Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastroenterology > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

How to differentiate between Acute vs Chronic Diarrhea?

A

Acute is < 1 month

Chronic is more than 1 month or recurrent diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the normal amount of fat found in stool?

What is the normal amount of stool nitrogen?

A

Less than 7 grams per 24 hours (values >14g indicates malabsorption)

Normal stool nitrogen is less than 2.5g/ 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When is workup needed for acute diarrhea?

A

If there is:

  • Fever
  • Abdominal pain
  • Recent Abx
  • Elderly
  • Dehydration for 48 hours
  • Immunocompromised
  • Food handlers
  • IBD
  • Pregnant or hospitalized patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 2 most common infectious causes of chronic diarrhea in the US

A

Giardia

Cryptosporidium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What nutrients gets absorbed by the duodenum

A

Iron
Calcium
Magnesium
Folate

Involved in celiac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What nutrients get absorbed by the Ileum?

A

ADEK
Vitamin B12
Conjugated bile acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a protein-losing enteropathy? And when should we suspect it?

What is a test for testing protein-losing enteropathy?

A

Patient present with hypoalbuminemia and Edema but Urine doesn’t not contain any protein.

Stool levels of Alpha 1 antitrypsin can be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Protein-losing enteropathy + High eosinophils is what

A

Eosinophilic gastroenteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Protein-losing enteropathy + Lymphopenia

A

Intestinal lymphangiectasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Howell-Jolly bodies plus Diarrhea indicates what disease

A

Celiac Disease

In celiac disease there is functional asplenia, give them pneumococcal vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When Pancreatic maldigestion is suspected what test can be done?

A

Serum trypsinogen level, which is elevated in acute pancreatitis but low in chronic pancreatitis leading to maldigestion.

Other test include: fecal chymotrypsin and elastase level, secretin stimulation test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the equation for stool Osmolar gap and what are the 2 types of diarrhea?

A

Stool osmolar gap= 290-2 (stool Na+Stool Pottasium)

  1. Osmotic Diarrhea (Osmolar Gap >50)
  2. Secretory Diarrhea (Osmolar gap <50)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the features of osmotic diarrhea?

What are the causes of Osmotic Diarrhea?

A
  1. Symptoms improves with 24 hour fasting
  2. Presence of stool osmotic gap plus stool pH< 5.6 suggest lactose deficiency

Causes:

  • Lactose deficiency
  • Laxatives: Magnesium and sodium citrate, Castor oil
  • Sugar alcohols: Sorbitol
  • Malabsorption: pancreatic insuf, celiac disease, bacterial overgrowth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the features of secretory diarrhea and types?

A

No Osmolar gap or <50
Doesn’t improve with fasting

Causes:

  • Enterotoxin from E.Coli, Cholera, staph
  • Collagenous colitis
  • Stimulant laxatives: docusate, senna, phenolphthalein
  • Cancers: Gastrinomas, VIPoma, carcinoid
  • Hyperthyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What part of the intestine is carcinoid tumors most commonly found?

How is it Diagnosed? And treated?

A

90 % found in Terminal Ileum

diagnosed with 24 hour urine for 5 hydroindole acetic acid, treatment is octreotide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diffuse pigmentation of the colon on colonoscopy is called what and is seen with abuse of what?

A

Melanosis coli

Seen with abuse of laxatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is cathartic colon?

A

A form of laxative abuse in which the colon is dilated and hypomotile with absence of haustration in barium enema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Bile acid Malabsorption is managed based on what?

A

Ileal disease/resection

Limited to < 100 cm=ileum can still absorb some bile acid, those that are not absorbed enters the colon, which cause secretory diarrhea. IMPORTANTLY THERE IS NO STEATORRHEA because their is enough bile acids to bind the fat.

