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Constipation & Diarrhea Flashcards

1
Q

Define Constipation

A

Passage of stool infrequently or with difficulty

Stool frequency of less than three per week (straining, hard stool, incomplete evacuation)

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2
Q

Etiology of Constipation

A

Inadequate fiber in diet
Inadequate hydration
Inactivity

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3
Q

Medications that can cause Constipation

A 
Opiates/narcotics
Antidepressants
CCB
Antipsychotic
Antiparkinsonian agents
Anticholinergics
Calcium, iron supplements
Antispasmodics
Antacids (calcium & aluminum)
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4
Q

Structural Abnormalities Causing Constipation

A 
Carcinoma
Ischemia
Volvulus
Megacolon
Anorectal Disorders (prolapse, rectocele, pelvic floor dysfunction)
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5
Q

What is present with ischemia of the bowel?

A

Usually present with pain

Rebound tenderness

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6
Q

Pelvic Floor Dysfunction

A

ANS neuropathy
Pregnancy
Males with surgeries near the perineum

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7
Q

Metabolic Issues Causing Constipation

A 
Hypokalemia
Hypomagnesemia
Hypothyroidism
Hyperparathyroidism
Porphyria- genetic hemoglobin disorder
Addison's disease
Hypercalcemia
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8
Q

Neurological Issues Causing Constipation

A 
Parkinson's
MS
Automonic neuropathy
Hirschsprung disease
Chugs disease
Spinal cord lesions
Cerebrovascular disease
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9
Q

Hirschprung Disease

A

Myenteric plexus affected

Lack of cells at birth

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10
Q

Systemic Issues Causing Constipation

A

Amyloidosis
Scleroderma
Polymyositis
Pregnancy

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11
Q

Define Amyloidosis

A

Sclerotic fibers embedded in tissues

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12
Q

Define Scleroderma

A

Tightening of all outside tissue

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13
Q

Surgical Issues Causing Constipation

A

Abdominal
Pelvic
Colonic
Anorectal

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14
Q

Psychiatric Issues Causing Constipation

A

Depression

Eating disorders

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15
Q

Treatment of constipation in patients less than 50 years old with no alarm symptoms

A

Empiric treatment

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16
Q

Further treatment should be performed on patients with any of the following:

A 
Over age 50
Severe constipation
Signs of an organic disorder
Hematochezia
Weight loss
Positive FOBT
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17
Q

Evaluation of Constipation

A

KUB
Barium enema
Colonoscopy
Blood Tests

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18
Q

Blood Tests for Constipation

A 
Glucose
CBC
Thyroid
Calcium
Magnesium
Phosphorous
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19
Q

Define Colonic Transit Study

A

Observe transit time in patients with refractory constipation not responding to conservative measures

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20
Q

Management of Constipation

A

Prevention

Patient Education

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21
Q

Patient Education for Constipation

A

Exercise
Fluid intake
Fiber intake

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22
Q

What does exercise do for bowel movements?

A

Stimulus to colon peristalsis and defecation

Encourage and enable patient to be mobile

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23
Q

Fluid intake

A

Constipated stools are low in water content

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24
Q

Fiber intake

A

Acute constipation low on fiber diet

Chronic constipation responds poorly to fiber

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25
Q

Classes of Medications for Constipation

A 
Stool softeners
Laxatives
stimulant laxatives
Opioid-receptor antagonist
Digital disimpaction
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26
Q

Types of Stool Softeners

A

Colace

Docusate calcium

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27
Q

Types of Laxatives

A

Bulk laxatives

Osmotics

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28
Q

Types of Bulk Laxatives

A

Psyllium
Methylcellulose
Fibercon (polycarbonophil)
Benefiber (wheat dextran)

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29
Q

Types of Osmotics

A 
Lactulose
Sorbitol
Polyethylene glycol
Magnesium citrate
Magnesium sulfate
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30
Q

Types of Stimulant Laxatives

A

Bisacodyl

Senna

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31
Q

Type of Opioid-receptor Antagonist

A

Methylnaltrexone

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32
Q

What is methylnaltrexone approved for?

A

Palliative care patients

Patients on chronic opioid treatment

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33
Q

Define Diarrhea

A

Increase in stool liquidity and/or frequency

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34
Q

How many stools a day is considered abnormal?

