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GI > Diarrhea and Constipation - Exam 3 > Flashcards

Diarrhea and Constipation - Exam 3 Flashcards

1
Q

What are the 7 different types of stool as described by the Bristol stool chart.

A
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2
Q

What is considered acute diarrhea? persistent? chronic?

A

acute: less than 2 weeks

persistent: 2-4 weeks

chronic: greater than 4 weeks

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3
Q

More than 90% of cases of acute diarrhea are caused by _________

A

infectious agents either viral or bacterial

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4
Q

How are the 2 most infectious agents of acute diarrhea acquired?

A
  1. fecal-oral transmission
  2. Disturbances of flora by antibiotics allowing overgrowth of
    pathogens, such as Clostridium difficile
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5
Q

**What are the 5 high risk groups for acute diarrhea in the United States?

A

travelers

consumers of certain foods

immunodeficient persons

daycare attendees and their family members

institutionalized persons

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6
Q

** What are the 2 MC pathogens for traveler’s diarrhea?

A

E Coli & Giardia lamblia

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7
Q

** What 3 pathogens are associated with chicken?

A

Salmonella, Campylobacter, or Shigella

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8
Q

**What pathogen is associated with undercooked hamburger?

A

E. Coli

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9
Q

**What pathogen is associated with fried rice or other reheated foods?

A

Bacillus cereus

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10
Q

**What pathogen is associated with dairy, produce, meats, eggs, salads that have been left out at room temp for too long?

A

Staph aureus

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11
Q

** What pathogen is associated with eggs?

A

salmonella

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12
Q

**What pathogen is associated with undercooked shellfish?

A

vibrio

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13
Q

**What pathogen is associated with uncooked foods, lunch meat or soft cheeses?

A

Listeria

higher rates in preg women

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14
Q

** What pathogen is associated with improperly stored food/canned food?

A

Clostridium Botulinum

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15
Q

What do community outbreaks suggest?

A

viral etiology or a common food source

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16
Q

**What pathogens are associated with daycare attendees and their family members?

A

Shigella, Giardia, rotavirus, Hepatitis A

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17
Q

**What pathogen is associated with institutionalized persons?

A

C diff

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17
Q

What does bloody diarrhea indicate? non-bloody?

A

bloody= inflammatory if gross or occult blood

non-bloody= non-inflammatory

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18
Q

What are the s/s of acute non-inflammatory diarrhea? What type of cramps? What is included in the diagnostic evaluation?

A

watery and NON-bloody

periumbilical cramps

Diagnostic evaluation is limited to patients with diarrhea that is severe or persists beyond 7 days

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19
Q

What are the s/s of acute inflammatory diarrhea? What type of cramps? What is included in the diagnostic evaluation?

A

fever and bloody diarrhea

LLQ cramps

Diagnostic evaluation requires routine stool bacterial cultures (including E coliO157:H7) in all and testing as clinically indicated for Clostridium difficile toxin, and ova and parasites.

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20
Q

What is the function of the small bowel? What does dysregulation lead to? Is fever a significant symptom?

A

The small bowel functions as a fluid/enzyme secretory and nutrient-absorbing organ

Dysregulation of these d/t infections lead to a watery diarrhea in large volume with cramping, bloating, gas and weight loss

Fever is RARELY a significant symptom

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21
Q

** ______ are the MC cause of watery diarrheas

A

Enteric Viruses

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22
Q

What is the main function of the large bowel?How does large bowel s/s present? **Is fever typically associated? What 2 things are routinely seen on stool smear?

A

The main function of the large bowel is to absorb fluid and salt and to excrete potassium

present with frequent, regular, small-volume, often painful bowel movements

**Fever and bloody/mucoid stools are COMMON

Red blood cells and inflammatory cells can be routinely see on stool smear

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23
Q

** ______ are more common causes of inflammatory, large intestinal diarrhea

A

Bacterial pathogens

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24
Q

How will most foodborne infections present?

