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CPD II > CPD Lower GI > Flashcards

CPD Lower GI Flashcards

1
Q

What test is performed to find a parasitic infection? How many times?

A

Ova and parasites (O & A), 3

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2
Q

What test is used as a marker for fecal WBCs?

A

Fecal lactoferrin -differentiates be inflammatory and non-inflammatory causes

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3
Q

What test is used as a marker for IBD?

A

Fecal lysozyme

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4
Q

What are the four categories of diarrhea?

A

Osmotic, secretory, exudative, motility inc.

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5
Q

What three types of pain can occur in the abdomen?

A

Visceral, parietal/somatic, referred

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6
Q

What artery most commonly becomes occluded in acute mesenteric ischemia? And why?

A

Superior mesenteric.

Due to low cardiac output or occlusive dz of vascular supply (embolis)

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7
Q

What are the four important qualities of an intestinal obstruction?

A

Complete or partial
Simple or strangulated
Location (sm, lg intestine)
Onset: acute or gradual

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8
Q

What is the m/c cause of gastroenteritis?

A

INFECTIONS

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9
Q

What is the difference in SSX between small intestine and colon obstruction?

A

sm. intestine: sudden onset, periumbilical pain

colon: gradual

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10
Q

Most common cause of infectious diarrhea worldwide?

A

Rotavirus

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11
Q

Which organisms commonly cause bacterial gastroenteritis using an exotoxin? What are the ssx?

A

S. aureus - severe vomiting 2-6hr after ingestion, explosive diarrhea, rarely fever

B. cereus - no fever, vomiting 2-6 hrs post-ingestion. OR diarrhea 8-16 hrs post-ingestion.

C. perfringens - watery diarrhea, foul-smelling, 8-16 hrs post-ingestion

C. botulinum - 4hr- 8 days after ingestion.
phase 1: fatigues, N/V abd cramps, diarrhea
phase 2: diplopia, decreased acuity, PERRLA defects, ptosis
phase 3: DESCENDING weakness, dysarthria, dysphagia,
65% mortality 2-9 days post-ingestion

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12
Q

Which organisms commonly cause bacterial gastroenteritis using an endotoxin? What are the ssx?

A

Cholera - rice-water stools

E. coli - profuse watery diarrhea lasting 3-5 days, 1-3 days post-ingestion

C. difficile - watery diarrhea, crampy abdominal pain

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13
Q

How is C. difficile most often contracted?

A

Nosocomial, after antibiotic therapy

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14
Q

What is the worst complication of C. difficile? And what dx exam is contraindicated?

A

Toxic megacolon

Colonoscopy

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15
Q

Which organisms commonly cause bacterial gastroenteritis by invading the mucosa? What are the ssx?

A

Salmonella - watery diarrhea (may have blood), malaise, N/V, abd. pain 6-48 hrs post-ingestion

Campylobacter jejuni - prodrome of h/a, myalgia, malaise for 12-24 hrs. Then abd pain, high fever, profuse watery then bloody diarrhea.

Shigella - starts in lower abdominal pain, diarrhea, 50% fever 1-3 days post-ingestion

E. coli 0157:H7 -watery diarrhea becoming blood in > 24hrs. Sx occur 16+ hrs post-ingestion.

Yersinia enterocolita -water or bloody diarrhea, fever, mimics appendicitis if infects ileum.

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16
Q

What organism is the most common cause of bloody diarrhea in the U.S.?

A

Campylobacter jejuni

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17
Q

What are two complication of a E. Coli 0157:H7 infection?

A

Hemolytic-uremic syndrome (HUS)

Thrombotic thrombocytopenic purpura (TTP)

18
Q

Which organisms commonly cause parasitic gastroenteritis? What are the ssx?

A

Giardia lamblia - mild watery diarrhea, abd. bloating, cramps, flatulence for 1-3 wks, stools bulky and foul-smelling. Sx 7 days after ingestion.

Cryptosporidium parvum - profuse watery diarrhea, anorexia, low-grade fever 5 days post ingestion.

Entamoeba histolytica - mild-crampy abd. pain, intermittenet diarrhea. If severe, bloody diarrhea tenesmus, fever, toxic megacolon

19
Q

In which population would you be more concerned about a C. parvum infection?

A

Immunocompromised- water diarrhea can cause severe dehydration.