Treatment is cholestyramine to bind the bile acids in the colon

Extensive >100 cm:No ileum to absorb the bile acid so pretty much all of it get dumped in the colon causing SECRETORY DIARRHEA + STEATORRHEA because the liver cant compensate

-Treatment:low fat diet and medium chain triglyceride administration. Giving cholestyramine will worsen this

19
Q

What are the clinical findings for bacterial overgrowth?

A

The bacteria deconjugate bile acids, which then get absorbed in the upper small intestine. The bile acids does not reach the ileum so fat does not get absorbed leading to 1. STEATORRHEA

  1. Low vitamin B12
20
Q

How is bacterial overgrowth diagnosed?

A

Gold standard is is culture of jejunal aspirate but that is invasive

We instead can use C14 Xylose breath test and Hydrogen breath test; however, Dx when Dx is suspected patients are treated empirically with antibiotics

21
Q

What self limiting diarrhea do you get from reheating beef or turkey

A

Clostridium perfringens

22
Q

What is the treatment for Travelers diarrhea (ETEC) severe diarrhea or diarrhea with fever or pus/mucus in stool?

A

Fluoroquinolones (Cipro, Levaquin)

Azithromycin (preffered for dystenry and traveling to south east Asia because they have fluoroquinolone resistant Campylobacter amusing travelers diarrhea

23
Q

What are the causes of invasive diarrhea?

A
  • Shigella
  • Salmonella tiphimurium
  • Vibrio parahaemolyticus, vulnificus
  • EHEC: note giving Abx does not increase risk of HUS as previously thought
  • Yersinia
  • Campylobacter
  • Aeromonas= diarrhea after swimming in fresh water
  • Klebsiella oxytoca= another cause of antibiotic associated colitis, think of this when c.dif is negative
  • Giardia lamblia
24
Q

When do we treat patients with salmonella infections

A

Treatment is reserved for patients:

  • <2 years or >50 years old
  • Severe infection leading to hospitalization
  • Immunocompromised
  • Patients with endovascular or bone prosthesis

Treatment is fluroquinolones for 7-10 days or 14 days if Immunocompromised

Healthy people between 2-50 disease is self limited and only supportive care is warranted.

25
Q

Whaat infectious diarrhea mimics appendicitis or Crohn’s disease with RLQ pain?

A

Yersinia enterocolitica with mesenteric adenitis, that is what causes the RLQ pain

26
Q

What are the extra-intestinal manifestations of Yersinia? Ad how is yersinia treated?

A 
Arthritis
Ankylosing spondylitis
Skin manifestations with erythema no do sum and multi force
Thyroid: Grave’s, Hashimoto
Multiple liver abscess and granulomas

Treated with aminoglycosides or Bactrim

27
Q

Campylobacter Jejuni mimics what disease and is associated with what?

A

Mimics UC

Associated with:GBS, HUS, Post-infectious arthritis

28
Q

Aeromonas sepsis is seen in what types of patients?

A

Trauma
Burn victims

Aeromonas also associated with medical leech therapy

29
Q

Patients presenting with high suspicion for Giardia but negative stool ova and parasite do we treat?

A

Yes , stool Ova and Parasite has low sensitivity. Note Upper GI sampling has high sensitivity but is invasive

The best test to use is Stool antigen test and serology

30
Q

What test to order to Dx Celiac Disease?

A

IgA and IgA tissue transglutaminase

Antideaminated gliadin peptided (DGP) antibodies IgA

These screening test are done while patient is consuming normal diet

31
Q

What is the most feared complication of Celiac disease?

A

T Cell Lyhoma

32
Q

All patients with Diarrhea predominant IBS should be screened for what?

A

Celiac disease

33
Q

What is the clinical presentation of Tropical Sprue and what organism is it associated with?

A

Tropical sprue is associated with Klebsiella and E.Coli

Patients present with diarrhea Folate and B12 deficiency.

Small bowel biopsy shows blunted villi like celiac

34
Q

What are the typical symptoms of Whipples?

