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Clin Med: GI (block 3) > Colorectal Disorders > Flashcards

Colorectal Disorders Flashcards

1
Q

Diverticular Dz is most common in which part of the colon?

A

sigmoid colon

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2
Q

What is diverticula?

A

small outpouching in the colon

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3
Q

When diverticular gets inflamed its called….

A

diverticulitis

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4
Q

RFs of development of diverticular

A
  • incr age
  • obesity
  • lack of exercise
  • lack of fiber
  • NSAID and/or ASA
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5
Q

Average age of dx for diverticular dz

A

62 yo

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6
Q

Diverticulosis Patho

A

Chronic constipation/straining leads to pressure gradient in the abdomen, causing outpouchings

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7
Q

Diverticulitis Main S/S

A
  • abdo pain (LLQ)
  • fever (sometimes)
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8
Q

Diverticular Dz other S/S

A
  • constipation
  • N/V
  • diarrhea
  • dysuria
  • Anorexia
  • rectal bleeding
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9
Q

When do you refer a patient w/ diverticular dz?

A
  • Failure to improve w/n 72 hrs of medical management
  • (+) peridiverticular abscesses (4 cm or larger) req poss. drainage
  • Generalized peritonitis or sepsis
  • Recurrent attacks
  • Chronic complications
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10
Q

Diverticulitis patho

A

Inflammation of a diverticula caused by irritation from fecal material

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11
Q

Diverticular Dz Dx

A
  • CBC
  • CMP
  • Lipase
  • UA
  • UCG
  • CT abd/pelvis w/ IV contrast
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12
Q

Diverticular Dz PE

A
  • Fever
  • LLQ tenderness
  • (+/-) palpable mass
  • Distension
  • +/- blood on rectal or occult blood
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13
Q

Diverticular Dz Tx for mod cases

A
  • bowel rest
  • IV fluids
  • IV antibiotics
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14
Q

Diverticular Dz Tx for mild cases

A

Outpatient treatment
- Clear liquid diet
- cipro/metro
- close FU

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15
Q

Diverticular Dz Tx for severe cases

A

Surg indicated for
- generalized peritonitis
- Large abscesses that can’t be drained
- Clinical deterioration despite medical management & drainage

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16
Q

When do you admit a patient w/ diverticular dz?

A
  • Severe pain or inability to tolerate oral intake
  • Signs of sepsis or peritonitis
  • CT scan showing signs of complicated dz (abscess, perforation, obstruction)
  • Failure to improve w/ outpt management
    Immunocompromised or frail, elderly pt
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17
Q

Diverticulitis Patient Edu

A

high fiber diet

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18
Q

What are the 2 separate disease entities for IBD?

A
  • Crohn’s dz
  • Ulcerative colitis
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19
Q

Crohn’s Dz is an inflammatory dz of the…

A

GI tract

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20
Q

Patient after having Crohn’s for how long are at incr risk of colon cancer?

A

8-10 yrs

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21
Q

Where is Crohn Dz most commonly found?

A

terminal ileum

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22
Q

Crohn Dz affects which part of the GI tract

A

any segment of the GI tract
“mouth to anus”

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23
Q

Crohn Disease onset age & gender prevalence

A
  • 10-30 years old
  • women > men
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24
Q

Crohn Dz RFs

A
  • FHx
  • Smoking
  • Lower levels of physical activity
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25
Q

Crohn Dz pathophys

A
  • not exactly known
    ~ environmental, genetic, gut microbiome, immune response
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26
Q

Crohn Dz S/S

A
  • Insidious onset
  • Intermittent low-grade fever, diarrhea, & RLQ pain
  • RLQ mass & tenderness
  • Malaise
  • Diarrhea (usually non bloody)
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27
Q

Crohn Dz PE

A
  • RLQ tenderness/mass
  • Perianal dz (fistula, stricture, abscesses)
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28
Q

How does Crohn Dz look upon visualization?

