Colitis, Toxic Megacolon, & IBS Flashcards
what are 5 risk factors for infectious colitis?
immune deficiency
recent abx usage - C. diff
ingestion of undercooked foods
endemic area travel
receptive rectal intercourse
a patient with a history of Herpes presents with abdominal pain, tenderness, +/- fever, and diarrhea +/- gross blood. Dx?
infectious colitis
what is the management for infectious colitis? (4)
antibiotics or antivirals
address underlying deficiency
D/C problematic meds
STI precautions
potentially life-threating complication of IBD or infectious colitis that results in an ileus, dilation, and sepsis
toxic megacolon
what are 4 etiologies of toxic megacolon?
hypokalemia
meds: antimotility, anticholinergics, opiates, antidepressants
barium enemas
colonoscopy
a patient presents with worsening abdominal pain, worsening diarrhea + bloody or obstipation, with abdominal tenderness, +/- peritonitis, and +/- sepsis. Dx?
toxic megacolon
what diagnostic can we do to diagnose toxic megacolon? (2)
CT scan OR abdominal xray
what will we see in a CT scan or abdominal xray of a patient with toxic megacolon? (2)
colon dilation
free air in RUQ if perforation
what should we avoid doing in a patient with toxic megacolon? (2) why?
colonoscopy
sigmoidoscopy
avoid perforation
what will be seen in labs of toxic megacolon? (4)
leukocytosis
anemia
electrolyte abnormalities
+ FOBT
what are the diagnostic criteria for toxic megacolon? (3)
radiographic colon distention
+
at least 3: fever > 100.4, HR > 120, neutrophil > 10,500, anemia
+
at least 1: clinical dehydration, AMS, electrolyte disturbance, hypotension
what is the management for toxic megacolon? (5)
NPO
IV hydration
NG tube decompression OR log roll
D/C problematic meds
antibiotics
when is surgery indicated for toxic megacolon? (4)
uncontrolled bleeding
perforation
worsening toxicity
dilation
idiopathic, functional GI disorder that is characterized by chronic or recurrent symptoms with no evidence of structural or biochemical abnormalities
irritable bowel syndrome
what are the diagnostic criteria for IBS?
at least 3 months of abdominal pain
at least 1x per week
+
at least 2:
relief with bowel movement
change in stool frequency
change in stool form
a patient presents with abdominal cramps (esp. in lower abdomen), change in stool frequency or consistency, diarrhea/constipation, and does not interfere with sleep. Dx?
irritable bowel syndrome
how is irritable bowel syndrome diagnosed?
clinically
in which patients should IBS be suspected? (2)
abdominal pain
altered bowel habits
when should labs and colonoscopy be performed in a patient with suspected IBS?
if patient has red flags:
nocturnal diarrhea
hematochezia
weight loss
reported fever
FHx of cancer, IBD, or celiac disease
onset > 40 yo
what is the management for IBS? (4)
reassurance
education
support
diet
what is the 1st line treatment for IBS? (2)
exercise
increased soluble fiber in diet
what is the 2nd line treatment for IBS? (2)
TCAs
SSRIs
what is the recommended diet that should be avoided in IBS?
Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
Polyols
what med can be used for diarrhea in IBS?
rifaximin
what med can be used for constipation in IBS? (2)
lubiprostone
OR
linaclotide