A

as a mixture of diarrhea, nausea, vomiting, and abdominal discomfort

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25
Q

Ingested preformed toxins (staph. aureus and bacillus cereus) cause illness within ________

A

hours of exposure (gen. 1-6hrs

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26
Q

Ingested pathogens which produce toxins (enterotoxigenic E. Coli) or directly damage or invade across epithelial cell wall (Salmonella, Shigella, Campylobacter) usually result in symptoms __________

A

approx. 24 hours or longer

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27
Q

Protozoal pathogens (cryptosporidium, Giardia) usually take ______ to start showing illness s/s

A

generally 7 days

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28
Q

norovirus and other enteric viruses, symptoms usually start _______ and resolve _______. How is it transmitted?

A

symptoms begin 24-48 hours after exposure and resolve in 48-72 hours

usually household/community spread

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29
Q

Giardia, cryptosporidium, entamoeba hystolytica s/s usually start _______ and last for _______. How are they usually transmitted?

A

7-14 days after exposure

can last for weeks and turn into chronic

parasite that is found in daycares and mountainous streams, endemic areas and community swimming pools

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30
Q

What setting does C. diff usually occur? What is the timeframe?

A

after abx

may take up to 1 month AFTER antibiotic therapy; most within 2 weeks

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31
Q

What abx are most frequently associated with C diff?

A

fluoroquinolones, clindamycin, cephalosporins, and penicillins

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32
Q

On the PE, what 3 things do you need to note? When would you want to hospitalize them?

A
  1. level of hydration
  2. mental status
  3. presence of abdominal tenderness or peritonitis

severe dehydration, organ failure, marked abdominal pain, and or altered mental status

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33
Q

_____ of acute noninflammatory diarrhea is self-limited. What is the tx?

A

90%

Typically does not require diagnostic investigation

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34
Q

What presenting s/s makes you think diarrhea is self- limiting?

A

present for less than 2 weeks

no fever

non-bloody

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35
Q

When would you want to consider working a pt up for diarrhea? What would you order?

A

If diarrhea persists more than 7 days, if dysentery present, or severe illness

fecal leukocytes
stool culture
stool O&P
stool for c. diff

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36
Q

What does a positive fecal leukocyte indicate? negative?

A

Positive = inflammatory
Negative = non-inflammatory

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37
Q

What are you looking for in a stool culture?

A

Typically detects Salmonella, Shigella, and Campylobacter

e coli

38
Q

What is the tx for acute diarrhea?

A

hydration
bowel rest: avoid high fiber, fats, milk products, caffeine, alcohol
easily digested foods (BRAT diet)

39
Q

When should you NOT use an antidiarrheal agent?

A

Should not be used in patients with bloody diarrhea, high fever, or systemic toxicity

40
Q

_____ MOA binds to gut wall opioid receptor which inhibits peristalsis. **When is it CI?

A

Loperamide (Imodium)

**contraindicated in acute inflammatory diarrhea

41
Q

_____ MOA reduces secretions in the gut. What two pt populations should this medication be avoided?

A

Bismuth subsalicylate (Pepto–Bismol)

avoid in pregnant pts and kids

42
Q

_____ MOA has anticholinergic effects =_______ inhibits excessive GI motility and GI propulsion

A

Diphenoxylate / atropine (Lomotil)

Diphenoxylate

43
Q

**What is the CI to Diphenoxylate/ atropine? What part is added to discourage misuse?

A

Contraindicated in acute and inflammatory diarrhea. Can cause toxic MEGACOLON

atropine to discourage misuse

44
Q

Why does using Diphenoxylate/atropine (Lomotil) in acute/inflammatory diarrhea cause toxic megacolon?

A

use may slow GI motility and enhance bacterial overgrowth and release of bacterial exotoxins

also can lead to severe dehydration by inhibiting peristalsis may lead to fluid retention in the intestines aggravating electrolyte imbalance

45
Q

When would abx be considered for diarrhea?

A

May be considered in patients with high fever, bloody stools, immunocompromised, or severe dehydration

NOT indicated for acute diarrhea

46
Q

What is the abx treatment of choice for diarrhea? What are the 2 alternatives? What should you do before starting abx?

A

Cipro/Levo

bactrim or doxy

Culture should be obtained prior to starting abx therapy

47
Q

What is the specific abx treatment for shigellosis?

A

cipro

48
Q

What is the specific abx treatment for cholera?