A

“skin lesions” w/ “cobblestone appearance”
- Transmural lesions

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29
Q

Crohn Dz Dx Labs

A

Obtain CBC, ESR/CRP, serum albumin
- Anemia b/c chronic inflammation, blood loss, iron deficiency, or vitamin B12malabsorption
- Leukocytosis occurs w/ abscesses
- ESR/CRP elevated

Fecal calprotectin
- Excellent noninvasive test
- Elevated levels correlated w/ active inflammation as seen on ileocolonoscopy or radiologic CT or MR enterography

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30
Q

Crohn Dz Dx Imaging

A
  • CT w/ IV and oral contrast
  • Colonoscopy w/ biopsy (skin lesions, cobblestone appearance)
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31
Q

UC peak onset age & gender prevalence

A
  • 10-40yo
  • men = women
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32
Q

Crohn Dz Tx for maintenance

A
  • Mesalamine (oral or rectal)
  • Sulfasalazine
  • Immune modifying agents (Methotrexate)
  • Anti-TNF agents
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33
Q

Crohn Dz Indication for surg

A
  • No response to medical therapy
  • Intra-abdominal abscess
  • Massive bleeding
  • Obstruction w/ fibrous stricture
  • Fistula formation
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34
Q

Complications of Crohn Dz

A
  • Abscess
  • Small bowel obstruction
  • Fistulas
  • Perianal dz
  • Carcinoma
  • Hemorrhage (unusual)
  • Malabsorption
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35
Q

UC Dz is an inflammatory condition of the…

A

mucosal surface of the rectum & colon

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36
Q

Crohn Dz Tx for acute flare

A

corticosteroids

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37
Q

UC RFs

A
  • FHx
  • High fat intake
  • Inconsistent evidence regarding UC & NSAIDS
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38
Q

What is a condition characterized an abdo pain or discomfort that occurs w/ altered bowel habits?

A

Irritable Bowel Disease (Syndrome)

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39
Q

List subtypes of IBS

A
  • IBS w/ constipation
  • IBS w/ diarrhea
  • Mixed (unsubtyped) IBS
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40
Q

IBS gender prevalence & age?

A
  • women > men
  • 20-30 yo
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41
Q

IBS RFs

A
  • Depression
  • Anxiety
  • Migraines
  • Fibromyalgia
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42
Q

IBS Patho

A
  • There’s a link b/t the brain & gut b/c serotonin is made in the gut.
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43
Q

IBS S/S

A
  • subj abdo distention
  • Abdo pain, intermittent, crampy, in the lower abdomen, that may be improved or worsened by defecation
  • More frequent or less frequent stools w/ the onset of abdo pain
  • Looser stools or harder stools w/ the onset of pain
  • Constipation, diarrhea, or alternating constipation & diarrhea
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44
Q

IBS PE

A
  • usually normal
  • maybe non specific lower abdo tenderness
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45
Q

IBS Dx

A
  • rule out other patho prior to making dx
  • dx based on Hx, PE, & absence of “alarm symptoms”
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46
Q

ACG Dx Criteria for IBS syndrome

A

recurrent abdo pain or discomfort for >/=3 days/month in past 3 months w/ >/=2
- improvement w/ defeacation
- onset assoc. w/ change in stool freq or appearance

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47
Q

IBS alarm symptoms

A
  • > 60 yo w/ change in bowel habits to looser and/or more freq stools > 6wks
  • unintentional & unexplained weight loss
  • rectal bleeding
  • FHx of bowel or ovarian cancer
  • anemia
  • inflammatory markers for IBD
  • abdo or rectal mass
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48
Q

IBS Tx

A
  • For abdo pain/spasm: antispasmodics (dicyclomine, hyoscyamine)
  • SSRI
  • Antidiarrheal if needed (loperamide)
  • Fiber supplements, osmotic laxatives for constipation
  • Ondansetron for nausea
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49
Q

IBS Pt. Edu

A
  • Reassure pt
  • Consider behavioral modification w/ relaxation techniques, hypnotherapy
  • Recommend moderate exercise as helpful
  • Restrict dietary “FODMAPS” (to improve bloating, flatulence, & diarrhea in some pts)
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50
Q

Abx Associated Colitis is caused by…

A

C. diff

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51
Q

Route of transmission for Abx associated colitis?