20
Q

What four patterns are present in Crohn’s dz?

A

inflammation, obstruction, diffuse jejunoileitis, abd. fistulas/abscesses

21
Q

What are the two m/c complications of Crohn’s dz? What two are rare?

A

Intestinal obstruction and fistula/abscess formation.
(also increased risk for developing squamous cell carcinoma)

Perforation and hemorrhage RARE

22
Q

What would be seen on barium swallow for Crohn’s dz?

A

String sign (advanced), irregularity, nodularity, stiffness, thickening of terminal ileum, narrowed ileum lumen.

23
Q

What would be seen in colonoscopy of Crohn’s dz?

A

“skip areas,” cobblestone appearance, longitudinal ulcers, rectal sparing, narrowing, fistulas

Epithelial granulomas - pathognomonic

24
Q

What are the most common complications with ulcerative colitis?

A

Hemorrhage, toxic megacolon, colorectal cancer

25
Q

What are the red flag features for IBS?

A 
Onset after 50yo
Severe, unrelenting diarrhea
Nocturnal sx
Unintentional weight loss
Hematochezia
Family hx of IBD, celiac sprue, CA
26
Q

What is the Rome III criteria for diagnosing IBS?

A

abd pain or discomfort +3d/month for 3months, associated with at least 2 of the following:
relieved by defacation
onset assoc. w/ change in stool frequency
onset assoc w/ change in stool form/appearance

27
Q

Ulcerative colitis vs. Crohn’s dz

A

UC: cramping pain, lower abd, relieved by BM, bloody stool, no abd. mass, always involves rectum, mucosal, diffuse, continuous spread.

Crohn’s: constant pain, RLQ, not relieved by BM, usu no blood in stool, abd mass in RLQ, can affect any part of GI, transmural, granulomas, skip areas, fistulas/abscesses or obstruction

28
Q

Extraintestinal manifestations of Crohn’s?

A

Cholelithiasis, renal oxalate stones, Vit B12 def, obstructive hydronephrosis, aphthous ulcers

29
Q

What is a “keynote” for SIBO?

A

transient improvement of sx w/ antibiotic tx, worsening when on pro/prebiotics, worsening when eating more fiber.

30
Q

What test is most often done for SIBO?

A

Hydrogen breath test (also Methane)

31
Q

What are general sx of malabsorption?

A

Chronic diarrhea, steatorrhea, abd. bloating, weight loss, amenorrhea

32
Q

What are ssx of diverticulitis?

A

Pain: LLQ, steady, severe, deep
fever/chills
previous episodes of dull, colicky, and diffuse pain with flatulence, distention, and change in bowel habits.
Rectal bleeding: bright red or wine-colored stools.

33
Q

What are the complications of diverticulitis?

A

Perforation or fistula

34
Q

Congenital bulge in distal ileum, remnant of omphalomesenteric duct.

A

Meckel’s diverticulum

35
Q

What is used to diagnose lactose intolerance?

A

Hydrogen breath test

36
Q

SSX of tropical sprue

A

1) acute phase: diarrhea w/ fever and malaise
2) chronic phase: diarrhea, nausea, anorexia, steatorrhea, parasthesia

SX of vitamin deficiency:
glossitis, stomatitis, cheilosis, cutaneous hyperpigmentation, dry rough skin, abd. distension, tenderness and edema, weight loss

37
Q

What is the difference between non-celiac gluten intolerance and celiac’s dz?

A

Look similar w/p villous atrophy

Neg IgA tTG Ab
Neg biopsy
Pos gliadin Ab
Total IgA normal

38
Q

What is the best test to determine the presence of celiac’s dz?

A

Serology!

1) Total IgA
2) IgA anti-endomysial Ab
3) IgA anti-tissue transglutaminase Ab
3) Deamidated gliadin peptide IgA or IgG.

39
Q

What is Whipple’s disease?

A

rare, systemic infection by Tropheryma whipplei.

SSX: diarrhea, weight loss, arthralgia, fever, and malabsorption

40
Q

What are some risk factors for celiac’s dz?

A

Heredity, early intro to gluten, absent breastfeeding, crohn’s dz, type 1 DM, down syndrome, chronic fatigue syndrome, AI thyroid dz. viral exposure, adenovirus 12

CPD II (3 decks)

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