A

azithromycin

49
Q

What is the specific abx treatment for salmonellosis?

A

cipro

50
Q

What is the specific abx treatment for listeriosis?

A

amoxicillin or bactrim

51
Q

What is the specific abx treatment for C. diff?

A

Vanc or flagyl

52
Q

What is the specific abx treatment for giardiasis?

A

metronidazole (Flagyl)

53
Q

What is considered chronic diarrhea? What are the top 4 highlighted meds from lecture?

A

present for longer than 4 weeks

SSRIs
Metformin
allopurinol
orlistat

54
Q

What does osmotic diarrhea result from? What are the MC forms? **Osmotic diarrheas resolve _______

A

Results from the presence of osmotically active, poorly absorbed solutes this inhibits normal water and electrolyte absorption

carbohydrate malabsorption: think lactose intolerance

during fasting

55
Q

What is the pathophys behind secretory disorders? **Do secretory disorders improve with fasting? What are 2 listed causes?

A

increased intestinal secretion or decreased absorption results in high-volume watery diarrhea

**Little change in stool output during fasting

endocrine tumors

bile salt malabsorption

56
Q

How do secretory disorders present? What are these pts at high risk for?

A

may vary from a few to up to 30 nonbloody, watery stools per day
can be explosive
high-volume watery diarrhea

Dehydration and electrolyte imbalance may develop

57
Q

What does diarrhea with abdominal pain, fever, weight loss, and hematochezia make you think?

A

inflammatory conditions: UC or Crohn dz

58
Q

What does Weight loss, Osmotic diarrhea, Steatorrhea and Nutritional deficiencies make you think?

A

Malabsorptive Conditions

59
Q

______ is the MC cause of chronic diarrhea in young adults. How does it present? What makes it worse?

A

Irritable bowel syndrome

Lower abdominal pain
Altered bowel habits
No evidence of serious organic disease

exacerbated by stress

60
Q

What are the top 5 MC pathogens associated with chronic infectious diarrheas?

A

Giardia
E. histolytica
Cyclospora
Intestinal nematodes
C. diff

61
Q

What effect does your thyroid gland have on GI motility? How does DM effect?

A

hyperthyroid - hypermotility
hypothyroid - hypomotility

autonomic neuropathy of the GI track, slows everything down

62
Q

If chronic diarrhea persists, would want to order ________. What are you looking for?

A

Endoscopic/colonoscopy examination and mucosa biopsy

To exclude inflammatory bowel disease or colonic neoplasia

63
Q

What forms does Imodium come in? Lomotil? Which one is OTC?

A

Imodium: OTC: oral suspension

Lomotil: rx. tablet or oral suspension

64
Q

What are the 2 CI for antidiarrheals?

A

DO NOT USE with bloody diarrhea or C. diff related diarrhea

Not for use in pts < 2 years of age

65
Q

What is the serious adverse reaction for antidiarrheals: loperamide and diphenoxylate?

A

Serious: Paralytic ileus, toxic megacolon

66
Q

What are the 4 common reactions for bismuth?

A

Antidiarrheals:
Bismuth (Pepto-Bismol, Kaopectate, Maalox)

Black stool
Black tongue
Constipation
Tinnitus

NEED TO TELL PTS BECAUSE IT WEIRDS THEM OUT

67
Q

_______ MOA inhibits intestinal fluid secretion and stimulates intestinal absorption and is indicated for chronic secretory diarrhea

A

Octreotide (Sandostatin)

68
Q

Where else is Octreotide (Sandostatin)
commonly used?

A

it is a somato statin analogue and used for a tx for giagantism

69
Q

________ is indicated for chronic secretory or malabsorptive diarrhea (post small bowel resections, post cholecystectomy). What is the important pt education point?

A

Cholestyramine (Questran)

POWDER form!! must sprinkle on food to ingest

70
Q

What are the 2 medications used PRN for diarrhea associated with IBS?

A

Hyoscyamine (Levsin)

Dicyclomine (Bentyl)

71
Q

______ MOA relaxes intestinal smooth muscle, inhibits spasms and contraction. Which one is also indicated for bladder spasm?