A
  • person-to-person via fecal-oral
  • contaminated surfaces or equipment
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52
Q

How long can c. diff spores survive on dry inanimate surfaces?

A

up to 5 months

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53
Q

Abx associated colitis RFs

A
  • abx exposure
  • hospitalization or exposure to other healthcare setting
  • incr age
  • higher # of comorbidities
  • IBD
  • immunodeficiency
  • use ofPPI
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54
Q

Abx Associated Colitis Patho

A

Abx disrupts the colon microflora–> C. diff gets ingested & colonized–> either are a carrier or get the clinical dz

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55
Q

Abx associated colitis S/S

A
  • abdo pain, profuse watery diarrhea w/ up to 30 stools/day
  • stools may have mucus but seldom gross blood
  • usually low-grade fever
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56
Q

Abx associated colitis PE

A

non-specific

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57
Q

Abx associated colitis Dx options

A
  • glutamate dehydrogenase assay
  • enzyme immunoassays, which detect toxin A or toxin B
  • nucleic acid amplification tests
  • CT
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58
Q

Abx associated colitis CT may show

A
  • inflammation
  • bowel wall thickening
  • dilated colon
  • perforation
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59
Q

Abx associated colitis Standard Tx

A
  • Metronidazole (10-14 days)
    OR
  • Vanc
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60
Q

In Abx associated colitis, Tx w/ Vanc is reserved for…

A
  • Pts who are intolerant ofmetronidazole
  • Pts w/ IBD
  • Pregnant women
  • Children
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61
Q

Abx associated colitis Tx if severe

A
  • Intravenousmetronidazole:
  • Supplement w/ vanc nasoenteric tube or enema
  • Total abdo colectomy or loop ileostomy w/ colonic lavage may be required in pts w/ toxic megacolon, perforation, sepsis, or hemorrhage
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62
Q

Abx associated colitis investigational therapy

A
  • Fecal microbiota transplantation (FMT)
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63
Q

Abx associated colitis Prevention & screening

A
  • Abx stewardship
  • Infx control
  • Hand washing > alcohol hand sanitizer
  • Probiotics while taking antibiotics (DanActive twice daily)
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64
Q

What is toxic megacolon?

A

toxic colitis w/ dilation of the colon

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65
Q

What are the qualifications of toxic megacolon?

A

nonobstructive colonic dilation larger than 6 cm & signs of systemic toxicity

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66
Q

Dx Criteria for toxic megacolon

A
  • Radiographic evidence of colonic dilatation - The classic finding is > 6 cm in the transverse colon
  • Any 3 of the following - Fever (>101.5°F), tachycardia (>120 beats/min), leukocytosis (>10.5 x 103/µL), or anemia
  • Any 1 of the following - Dehydration, AMS, electrolyte abnormality, or HPTN
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67
Q

Causes of toxic megacolon

A
  • Inflammatory
  • Infectious
  • Other
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68
Q

Inflammatory causes of toxic megacolon

A
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69
Q

Infectious causes of toxic megacolon

A

Bacterial
- C. diff
- Salmonella
- Shigella
- Campylobacter
- Yersinia

Parasite
- Entameba histolytica
- Cryptosporidium

Viral
- CMV colitis

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70
Q

Other causes of toxic megacolon

A
  • Pseudomembranous colitis 2ndary to methotrexate therapy
  • Kaposi’s sarcoma
71
Q

Ischemic colitis gender prevalence & age onset

A
  • female > men
  • esp > 49yo
72
Q

Is ischemia colitis occlusive or non-occlusive?

