infection; 2-3 weeks

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4
Q

half of the episodes of infectious diarrhea in the US are due to?

A

epidemics with contaminated food or water

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5
Q

major bacterial causes of infectious diarrhea

A

salmonella, shigella, campy, e coli, c diff

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6
Q

major viral causes of infectious diarrhea

A

noravirus, rotavirus, adenovirus, astrovirus

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7
Q

major protozoan causes of infectious diarrhea

A

cryptosporidium, giardia, cyclospora, entamoeba

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8
Q

mechanism of infectious diarrhea

A

direct tissue destruction OR pre-formed toxin mediates secretion

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9
Q

most cases of acute infectious diarrhea are (bacterial/viral/protozoa)

A

viral

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10
Q

if sx of food borne illness present within 6 hours then it must be?

A

preformed toxin (staph, bacillus)

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11
Q

sx that begin more than 16 hours after infection are ____

A

viral or bacterial (direct tissue destruction)

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12
Q

incubation of 8-72 hours is common with ___toxins

A

cyto- or enterotoxins (ETEC, cholera) = fluid secretion from cells

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13
Q

presentation of bacterial enteritis

A

diarrhea, volume depletion, N/V, fever

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14
Q

bacterial enteritis that presents with distended, silent bowel may be?

A

toxic megacolon

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15
Q

warning signs that warrant testing of infectious diarrhea

A

systemic toxicity, severe pain, dehydration, bloody stools, >24 hours of sx

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16
Q

a sigmoidoscopy should be obtained only if sx last for ____

A

several days

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17
Q

name 5 categories of chronic diarrhea

A

osmotic, fatty, secretory, inflammatory, motility (IBS)

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18
Q

pathophysiology of osmotic diarrhea

A

osmotic load in intestine results in retention of water in the lumen (i.e. sorbitol, non-digestive foods)

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19
Q

pathophysiology of secretory diarrhea

A

excess secretion of electrolytes and water into the intestinal lumen

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20
Q

pathophysiology of inflammatory diarrhea

A

exudation of fluid and protein from intestinal mucosa

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21
Q

pathophysiology of motility-related diarrhea

A

rapid transit through the colon (i.e. caffeine)

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22
Q

an avg of ___ liters a day are delivered to the GI tract, of which only ___ liters are consumed

A

9; 2

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23
Q

the majority of water is absorbed in the (small/large) intestine

A

small

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24
Q

bacterial enteritis that presents with distended, silent bowel may be?

A

toxic megacolon

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25
Q

bacterial enteritis infecting the _____ produces large volume diarrhea without tenesmus

A

small intestine

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26
Q

bacterial enteritis affecting the _____ produces frequent, small volume, bloody diarrhea

A

large intestine

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27
Q

steatorrhea is a subset of what category of diarrhea?

A

osmotic/malabsorptive

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28
Q

in osmotic diarrhea, ____ do not account for all of the water secreted in stool

A

electrolytes

29
Q

osmotic diarrhea is due to one of these two major causes

A

mucosal disease (damage to bowl = malabsorption); osmotic agents in lumen

30
Q

name three mucosal diseases of the small intestine that cause osmotic diarrhea

A

celiac, tropical sprue, whipple’s disease

31
Q

name 2 mucosal diseases of the colon that cause osmotic diarrhea

A

IBD, infections

32
Q

name two causes of increased osmotic agents in the lumen

A

malabsorption or exogenous agents

33
Q

name two causes of malabsorption leading to osmotic diarrhea

A

pancreatic insufficiency (enzymes can’t break down food) or small bowel bacterial overgrowth

34
Q

name exogenous agents that cause osmotic diarrhea

A

laxative, sorbitol, fructose/lactose in pts with specific enzyme deficiency

35
Q

how severe must pancreatic insufficiency be in order to cause steatorrhea?