A

Hyoscyamine (Levsin), Dicyclomine (Bentyl

Hyoscyamine is also indicated for bladder spasm

72
Q

What are the 4 different definitions of constipation?

A

Infrequent stools (fewer than 3 per week)

Hard stools

Excessive straining

Sense of incomplete evacuation

73
Q

How long is the normal colon transit time? What is considered abnormal?

A

approx 35 hours

> 72 is abnormal

74
Q

What are the 2 MC causes of constipation?

A

Inadequate fiber or fluid intake

Poor bowel habits

75
Q

Need to perform ____ as part of the PE

A

DRE

76
Q

When should you need to further work a pt up for constipation?

A

Severe constipation or age over 50

Alarm symptoms: Hematochezia, weight loss, positive FOBT

Family history of colon cancer or inflammatory bowel disease

Refractory constipation not responding to routine medical management

77
Q

What are the alarm symptoms as related to constipation?

A

Hematochezia, weight loss, positive FOBT

78
Q

What are the lifestyle modifications associated with constipation?

A

Increase fiber and fluid intake

Regular exercise

79
Q

What are the 4 fiber/bulk forming laxatives? What is the MOA?

A

Psyllium (Metamucil)
methylcellulose (Citrucil)
calcium polycarbophil (FiberCon)
wheat dextran (Benefiber)

Fiber promotes intestinal motility by increasing “bulk” of stool. Fiber draws more water into stool

80
Q

When are fiber/bulk forming laxatives CI? What is important to note about their pharmacology?

A

GI obstruction

NO SYSTEMIC ABSORPTION

81
Q

______ MOA is an emollient that covers stool and softens it - allowing it to pass through colon easier. When should you NOT use them? What form?

A

Ducosate (Colace) and Mineral Oil

Not for use in severe constipation

can take orally or rectal suppository

82
Q

What are the 3 osmotic laxatives? What is the MOA?

A

Magnesium hydroxide (Milk of Magnesia) Polyethylene glycol (Miralax)
lactulose (Enulose)

Increase secretion of water into the intestinal lumen
Softens stools and promotes defecation
Usually works within 24 hours

83
Q

________ are often used in the treatment of opioid induced constipation and in chronic constipation in the elderly. How long does it usually take to work?

A

Osmotic Laxatives:
Magnesium hydroxide (Milk of Magnesia)
Polyethylene glycol (Miralax)
lactulose (Enulose)

usually works within 24 hours and are safe to use daily

84
Q

Polyethylene glycol (GoLYTELY), Magnesium citrate, Sodium phosphate (Fleets) are considered ________

A

bowel cleansers

used before colonoscopy

85
Q

What are the 3 stimulant laxatives? When are they indicated?

A

Bisacodyl (Dulcolax)
Senna (Senekot)
Cascara

For patients with incomplete response to osmotic agents
“rescue” agent, or used 3 – 4 times per week

86
Q

_______ MOA stimulates fluid secretion and colonic contraction by irritating the intestinal wall and cause fluid accumulations and increased contractions of the intestines

How long does it take to work?

A

Stimulant Laxatives:
Bisacodyl (Dulcolax), Senna (Senekot), Cascara

works within 6-12 hours

87
Q

Which laxative variant is NOT safe for everyday or long term use?

A

Stimulant Laxatives:
Bisacodyl (Dulcolax), Senna (Senekot), Cascara

are NOT safe for everyday or long term use

88
Q

**What is the stepwise approach to constipation?

A
89
Q

What are the 5 predisposing factors for fecal impaction?

A

1) Medications
2) Severe psychiatric disease
3) Prolonged bed rest
4) Neurogenic disorders of the colon
5) Spinal cord disorders

90
Q

What is paradoxical “diarrhea” associated with fecal impaction? How do you determine?

A

Liquid stool that leaks around the impacted feces

DRE will feel firm feces

91
Q

What is the treatment for fecal impaction? What is the long-term care?

A

Relieving impaction with enemas: saline, mineral oil, soap suds and digital disruption of the impacted fecal material

Maintaining soft stools and regular bowel movements

92
Q

go back and look at the case studies in the lecture with practice questions

A

do it!

93
Q
A

GI (12 decks)

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