A

non-occlusive

73
Q

Ischemic colitis precipitating events

A
  • HPTN
  • MI
  • Sepsis
  • Heart failure
  • Aortic surg
  • cocaine
74
Q

Ischemic Colitis Pathophys

A

Due to inflammation/ischemia the colon receives less blood supply compared to the rest of the GI tract

*most vulnerable during systemic HPTN

75
Q

Watershed areas during ischemic colitis

A
  • Splenic flexure
  • Rectosigmoid junction
76
Q

Ischemic colitis S/S

A
  • acute onset of mild, crampy, left sided abdo pain
  • tenesmus
  • diarrhea
  • passage of red or maroon blood w/n 12-24 hours of onset
  • symptoms of systemic response: fever, tachypnea, tachycardia, fever
77
Q

Ischemic colitis PE

A
  • tenderness
  • increasing abdo tenderness, guarding & rebound tenderness w/ gangrenous colitis
  • abdo distention
78
Q

Ischemic colitis Dx

A
  • CT scan may show segmental circumferential wall thickening or be normal
  • Colonoscopy to confirm
79
Q

Ischemic colitis primary goal of tx

A

maintaining perfusion of the colon for mild symp w/ no perf or infarction

80
Q

In Ischemic colitis tx for maintaining perfusion of the colon

A
  • digestive rest to reduce O2 requirements of colon
  • fluid & electrolyte replacement to optimize CO
  • prevention of venous thromboemb
81
Q

When is bowel resection indicated in ischemic colitis?

A
  • if peritoneal signs
  • symp persisting > 2wks or
  • severe complications (perf or infarction on CT or colonoscopy)
82
Q

Most LBO are due to…

A

neoplasm (usually colon, but can be ovary, pancreatic, or lymphoma)

83
Q

LBO tx

A

most require surg intervention

84
Q

What are colon polyps?

A

growths that arise from epithelial cells lining the colon

85
Q

Which type of colorectal polyps put pts are higher risk of colon cancer?

A

adenomatous polyps

86
Q

Colon polyps epidemiology

A
  • middle aged & elderly
  • screening & autopsy
87
Q

Colon polyps RFs

A
  • Older age
  • FHx
  • Diet: Animal fats in red meat, incr conversion of normal bile acids to carcinogens
  • UC
  • Excess body weight
  • Mod to heavy etoh consumption
88
Q

Colon polyps S/S

A
  • Usually asymp
  • Pts may experience overt or occult rectal bleeding.
  • Change in bowel habits
89
Q

For colon polyps, repeat colonoscopy depends on…

A

type & number of polyps

90
Q

Describe repeat colonoscopy requirement for colon polyps

A
  • Every 5-10 yrs for those w/ 1-2 small tubular adenomas w/ low-grade dysplasia after initial polypectomy
  • Every 3 yrs for pts w/ 3-10 adenomas or 1 adenoma > 1 cm or any adenoma w/ villous features or high-grade dysplasia
  • > every 3 years for pts w/ > 10 adenomas
  • At 2 to 6 months to verify complete removal in pts w/ sessile adenomas that are removed piecemeal
91
Q

What is FamilialAdenomatous
Polyposis?

A

An inherited condition characterized by early development of 100s to 1000s of colonic adenomatous polyps & adenocarcinoma

92
Q

FamilialAdenomatous
Polyposis Tx

A

Prophylactic colectomy recommended to prevent otherwise inevitable colon cancer

93
Q

Colorectal cancers are almost all…

A

adenocarcinomas

94
Q

Colorectal age seen & gender

A

> /= 60 yo
men > women

95
Q

Colorectal cancer RFs

A
  • age
  • FHx
  • IBD
  • high meat/low fiber diet,
96
Q

Colorectal cancer pathophys

A

growths that arise from epithelial cells of the colorectal mucosa

97
Q

Colorectal Cancer primary symptoms

A
  • rectal bleeding w/o anal symp (soreness, discomfort, itching, lumps, or pain)
  • occult blood in stool
  • change in bowel habit to looseness or incr frequency
98
Q

