Diarrhea

Question 1

What are the 2 concerning things lost in a patient’s Diarrhea?

Answer 1

Potassium and Bicarb

Question 2

When is acute diarrhea concerning and need a workup?

Answer 2

Bloody or pus (Dysentery)
Fever
Risk of E. Coli
Risk of C. Diff

Question 3

3 big causes of Non-infectious Diarrhea

Answer 3

1. Meds
2. Food allergies/intolerances
3. Artificial Sweeteners

Question 4

What is the difference between ABX-associated diarrhea and ABX-associated colitis?

Answer 4

Colitis is attributable to the C. Diff infection that follows ABX use
Diarrhea is caused by the drug itself

Question 5

Osmotic Diarrhea

Answer 5

Caused by stuff staying in the GI tract and pulling water in.
Gets better with fasting.
Lactose intolerance, artificial sweeteners, and alcohol
Laxative abuse

Question 6

Secretory Diarrhea

Answer 6

Does NOT improve with Fasting
Dehydration/hyponatremia can develop
Causes: Zollinger Ellison, Crohns, Laxative abuse

Question 7

3 most common causes of chronic diarrhea

Answer 7

1. Meds
2. IBS
3. Lactose Intolerance

Question 8

What findings are red flags for chronic diarrhea?

Answer 8

Nocturnal diarrhea
weight loss
anemia
Positive fecal occult blood test

Question 9

Examples of Routine lab work for Diarrhea

Answer 9

CBC
CMP
anti tTG test (celiac’s)
Albumin

Question 10

Common causes of diarrhea due to malabsorption

Answer 10

Pancreatic insufficiency/pancreatitis

Question 11

A high Gastrin level (>1000) is a sign of what?

Answer 11

Zollinger-Ellison Syndrome

Question 12

Meds that can cause Diarrhea

Answer 12

AcHe Inhibitors
SSRIs
PPI
NSAIDs
Metformin

Question 13

3 clinical presentations of IBS

Answer 13

1. Spastic colon (abd pain)
2. Alternating diarrhea/constipation
3. Chronic, painless diarrhea

Question 14

Lactase Deficiency

Answer 14

No Lactase in brush border
Diarrhea, cramping, flatulence post lactose ingestion
Can diagnose with Hydrogen breath test or by improvement of symptoms when lactose is removed from diet

Question 15

What is the most common cause of antibiotic-associated colitis?

Answer 15

C. Diff- can cause pseudomembranous colitis as well

Question 16

3 risk groups of C. Diff

Answer 16

1. Hospitalized
2. Elderly
3. Immunocompromised

Question 17

C. Diff caused colitis

Answer 17

Usually after ABX that alters normal gut flora.
Foul-smelling watery diarrhea many times a day
Pseudomembranous Colitis characterized by Volcano exudate

Question 18

Symptoms that lead you to a malabsorption syndrome

Answer 18

Weight loss
Vitamin Def
Steatorrhea
Nutritional def

Question 19

Examples of malabsorption disorders

Answer 19

Pancreatitis
Whipple disease
Crohns
Celiac
CF

Question 20

Celiac Dz

Answer 20

Caused by gluten (gliadin) allergy 
damages small intestine and shows villous atrophy 
HLA-DQ2 and HLA-DQ-8 associated 
Dermatitis Herpatiformis
Fe-Def Anemia 
Test for anti-tTG ab

Question 21

Where are Bile salts resorbed?

Answer 21

distal Ileum
resection or disease (Crohns) can cause malabsorption and lead to steatorrhea/watery diarrhea and malabsorption of fat-soluble vitamins

Question 22

Whipple Disease

Answer 22

Caused by the gram + Tropheryma Whipplei
White men (farmers)
Causes weight loss, malabsorption, and can lead to heart failure of untreated.
Diagnose using PAS staining for foamy macrophages

Question 23

Upon colonoscopy, your patient’s colon is brown/black and you freak out. Should you?

Answer 23

No, it is most likely melanosis coli, a benign hyperpigmentation of the colon due to chronic laxative use