A

SEVERE, greater than 90% decrease in secretions

36
Q

name 5 causes of pancreatic insufficiency

A

chronic alcoholism pancreatitis, CF, pancreatic resection, pancreatic cancer in certain locations, somatostatinoma

37
Q

how to dx pancreatic insufficiency

A

stool studies show fat, decreased fat soluble vitamins (DAKE)

38
Q

what causes bacterial overgrowth in the small bowel

A

decreased transit time due to motility disorders, diverticulae, strictures, diabetes

39
Q

dx of bacterial overgrowth

A

small bowel follow-through, hydrogen breath test (use sucrose), empiric abx trial

40
Q

osmotic diarrhea _____ with fasting while secretory diarrhea ____

A

goes away/decreases, continues

41
Q

secretory diarrhea is due to?

A

stimulated secretion of intestinal cells

42
Q

secretory diarrhea is associated with what major sx and major lab finding

A

substantially elevated stool volumes; hypokalemia

43
Q

what channel is involved in secretory diarrhea? What ion is secreted?

A

CFTR, increase in cAMP leads to opening of CFTR and increased chloride secretion

44
Q

MoA of cholera toxin

A

B subunit binds, A subunit enters enterocyte and catalyzes persistent activation of adenylate cyclase (constitutive opening of CFTR)

45
Q

name 4 bacterial toxins that cause secretory diarrhea

A

vibrio cholerae, c diff, e coli, shigella

46
Q

____ tumors (name 3) can also cause increased secretion

A

endocrine (VIPoma, gastrinoma, carcinoid)

47
Q

inflammatory cell products can cause what type of diarrhea

A

secretory

48
Q

plasma osmolarity is normally

A

290

49
Q

equation for the stool osmotic gap

A

290 - 2(stool Na + stool K)

50
Q

osmotic diarrhea is defined by an osmotic gap greater than ____ which stool Na less than ___

A

100; 60

51
Q

secretory diarrhea tends to have a ___ osmotic gap and a ___ sodium (Na)

A

low; high

52
Q

in inflammatory diarrhea, _____ leads to increased permeability, while _______ lead to stimulated secretion and inhibited absorption

A

mucosal destruction; cytokines

53
Q

4 features associated with inflammatory diarrhea

A

WBCs in stool, blood in stool, fever, tenesmus

54
Q

what are the two major causes of inflammatory diarrhea

A

IBD, infections

55
Q

name 4 infections that cause destruction and thus inflammatory diarrhea

A

EIEC, shigella, salmonella, c diff

56
Q

c diff is (aerobic/anaerobic) and gram (positive/negative)

A

anaerobic, gram positive

57
Q

pathophysiology of c diff

A

2 primary toxins leads to increased epithelial permeability, cytokine secretion, infiltration of inflammatory cells, and cell death

58
Q

dx of c diff

A

toxin assay, PCR, endoscopy (pseudomembranous colitis)

59
Q

blood workup for diarrhea

A

CBC, ESR, electrolytes

60
Q

stool studies for diarrhea

A

c diff toxin, bacterial screen, ova/parasites, electrolytes, WBCs, lactoferrin/calprotectin

61
Q

what do lactoferrin/calprotectin detect?

A

inflammation (IBD?); neutrophil derived proteins measured with ELISA

62
Q

this test looks for fat in the stool

A

sudan stain (looks orange-brown)

63
Q

this tests for bacterial overgrowth and/or lactase deficiency

A

breath hydrogen tests

64
Q

special media are required to detect?

A

aeromonas and pleisiomonas (from well water, fresh ponds)

65
Q

for what two diseases might you do a capsule endoscopy?

A

Crohn’s dz, celiac dz (small bowel processes)

66
Q

thick folds on capsule endoscopy suggest?

A

celiac dz

67
Q

the immune response produced in celiac dz is (innate/adaptive/both)

A

both

68
Q

anti-endomesial Ab, Anti TTG test for..

A

celiac dz

Gastrointestinal (40 decks)

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