Colorectal Cancer other non-specific symptoms

A
  • fatigue
  • weight loss
  • generalized or localized abdo pain
  • symp of iron deficiency & anemia, such as shortness of breath & pale appearance
99
Q

Colorectal Cancer PE

A
  • abdo mass
  • signs of intestinal obstruction, such as distention or pain
  • assess for lymphadenopathy
  • assess for hepatomegaly & ascites
  • may present w/ palpable rectal mass
100
Q

Colorectal Cancer Dx

A
  • CBC may reveal IDA
  • Elevated liver biochemical tests, esp serum ASP, are suspicious for metastatic dz
  • Carcinoembryonic antigen (CEA) may be elevated & is used to monitor colorectal cancer
  • Colonoscopy for dx & biopsy/staging
  • CT or MRI chest/abdo/pelvis for staging
101
Q

Colorectal Cancer Tx

A
  • Surgery
    —> resection of primary colonic or rectal cancer
    —> regional lymph node removal to determine staging
    —> for metastatic dz, resection of liver or lung metastases
  • Chemotherapy
  • Tx largely dependent on TNM staging
102
Q

5-year survival rates w/ dz at all stages

A

65%

103
Q

5-year survival rates w/ localized dz

A

90%

104
Q

5-year survival rates w/ regional dz

A

71%

105
Q

5-year survival rates w/ distant stage dz

A

14%

106
Q

Constipation description

A

persistent, difficult, infrequent, or seemingly incomplete defecation

107
Q

Types of Constipation

A
  • functional
  • slow transit
  • Defacatory dysfunction/disorder
108
Q

Constipation alarm symp for colorectal cancer

A
  • rectal bleeding
  • change in caliber of stools
  • blood in stool
  • weight loss
  • anemia
  • FHx of colorectal cancer
109
Q

Constipation PE

A
  • Usually unremarkable
  • May have abdo distension
  • May have firm stool on rectal exam
110
Q

In healthy pts w/ constipation, under age 50 w/o alarm symp it is reasonable to initiate…

A

a trial of empiric treatment without diagnostic tests

111
Q

Further dx tests for constipation should be performed in…

A
  • Pts age > 50 yo
  • Pts of any age w/
    –> Severe constipation
    –> Hematochezia
    –> Weight loss
    –> (+) fecal occult blood or fecal immunochemical tests
  • (+) FHx of colon cancer or IBD
  • No response to empiric tx
112
Q

Constipation Dx

A
  • Anorectal manometry
  • Colonic transit study
  • Colonoscopy if alarm symptoms
  • Abdo XR & CT
113
Q

Constipation Tx

A
  • Fiber (psyllium, bran)
  • Stool Surfactants (Docusate sodium, mineral oil)
  • Osmotic Laxatives (PEG, magnesium hydroxide)
  • Stimulant Laxatives (Senna)
  • Enemas (sodium phosphate, mineral oil)
  • “special enemas”: soap suds, milk & molasses
114
Q

Constipation Pt Edu

A
  • High fiber diet
  • Incr activity
  • Regular toileting
  • Do not hold defecation
115
Q

Define fecal impaction

A

severe bowel condition where hard, dry mass ofstoolbecomes stuck in the colon or rectum

116
Q

What doesn’t treat fecal impaction?

A

laxatives or enemas

117
Q

Can you have diarrhea w/ fecal impaction?

A

yes

118
Q

Fecal impaction dx

A

rectal exam

119
Q

Fecal impaction tx

A

dis-impacted

120
Q

Differentiate internal vs external hemorrhoids

A
  • internal–> dilation above the dentate line
  • external–> dilation below the dentate line
121
Q

Hemorrhoids peak prevalence age, common during?