A 
Weight loss
Hyperpigmentation 
Infection with tropheryma whipped
PAS positive
Polyarthritis 
LAD
Enteric involvement 
STEATORRHEA 
CNS
35
Q

What are the two types of protein-losing enteropathy

A
  1. Eosinophilic gastroenteritis
    - Associated with allergies
    - Lab shows elevated eosinophils , iron def anemia, and protein losing enteropathy with or without STEATORRHEA Small bowel imaging shows folds and filling defects
    - Bx revealed Eosinophilic infiltration
    - Parasites have to be rules out

Rx: steroids

  1. Intestinal Lymphangiectasia
    - due to lymphatic obstruction, which leads to hypoplastic lymphatics so lymph get dumped into the intestine.
    - protein losing enteropathy plus STEATORRHEA
    - UNILATERAL lyphedema of the leg is characteristics
    - CHYLOUS PERITONEAL OR PLEURAL EFFUSION CAN OCCUR
    - Lab shows lymphopenia and low serum protein
    - Small bowel biopsy shows dilated lacteals and lymphatics

Treatment: low fat diet and medium chain triglycerides

36
Q

How does microscopic colitis present?

What are the 2 types of microscopic colitis?

How is Dx?

What disease is it associated with

A

Usually present in the 6th decade of life in women with recurrent watery diarrhea, abdominal pain, weight loss

2 types:

Collagenous colitis=Thick supepithelial collagen in biopsy (Collagenous band)
Lymphocytic colitis=intraepithelial lymphocytes on Bx

The colon will appear normal on imaging and colonoscopy, it has to be diagnosed through Bx

Microscopic colitis is associated with celiac disease with 72 fold increase of microscopic colitis in patients with celiac

37
Q

what is the treatment of Microscopic colitis

A

First line is Budesonide

If intolerant to budesonide treatment is prednisone, Mesalamine, bismuth subsalicylate

38
Q

What are the causes of drug induced microscopic colitis?

A 
NSAIDS (can also exacerbate it)
Aspirin
A car Bose
Ranitidine
Sertraline
Lanzoprazole
39
Q

Testing for C.Dif

A
  1. Toxin should not be tested alone
  2. Do not repeat test within 7 days of same diarrhea episode

Testing include:

  1. NAAT
  2. Glutamate dehydrogenase test + toxin (if values are discordant then perform NAAT)
  3. NAAT+ Toxin
40
Q

When should contact precaution for C. Dif be stopped

A

48 hours after diarrhea stops, but can continue until discharge if CDI rates are high

41
Q

Treatment of Acute initial occurrence of C.Dif

A

Non=severe
-WBC <15,000; Cr <1.5=PO Vanc or Fidaxomycin

Severe
WBC >15,000; Cr >1.5= PO vanc or Fidaxomycin

Fulminant 
-Hypotension/shock
-Ileus
-Megacolon
Rx: PO Vancouver 500 mg QID or through NG plus IV Flagyl; if ileus present add rectal vanco
42
Q

How is recurrence of C. Dif treated?

A

During first recurrence:

  • If flagyl was used first then treat with PO vanc 125
  • if PO vanc was used then treat with tapering dose of PO vanc (125 for 14 days, then 2 times.week for 1 week, 1 time per day for 1 week, then once every 2-3 days for 2-8 weeks)
  • another option if PO vanc was used is PO Fidaxomycin

Second recurrence (or the 3rd episode)

  1. Give tapering or pulsed regimen PO vanc
  2. PO vanc for 10 days and then Rifaximin for 2o days
  3. Fidaxomycin for 10 days
  4. Poop transplant
43
Q

What types of surgery have been shown to be better than subtotal colectomy in C.Dif patients

A

Diverting Loop ileostomy with intraoperative lovage with polyethylene glycol + 500 mg vancomycin every 8 hours

44
Q

What Antitoxin B monoclonal antibody is a proved for patients with C.dif on antibacterial therapy who are at high risk for recurrence?

A

Bezlotoxumab

Gastroenterology (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions