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GI2 E1 > diarrhea > Flashcards

diarrhea Flashcards

clin med

1
Q

differentiate between inflammatory and noninflammatory diarrhea

A

noninflammatory= watery, only eval if have severe diarrhea for longer than 7 days, no need a work up

inflammatory= blood/pus in stool, get a routine stool bacterial culture

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2
Q

acute diarrhea, defined as having diarrhea _____, is most often _____

A

< 2 weeks

infectious

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3
Q

most common cause of noninfectious dairrhea

A

meds

abx
NSAIDs
antidepressants
chemo
antacids, laxatives
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4
Q

differentiate between the organisms found in abx associated diarrhea vs abx associated colitis

A

abx associated coliits is mostly due to C Dfi where most cases of abx associated diarrhea are NOT C dif

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5
Q

give an example of an abx that causes abx associated diarrhea

A

augmentin (amaoxicillin-clavulanate)

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6
Q

in the case of chronic diarrhea, we can rule out med associated, IBS, and lactose intolerance when?

A

in the presence of nocturnal diarrhea
weight loss
anemia
(+) fecal occult blood test (FOBT)

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7
Q

normal osmotic gap of stool

A

<50

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8
Q

describe sx, trx, and causes of osmotic diarrhea

A

stool volume DECREASES w fasting, have increased osmotic gap

sx= distension, bloating, flatulence,

trx= stop lactose, fructose and sorbitol, and alc

causes= meds (antacids, lactulose), lactose intolerance

laxative abuse, malabsorptive syndromes

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9
Q

+ hydrogen breath test = ?

A

lactose intolerance

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10
Q

describe sx and causes of secretory diarrhea

A

stool volume NO change with fasting, normal osmotic gap of stool, high volume of watery diarrhea, NAGMA

causes
=endocrine tumors- zollinger ellison syndrome, carcinoid tumor, medullay thyroid carcinoma
= bile salt malabsorption= ileal resection, crohn, post-chole
= factitious diarrhea- laxative abuse
=villous adenoma

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11
Q

most common causes of chronic diarrhea

A

medications
IBS
lactose intolerance

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12
Q

what tests should you order for chronic diarrhea

A 
CBC
serum electrolytes
liver enzymes
albumin
Vit A+D
TSH
ESR+CRP
tTG
stool studies
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13
Q

what can a modified acid stain be used to detect

A

cryptosporidium

cyclospora

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14
Q

what can a wet mount or a fecal Ag by used to detect

A

giardia

E. hystolytica

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15
Q

what test can be done to rule out IBD, microscopic colitis, colonic neoplasia

A

colonoscopy with mucosal biopsy

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16
Q

what test can be done when celiac ds or whipple ds is suspected

A

upper endoscopy w small bowel biopsy

17
Q

what tests should be performed when malabsorption is suspected

A

fecal elastase <100 –> pancreatic insufficiency

abd radiograph with calcifications –> chronic pancreatitis

hydrogen breath test –> lactose intolerance

small intestine imagint –> crohn, tumor, diverticula

serologic test
VIP to look for VIPoma
calcitonin, look for medullary thyroid carcinoma
gastrin to look for zollinger-ellison syndrome
F-HIAA to look for carcinoid

18
Q

what meds can lead to diarrhea

A 
cholinesterase inhibitors
SSRIs
angiotensin II-receptor blocker
PPI
NSAID
metformin
allopurinol
19
Q

describe the three types of clinical presentation with IBS

A

spastic colon

alternative constipation and diarrhea

chronic, painless diarrhea

20
Q

what are the alarm sx with IBS and what do they indicate

A

they indicate the dx isn’t actually IBS, warrants further investigation

acute onset of sx
nocturnal diarrhea
severe constipation / diarrhea
hematochezia
weight loss
fever
family hx
21
Q

clinical manifestations of IBS

A

age < 30, female
crampy abd w irregular bowel habirs
distension, relief of pain w bowel movement, increased frequency of stools with pain, loose stools w pain, mucus in stools, sense of incomplete evacuation,
pasty pencil-thin stools

22
Q

diagnostics for IBS

A

chronic, at least 3 months
utilize ROMA IV clinical diagnostic criterion
= at least 3 months, improve w defecation, change in frequency or appearance of stool

consider sigmoidoscopy, barium radiograph

23
Q

trx for IBS

A

meds for the bowel habits and pain

low FODMAPS diet

24
Q

risk with lactose intolerant patients who choose to restrict milk products

A

osteoporosis

-Ca supplementation is recommended

25
Q

most common abx associated with C dif infection

A

ampicillin
clindamycin
3rd gen cephalosporin
flouroquinolone

26
Q

yellow adherent plaques and volcano exudate seen on flexible sigmoidoscopy

A

C dif= psuedomembranous colitis

27
Q

trx and complications of C df

A

PO/IV metronidazole
PO only vancomycin

complications= toxic megacolon, hemodynamic instability

28
Q

lymphocytic colitis/collagenous colitis

population,
hx
dx
trx

A 
population= females, 50s-60s
hx= NSAIDs, ASA, SSRI, ACE inhibitors, B blockers
dx= normal appearing, with chronic infl
trx= antidiarrhea therapy= loperamide
stop offending agent
29
Q

sx of malabsorption syndromes

A 
weight loss
osmotic diarrhea
steatorrhea
nutritional deficiency
must wasting
growth retardation
30
Q

gene mutations associated celiac ds

A

HLA-DQ2
HLA-DQ8

tTG A

31
Q

sx, hx, dx, trx of celiac

A

sx= weight loss, chronic diarrhea, dyspepsia, flatulence, bloating, growth retardation, fatigue
dermatitis herpetiformis, osteoporosis

dx= IgA tTG Ab, anti-DGP, 
endoscopy= atrophy or scalloping of the duodenal folds may be observed
histology= complete loss of intestinal villi
labs= cbc, Ca, Vit A+D, CMP w GGT, PT/INR

trx= removal of all gluten

32
Q

sx of pancreatic insufficiency

A

steatorrhea
weight loss
gaseous distension
large, greasy, foul smelling stools

33
Q

sx of bile salt malaborpsion

A

terminal ileum, crohn ds

mild steatorrhea, impaired Vit ADEK, watery secretary diarrhea

34
Q

whipple ds

sx, dx, trx, prognosis

A

tropheryma whipplei, white men in their 40s-60s
-weight loss, malabsorption, chronic diarrhea, HF, dementia
-endoscopy w duodenal biopsy= PAS+
-trx= abx, need prolonged trx
ceftriazone, TMP/SMX
repeat bipsies every 6 months

prognosis= fatal if not trx, neuro signs may be permanent

35
Q

define pseudodiarrhea

A

frequent passage of small volumes of stool

happens with IBS or proctitis

36
Q

define fecal incontinence

A

involuntary discharge, NMSK disorders or structural anorectal problems

37
Q

define overflow diarrhea

A

only contents that get by are liquid
elderly/nursing home pts

fecal impaction is detectable by rectal exam

38
Q

chronic use of laxatives can cause

A

melanosis coli

benign hyperpigmentation of the colon

GI2 E1 (19 decks)

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