A
  • 45 - 65yo
  • preg & childbirth
122
Q

Hemorrhoids patho (commonly cited factors)

A
  • exact etiology unknown
  • constipation & chronic straining at defecation
  • factors that incr intra-abdo pressure (pregnancy or cirrhosis w/ascites, straining
123
Q

Hemorrhoids S/S

A
  • Bright red blood on the toilet paper or in the toilet after BM
  • Internal hemorrhoids (painless)
  • External hemorrhoids (painful) esp if thrombosed
  • Anal itching
  • Feeling of mass or fullness
124
Q

Hemorrhoids Dx

A
  • typically made clinically in pts w/hx of anal symp (bleeding, itching, or prolapse of tissue
  • Visual inspection
  • anoscopy is req to confirm or exclude dx of internal hemorrhoids
125
Q

Hemorrhoids Tx

A

Conservative measures
- 1st line–> adequate fiber & fluids

  • Behavior modifications
    _–> avoid straining & reading while on toilet
    —> lose weight & incr exercise
    —> good perianal hygiene
  • topical ointments, suppositories
  • Excision of thrombosed hemorrhoids
  • Rubber band ligation & sclerotherapy
  • Hemorrhoidectomy
126
Q

What is an anal fissure?

A

linear fissure, usually <5mm

127
Q

Anal fissure arises from…

A

trauma during defecation

128
Q

Anal Fissure S/S

A
  • Pts report tearing sensation & bright red blood
  • Very painful
129
Q

Anal Fissure Dx

A

inspection

130
Q

Anal Fissure Tx

A
  • topically
  • stool softeners
  • incr fiber
131
Q

What are the 2 types of anorectal abscesses?

A
  • perianal
  • perirectal
132
Q

Types of Perirectal abscesses

A
  • Ischiorectal abscess
  • Intersphinteric abscess
  • Supralevator abscess
133
Q

Anorectal Abscess age onset & gender prevalence

A
  • 30-50yo; peak 40yo
  • men > women
134
Q

List the Aerobic & anaerobic bacteria

A
  • Bacteroides fragilis
  • E. coli
  • Clostridium spec.
  • Fusobacterium
  • Peptostrepto
  • Porphyromonas
  • Prevotella
  • S. aureus
  • Strep
135
Q

Anorectal Abscess Pathophys

A
136
Q

Anorectal abscess S/S

A
  • acute rectal pain (may be deep-seated)
  • swelling
  • tenderness or redness
  • fluctuant mass
  • fever
137
Q

Anorectal Abscess PE

A
  • redness
  • signs of 2ndary cellulitis
  • large skin tags or multiple fistulas = Crohn Dz
138
Q

Which abscesses tyically a have tender, fluctuant mass?

A
  • perianal
  • ischiorectal
139
Q

Which abscesses may have a normal external exam or tenderness or fluctuance on digital exam?

A
  • intersphincteric
  • supralevator
140
Q

Anorectal Abscess Dx

A
  • CBC
  • CMP
  • poss blood cultures
  • poss would cultures
  • lactate
  • CT–> extent of abscess
  • MRI–> track fistula
141
Q

What type of perirectal abscesses can be drained in the operating room?

A
  • ischiorectal
  • submucosal
  • intersphincteric
  • supralevator
142
Q

What type of perianal abscesses can be drained in the ED or office by gen surg?

A
  • simple
  • isolated
  • fluctuant
143
Q

Tx for perianal anorectal abscess

A
  • Augmentin or Cipro/Flagyl if being discharged/treated as outpt
144
Q

Tx for perirectal anorectal abscess

A
  • BSAbx
    (Zosyn or Invanz)
145
Q

What is a pilonidal cyst/abscess?

A

formed by the penetration of the skin by an ingrown hair–> causes a foreign body granuloma rxn

146
Q

Tx for pilonidal cyst/abscess

A
  • I&D
  • Abx (if cellulitis)
147
Q

What is the definitive tx for pilonidal cyst/abscess?

A

referral to surgeon - surgery

148
Q

Timeframe for acute diarrhea

A

> 2 wks

149
Q

Timeframe for persistent diarrhea

A

2-4 wks

150
Q

Timeframe for chronic diarrhea

A

> 4wks

151
Q

More than 90% of acute diarrhea is caused by….