A

3 times a day

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35
Q

Osmotic Diarrhea Pathophysiology

A

Non-absorbable substance draws out excess water into the intestines & increases stool weight and volume

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36
Q

Secretory Diarrhea Pathophysiology

A

Mucosal secretion of fluid and electrolytes secondary to bacterial enterotoxins, neoplasms, or exotoxins

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37
Q

Motility Diarrhea Pathophysiology

A

Food is not mixed properly, digestion is impaired and motility is increased
Secondary to resection of the small intestine, surgical bypass of an area of intestine or diabetic neuropathy

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38
Q

Acute Diarrhea Length

A
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39
Q

Persistent Diarrhea Length

A

More than 14 days in duration

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40
Q

Chronic Diarrhea Length

A

More than 30 days in duration

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41
Q

Clinical Manifestations of Acute Diarrhea

A

Self-limited
Fever
Cramping pain

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42
Q

Clinical Manifestations of Chronic Diarrhea

A

Secondary to IBS
IBD
Malabsorption syndromes

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43
Q

Clinical Manifestation of Inflammatory Diarrhea

A 
Blood
Fever
Peritoneal signs
Weight loss
Pus
44
Q

Clinical Manifestation of Non-inflammatory Diarrhea

A

Diarrhea

Self-limited

45
Q

Most common cause of diarrhea in pregnant women

A

Listeria

46
Q

Most common cause of diarrhea in daycares

A

Adenovirus

Norovirus

47
Q

Most common cause of diarrhea in drinking water

A

Giardia

48
Q

Most common cause of traveling diarrhea

A

E. coli

49
Q

Treatment for Diarrhea

A

Cipro (go to)

Flagyl (weird bugs)

50
Q

Leukocytes in the stool would be a sign of what type of bugs?

A

Invasive bugs

51
Q

Viral Agents for Acute Infectious Diarrhea

A

Norovirus
Rotavirus
Adenoviruses
Astrovirus

52
Q

Bacterial Culprits for Acute Infectious Diarrhea

A 
Salmonella
Campylobacter (Guillan Barre)
Shigella (blood, fever)
Enterotoxigenic E. coli
C. difficile
53
Q

Protozoa Culprits for Acute Infectious Diarrhea

A

Cryptosporidium
Giardia
Cyclospora
Entamoeba

54
Q

Sources for Salmonella Diarrhea

A 
Beef
Pork
Poultry
Eggs
Raw milk
Ice cream
Vegetables
Unpasteurized Orange juice
Pet ducklings
Lizards
Rattlesnake meat
55
Q

Sources for Campylobacter Diarrhea

A

Poultry
Raw milk
Raw cheeses

56
Q

Sources for Shigella Diarrhea

A

Daycare centers

Vegetables

57
Q

Sources for Vibrio Cholerae Diarrhea

A

Shellfish from the Gulf of Mexico
Inadequately cooked seafood from South America
Coconut milk from Thailand
Airline outbreaks

58
Q

Sources for C. Difficile Diarrhea

A

Hospitalization
Inpatient or outpatient antibiotics or chemo within last several weeks
Daycare centers

59
Q

Sources for Listeria Diarrhea

A 
Beef
Pork
Poultry
Milk cheese
Coleslaw
Hot dogs
Potato salad
Pregnancy
Neonates
Immunocompromised patients
60
Q

Sources for Rotavirus Diarrhea

A

Daycare centers
Nurseries
Australia

61
Q

Sources for Norovirus Diarrhea

A 
Schools
Nursing homes
Cruise ships
Camps
Military barracks
Vegetables
waterborne
Foodborne
Shellfish-associated outbreaks
62
Q

Sources for Hepatitis A Diarrhea

A 
Overcrowding
Lack of clean water
Patient & staff of institutions
Daycare centers
Men who have sex with men
IV drug users
Travelers
Military barracks
Shellfish
63
Q

Sources for Adenovirus Diarrhea

A

Infantile diarrhea

AIDS

64
Q

Sources for CMV Diarrhea

A

HIV-infected homosexual men with AIDS

Organ transplantation

65
Q

Sources for Giardia Diarrhea

A

Daycare centers
Swimming pools
Travel
Fruit salad

66
Q

Sources for Cryptosporidium Diarrhea

A 
Daycare centers
Swimming pools
AIDS
Farm animal exposure
City water supply contamination
67
Q

Sources for Cyclospora Diarrhea

A

Raspberries from Guatemala

68
Q

Non-infectious Agents Acute Diarrhea

A

Drugs
Food allergies
Thyrotoxicosis
Carcinoid syndrome

69
Q

Indications for Diagnostic Evaluation of Acute Diarrhea

A

Profuse watery diarrhea with signs of hypovolemia
Passage of small volume stools containine blood and mucus
Bloody diarrhea
Temperature > 101.3
Passage of >6 unformed stools in 24 hours or a duration of illness >48 hours
Severe abdominal pain
Hospitalized patients or recent use of antibiotics
Diarrhea in the elderly or immunocompromised
Systemic illness with diarrhea

70
Q

Etiology of Chronic Diarrhea

A 
Medications
Osmotic
Secretory
Inflammatory
Malabsorptive
Motility disorders
Chronic infections
71
Q

