Diarrhea

Question 1

A 66 yr old woman comes to the office due to bloating, flatulance, discomfort, intermittent cramps unrelated to eating for the past 6months. She has 2 or 3 watery bowel movements daily. She has DM. Carbohydrate breath testing using glucose is abnormal.
Dx?
Causes?

Answer 1

SIBO ( small intestinal bacterial overgrowth)
Loss of ileocecal let’s bacteria into the SI. Causes: surgery; stricture; motility disorders like DM, scleroderma; cirrhosis; AIDS; ^age
Surgeries like Roux-en-Y gastric bypass result in blind loop of intestine that allows for excessive growth of bacteria

Question 2

SIBO

• Dx
• Rx

Answer 2

Endoscopy with jejunal aspirate showing >1 OS organisms/ml. But this is invasive n not easily performed.
- abnormal carbohydrate breath test using glucose or lactulose ( earlier pick in hydrogen or methane)
Rx - rifaximin or neomycin can also b used.

Question 3

Patients with UC, when should screening start? How frequent?

Answer 3

8yr after Dx

Every 1-2yrs

Question 4

Lactose intolerance is cxzd by? What happens to stool ph and stool osmotic gap?

Answer 4

Positive hydrogen breath test and positive stool test for reducing substance.
Low stool PH; increased stool osmotic gap

Question 5

Antibiotic associated diarrhea Dx?

Initial Rx? 2nd line Rx? Fulminant?

Answer 5

Clostridium diff toxin in the stool
Initial- oral vancomycin
2nd line- fidaxomicin
Fulminant- metronidazole + vancomycin

Question 6

PAS positive material in the lamina propria of small intestine is diagnostic of?

Answer 6

Whipple disease

Question 7

Celiac Vs tropical sprue

Answer 7

Histology is the same

Hx of travel or living in an endemic area eg. Puerto Rico favors tropical sprue

Question 8

IBD acute exacerbation Rx
Chronic maintenance?
Rx of fistula n severe dis unresponsive to therapy

Answer 8

Acute-Steroids
Chronic maintenance- 5-ASA derivatives like mesalamine
fistula n severe dis unresponsive to therapy- anti TNF such as inflixumab

Question 10

Toxic megacolon diagnostic criteria, Dx confirmed by?

Answer 10

Fever>38; pulse>120; WBC>10500; anemia

- plane abdominal X-ray showing dilated colon>6cm

Question 11

The commonest cause of LGIB in elderly is

Answer 11

Diverticulosis

Question 12

Most accurate test for diverticulosis

Answer 12

Colonoscopy

Question 12

Acute diverticulitis best initial test( especially if it fails to respond to initial mx after Dx has been made clinically)
Rx?

Answer 12

CT scan!
Barium n colonoscopy can b dangerous (risk of perforation)
Rx- IV abx, NPO.
Surgery for (no response to medical therapy; complications; frequent recurrence of infection)

Question 13

A pt with UC requires screening for—?

Answer 13

Colorectal carcinoma.

For other associated conditions like PSC, routine surveillance is not recommended.