Clinical- Disorders Of The Small Bowel And Colon Flashcards
What is the recommended age of testing for patients with hereditary nonpolyposis colorectal cancer
Every 1-2 years beginning at age 20-25 or 10 years younger than the youngest age in the family.
What are the most common causes of constipation in adults
Inadequate fiber or fluid intake
Poor bowel habits
Which toxins are assocaited with antibiotic assocaited colitis
TcdA and TcdB
What are the differentials for hypoalbuminemia in someone with chronic diarrhea
Malabsorption, protein losing conditions, and inflammatory conditions
What is the most effective testing method for C. Difficile
-PCR over EIA
How is perianal pruritus treated
Glucocorticoids or antifungals if needed
What are the characteristics of the turcots syndome
- adenamo colon polyps
- brain cancers
- 100% colorectal cancer over 40
Which intolerance normally accompanies celiacs
Lactose intolerance
What are the differentials for chronic diarrhea and anemia
Malabsorption syndromes and inflammatory conditions
How is lactose intolerance confirmed
hydrogen breath test
Which tests should be run to look for neuroendocrine tumors
- Serum chromogranin A
- Vasoactive intestinal peptide (VIP) (VIPoma)
- Gastrin
- 5-HIAA (carcinoid)
Which form of antibiotic association is with C. Difficile
Antibiotic assocaited colitis (not diarrhea, which is mild and self limited)
What is the clinical presentation of bacterial overgrowth
Osmotic and secretory diarrhea due to damage to the brush borders in the intestine
What is the differential for a patient with diarrhea and hyponatremia and non-anion gap metabolic acidosis
Secretory diarrhea
For lynch syndrome aka hereditary nonpolyposis colon cancer, what are lifelong risks for cancers
Colorectal cancer (22-75%) Endometrial cancer (30-60%)
What tests should be avoided in patients with diverticulitis
Colonoscopy for the risk of perforation
What is short bowel syndrome
Removal of a significant segment of the small intestine leading to malabsoprtion
What vitamins are affected due to terminal ileum resection
Bile salts and vitamin B12
What is the treatment for lynch syndrome aka hereditary nonpolyposis colon cancer
Subtotal colectomy with ileorectal anastomosis followed with surveillance
Upon performing a digital rectal exam, and you find firm feces in the rectal vault, what is possible
Stercoral ulcer
What is the result of fasting during osmotic diarrhea
Gets better
In nonfamiliar serrated polyps, what mutation doe a majority have
Kras or BRAF
What is the pathophysiology for IBS
Colonic or SI motility abnormality
Lower pain threshold to distention
How is a diagnosis of small bowel overgrowth confirmed
Breath tests for glucose or lactulose
What is the condition of perianal pruritus
Perianal itching and discomfort
What is the clinical manifestation of IBS
- Abdominal pain, and irregular bowel habits
- better with bowel movement
- Loose stool with some pain
- Sense of incomplete evacuation
The presence of which common conditions will rule out chronic diarrhea and warrant search into a different diagnosis
-Nocturnal diarrhea, weight loss, anemia, positive fecal occult blood test (FOBT)
What is acute paralytic ileum
Neurological failure or loss of peristalsis in the intestine in the abscence of mechanical obstruction
In nonfamiliar adenomatous polyps, what does the majority of cases have as the mutation
APC
What are the three reasons to not do a digital rectal exam
- No finger
- No rectum
- Leukopenia
What is dermatitis herpetiformis characterized by
Pruritic papulovesicles over the extensor surfaces of the extremities and over the trunk, scalp and neck
What are the polyps of the colon that have clinical implications aka can become colorectal cancer
Adenomatous polyps and serrated polyps
How is HSV2 diagnosed in an anorectal infection
viral culture or PCR of the vesicular fluid
In the case of terminal illeum resection, what presentations are expected
- Kidney stones (unabsorbed bile salts cause it)
- Reduced absorption of B12 leads to macrocytic anemia
- Watery diarrhea
How is postoperative ileus avoided
-No IV opiods as well as early gum chewing and initiation of clear liquid diet
What is the amount of GI needed to maintain oral nutrition
No colon, but at least 200cm of proximal jejunum
What are the clinical presentations of diverticulosis
Alternating constipation and diarrhea
Pain in the lower left quadrant, relieved by bowel movement
What is a very common cause of anorectal infections
Herpes simplex type 2
What is the clinical presentation in a patient with Whipple disease
Weight loss, arthralgias, diarrhea and abdominal pain
Which patients commonly show ogilvie syndome
Those on mechanical ventilation
What is the result of fasting on secretory diarrheas
Little change to the diarrhea amount
What is the treatment for acute colonic pseudoobstructive (ogilvie syndrome)
Conservative with no laxatives (causes complications) with radiographs every 12 hours
For lynch syndrome aka hereditary nonpolyposis colon cancer, what is the cause
DNA base pair mismatch, especially MLH1 and 2
What is IBS characterized by
Altered bowel habits
Abdominal pain
Abscess of detectable organic pathology
What is the prognosis of Whipple disease
Fatal if not treated
What are the lab findings for celiac disease
- Microcytic or macrocytic anemia
- impaired vitamin D deficiency
- Impaired fat soluble vitamins
- Hypoalbuminemia
What would low levels of fecal elastase represent
Pancreatic insufficiency
What are the two types of microscopic colitis
-Lymphocytic and collagenous colitis
What is required in a patient with no colon and less than 100-200 cm of jejunum
Parenteral nutrition
For lynch syndrome aka hereditary nonpolyposis colon cancer, what are the characteristics of the polyps that develop
Rapid transformation in 1-2 years from adenoma to cancer
What is the Sudan stain looking for
Qualitative analysis for fat
Which conditions commonly accompany celiacs disease