Examples of Medications in Chronic Diarrhea

A 
Cholinesterase inhibitors
Metformin
SSRI's
Flexors
ARB's
PPI
NSAIDs
72
Q

Examples of Osmotic Issues in Cause Chronic Diarrhea

A

Malabsorption
Lactose, fructose, sucrose
Laxative abuse

73
Q

Examples of Secretory Issues in Chronic Diarrhea

A

Endocrine tumors

Bile salt absorption

74
Q

Examples of Inflammatory Issues in Chronic Diarrhea

A

Crohn’s

Ulcerative colitis

75
Q

Examples of Malabsorptive Disorders in Chronic Diarrhea

A

Steatorrhea

Vitamin deficiences

76
Q

Example of Motility Disorders in Chronic Diarrhea

A

IBS

77
Q

Examples of Chronic Infections in Chronic Diarrhea

A

DM
Carcinoid syndromes
Collagen/vascular disorders
Thyroid issues

78
Q

Causes of Osmotic Diarrhea

A

Antacids, lactulose, sorbitol
Lactose Intolerance
Magnesium: antacids, laxitives

79
Q

Clues for Osmotic Diarrhea

A

Stool volume decreases with fasting

Increased stool osmotic gap

80
Q

Clues for Secretory Diarrhea

A 
Large volume (>1L/day)
Little change with fasting
Normal stool osmotic gap
81
Q

Causes of Secretory Diarrhea

A

Hormonally: carcinoid, medullary CA of thyroid, Zollinger-Ellison syndrome
Factitious: phenolphthalein, cascara, senna
Villous adenoma
Bile salt malabsorption
Medications

82
Q

Clues for Inflammatory Diarrhea

A

Fever
Hematochezia
Abdominal pain

83
Q

Causes of Inflammatory Diarrhea

A

IBD
Lymphoma
Adenocarcinoma
Radiation enteritis

84
Q

Clues for Malabsorption Syndrome Diarrhea

A

Weight loss
Abnormal laboratory values
Fecal fat

85
Q

Causes of Malabsorption Syndrome Diarrhea

A 
Small bowel mucosal disorders: celiac, tropical sprue, Whipple disease, eosinophilic, gastroenteritis, resection, Crohn's
Lymphoma
Carcinoid
Infectious
Kaposisarcoma
Sarcoidosis
Retroperitoneal fibrosis
Pancreatic disease
Bacterial overgrowth: motility disorders, scleroderma, fistulas, small intestinal diverticula
86
Q

Clues of Motility Disorder Diarrhea

A

Systemic disease

Prior abdominal surgery

87
Q

Causes of Motility Disorder Diarrhea

A 
Post surgical: vagotomy, partial gastrectomy, blind loop with bacterial overgrowth
Scleroderma
DM
Hyperthyroidism
IBS
88
Q

Causes of Chronic Infection Diarrhea

A 
AIDS related: CMV, HIV
C. difficile
Mycobacterium avid complex
Giardia, Entamoeba histolytica
Microsporida
Cryptosporidium
Isospora
89
Q

Diarrhea Work-Up

A 
History: travel, longevity of symptoms, family hx, food intake and relationship to onset
CBC
TSH
CMP
ESR
CRP
Wet mount of stool
Guiac
90
Q

What are you looking for in a fecal analysis?

A 
Fecal leukocytets
Fecal occult blood
Fecal fats
Enteric pathogen cultures
C. difficile toxin
Ova & parasites
91
Q

What are you looking for on a CMP for diarrhea?

A

Hypoalbumin- malabsorption

Hyponatremia- secretory

92
Q

What are you looking for on an ESR/CRP?

A

Crohn’s ulcerative colitits

93
Q

What are you looking for on a CBC for diarrhea?

A

Anemia

94
Q

What does the presence of fecal leukocytes indicate?

A

Bowel mucosal inflammation
Invasive bacterial enteritis
Ulcerative colitis

95
Q

What bugs are you looking for in a stool for culture & sensitivity?

A

Enterococcus
E. coli
Clostridium

96
Q

What do you treat enterococcus, e. coli, clostridium with?

A

Cipro

97
Q

What bugs are you looking for in a stool ova & parasite study?

A

Salmonella
Shigella
Giardia

98
Q

How does a C. diff toxin assay work?

A

C. diff multiplies and releases toxin that causes necrosis of the colonic epithelium which causes the diarrhea
Yellow, mucus stools

99
Q

Which diseases have fecal fat?

A

Steatorrhea
Sprue
Crohn’s
Whipples disease

100
Q

Colonoscopy with Mucosal Biopsy Excludes

A

IBD
Microscopic colitis
Colonic neoplasia

101
Q

What is an upper endoscopy looking for?

A

Celiac sprue

Whipple disease

102
Q

Further Stool Studies

A

24 hour stool collection

Other imaging

103
Q

What is the most common reason for a 24 hour stool collection?

A

Patient with IBS who wants a definitive answer

104
Q

Treatment of Diarrhea

A 
Fluid replacement
Antibiotic therapy
Bismuth subsalicylate
Opiate antidiarrheal agents
Cholestyramine (Questran)
105
Q

What is the best way to replace fluids in children?

A

Pedialyte

106
Q

What is the best way to replace fluids in adults?

A

1/2 tsp. salt
1 tsp. baking soda
8 tsp sugar
8 oz. orange juice in 1 L of water

107
Q

Most common antibiotic therapy for diarrhea

A

Cipro
Flagyl
Bactrim

GI (20 decks)

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