A

infectious agents

152
Q

Symptoms that accompany acute diarrhea

A
  • vomiting
  • fever
  • abdo pain
153
Q

Acute noninflammatory diarrhea
S/S

A
  • Watery, nonbloody.
  • Usually mild, self-limited.
  • Caused by a virus or noninvasive bacteria.
  • Dx evaluation is limited to pts with diarrhea that is severe or persists beyond 7 days.
154
Q

Acute inflammatory diarrhea S/S

A
  • Blood or pus, fever.
  • Usually caused by an invasive or toxin-producing bacterium.
  • Dx evaluation req routine stool bacterial testing (includingE coli) in all & testing as clinically indicated forC. diff toxin and ova & parasites.
  • Can also be caused by IBD
155
Q

Acute Diarrhea (Infectious) Non-inflammatory causes…

A
  • Viral: Rotavirus, norovirus, adenovirus
  • Toxin producing bacteria: E. coli, Staph aureus, clostridium perfingens
  • Parasitic: Giardia
156
Q

Acute Diarrhea (Infectious) inflammatory causes…

A
  • bacterial invasion of colonic tissue: shigellosis, salmonella, campylobacter, Yersinia, invasive e. coli
157
Q

Name the at risk groups for Acute Diarrhea (infectious)

A
  • travelers
  • consumers of certain foods
  • daycare attendees & their fam
158
Q

Describe the travelers at risk of Acute Diarrhea (infectious).

A
  • Latin America/Africa/Asia- E coli, campylobacter, shigella, salmonella
  • Campers/backpackers/swimmer- giardia
  • Cruise ships- norovirus
159
Q

Describe the foods that put you at risk of Acute Diarrhea (infectious).

A
  • Food left out (picnic)- salmonella, campylobacter
  • Mayo- staph aureus or salmonella
  • Eggs- Salmonella
  • Soft cheese- Listeria
  • Seafood (esp raw)- Vibrio, salmonella, hep A
160
Q

Describe the daycare attendees & family at risk of Acute Diarrhea (infectious).

A
  • shigella
  • giardia
  • rotavirus
161
Q

Acute Infx Diarrhea Dx

A

Stool studies
- Fecal Leukocytes
- Culture
- Ova & Parasites
- Immunoassays for C.diff, rotavirus, giardia

162
Q

Acute Infx Diarrhea Tx

A
  • Oral rehydration
  • Antidiarrheal agents (loperamide, bismuth) **
  • Avoid high fiber, high fat foods, milk products
163
Q

Acute Infx Diarrhea Empiric Abx Tx if…

A
  • Fever, tenesmus, bloody stools, presence of fecal leukocytes, immunocompromised pts
  • Quinolone, Bactrim, or doxy
  • Zithromax–> alt for traveler’s diarrhea
  • Once cultures return, tailor to results
164
Q

Mild Dehydration volume lost

A

5%

165
Q

Mild Dehydration symptoms

A

thirsty

166
Q

Moderate Dehydration volume lost

A

6-9%

167
Q

Moderate Dehydration symptoms

A
  • dry mucous membranes
  • sunken eyes
  • decr urine output
  • tachypnea
  • tachycardia
168
Q

Severe Dehydration volume lost

A

> 10%

169
Q

Severe Dehydration symptoms

A
  • very dry mucous membranes
  • decr skin turgor
  • cool limbs
  • anuria
  • significant tachypnea & tachycardia
170
Q

What makes diarrhea chronic?

A

present longer than 4 wks

171
Q

Chronic diarrhea causes…

A
  • Meds (metformin
  • Osmotic Diarrheas (malabsorption of lactose)
  • Secretory conditions (endocrine tumors)
  • Inflammatory conditions (IBD)
  • Irritable bowel syndrome
  • Chronic infections (giardia)
172
Q

Chronic Diarrhea Tx

A
  • treat underlying cause
  • antidiarrheal as needed
173
Q
A

Clin Med: GI (block 3) (8 decks)

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