- Dermitits herpetiformis
- Iron deficiency anemia
- osteoporosis
What are the clinical presentations of diverticulitis
LLQ pain, fever, constipation that is now only allowing liquid to pass
What is the most sensitive testing method for Giardia and E. Histolytica
Fecal antigen testing
For lynch syndrome aka hereditary nonpolyposis colon cancer, what is the hereditabilty
Autosomal dominant
Where are bile salts reabsrobed
Terminal ileum
What are drugs that commonly cause chronic diarrhea
-SSRIs, cholinesterase inhibators, NSAIDs, PPI, ACE inhibitors, metformin, allopurinol
What are the clinical manifestations of C. difficile infection
- Mild to moderate greenish stool
- Foul smelling stool 5-15 times a day
- Lower abdominal cramps
What is the most common cause of diarrhea in young adults
Irritable bowel syndrome
How is carbohydrate malabsoprtion tested for
Hydrogen breath test
What are the characteristics of Gardner syndrome
- adenoma polyps
- 95% colorectal polyps
- osteomas of mandible, skill and long bones
- thyroid, adrenal tumors, sebaceous teeth
What can anorectal infections with chlamydia trachomatis cause
Lymphogranuloma venereum
What is the treatment for hemorrhoids
Sitz baths, stool softeners, rubber band ligations
What are the histological findings in Whipple disease
Duodenal biopsy with periodic acid Schiff (PAS) with macrophages and bacillus
What are the main causes of bacterial overgrowth
- Gastric achlorydria
- Anatomical abnormalities leading to stain
- Small intestine motility issues
- gastrocolic or coloenteric fistula
What is the recommended in women with lynch syndrome aka hereditary nonpolyposis colon cancer
Hysterectomy after 40, due to increased risk of endometrial cancers
What condition is characterized by:
-several juvenile hamartomatous polyps in the colon
Incrased risk of adenocarcinoma
Familial juvenile polyposis
Before taking a test for the antibodies involved in celiac, what should be asked
If they are still eating gluten, because if they are not, the antibodies will not be present and will give a false negative
For treponema pallidum, what testing is done for anorectal infections
Dark fired microscopy or fluorescent antibody testing from a chancre
VDRL or RPR in 75% or primary cases or 99% of secondary cases
What are the clinal presentations of a patient with chronic mesenteric insufficiency
Abdominal angina (pain after a meal that lasts for several hours), will have fear of food, weight loss
What is collagenous colitis characterized by
Thicken band of subepithelial collagen
What is the treatment for acute paralytic ileus
-Restriction of oral intake until the bowel function returns
What is acute colonic pseudoobstruction (ogilivie syndrome)
-Spontaneous massive dilation of the cecum or right colon without mechanical obstruction
What are the complications of infection with C. Difficile
- Megacolon
- respiratory failure
- metabolic acidosis
Which malabsorptions are expected with a duodenal resection
Folate, iron, calcium
What portion of the GI tract is most involved in diverticula disease
Sigmoid colon
What medications have been indicated in microscopic colitis
NSAIDs, PPI, SSRI, ACE inhibitors
How is the diagnosis of bacterial overgrowth confirmed
Jejuni aspiration with quantitative bacterial cultures
For neisseria gonorrhoeae, what testing is done for anorectal infection
Rectal swabs, pharynx and urethra, as we all as cervix for a gram stain
What is the degree of malabsorption in short bowel syndrome dependent on
-Type and degree depend on the length and location that was removed
What condition is characterized by:
-harmatomatous polyps in GI
-Trichilemmomas
Increased malignancy of thyroid, breast, and urogenital tract
Chowdrey aka PTEN Multiple hamartomatous syndrome
Which patients are commonly seen to have acute paralytic ileus
Surgery, peritonitis, electrolyte abnormalities, medication,
What condition is characterized by:
- hamartomatous polyps in GI
- pigmented nucleus on lips, buccal, and skin
Peugeot-Jeghers
What are complications of colonoscopies polypectomy
Perforation and significant bleeding
What is the result of a high (>75) osmotic gap between the measured and expected stool osmolarity
Diarrhea due to ingestion or malabsoprtion of osmotically active substance
What are the diagnostic criteria for IBS
- Improvement with defecation
- Onset association with change in frequency of stool
- Onset association with change in form of stool
What are the laboratory findings that should indicate C. Difficile
- WBC >30,000
- Albumin <2.5
- Elevated serum lactate
- rising creatinine
What is the recommended age of colon cancer testing for a patient with FAP
10-12
What are risk factors for fecal impaction
- Medications (opioids)
- Prolonged bed rest
- Spinal cord and neuro disorders
What is the best method of diagnosis for diverticulitis
CT with contrast
Which conditions will show thumbprinting sign
Aka submucosal edema seen in acute mesenteric ischemia
What is the complication associated with acute colonic pseudo-obstruction aka ogilvie syndrome
Perforation if the diameter reaches greater than 10-12 cm
What will an anal fissure look like upon inspection
Linear or rocket shaped ulcers
How is the diagnosis of bacterial overgrowth suggested
Breath test
What is the diagnostic tool used for Whipple disease
Endoscopy of the duodenum with histological evaluation
What is a drug that can readily cause ischemic colitis
Vasoconstriction drugs such as cocaine
What is the histological finding with infection of C. Difficile
Volcano exudate of fibrin and neutrophils
What are the antibiotics that are commonly associated with the C. Difficile infection
- ampicillin
- clindamycin
- 3rd gen cephalosporins
- Fluoroquinolones
How is stool osmolarity measured
(Na + K) x 2
What drug can be given in acute colonic pseudoobstructive syndrome
Neostigmine
What is the cause of secretory diarrheas
Endocrine tumors
Bile salt malabsorption
Medullary Thyroid carcinoma
