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Gastrointestinal STEP 2 > diarrhea - IBS > Flashcards

diarrhea - IBS Flashcards

1
Q

Antibiotic associated diarrhea - etiology

A

although clindamycin may be associated with the highest incidence diarrhea and C. Diff, any antibiotc can potentially cause diarrhea

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2
Q

antibiotics associated diarrhea - characteristics of the diarrhea

A

blood + white cells in the stool

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3
Q

antibiotics associated diarrhea - time

A

several days or weeks after the start of antibiotivs

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4
Q

antibiotics associated diarrhea - best initial test

A

stool C. diff toxin test or PCR

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5
Q

antibiotics associated diarrhea - best initial therapy

A

ORAL metronidazole

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6
Q

antibiotics associated diarrhea - therapy

A

best initial: oral metronidazole

if no response: switch to oral vancomycn or fidaxomicin

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7
Q

repeated episode of antibiotics associated diarrhea

A

AGAIN oral metronidazole

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8
Q

antibiotics associated diarrhea - IV metronidazole

A

onky if oral cannot be used (such as adynamic ileus)

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9
Q

C. diff - culture

A

never –> not grow in culture

the source of the name

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10
Q

C. diff - endoscopy

A

diagnose antibiotic associated diarrhea –> NOT necessary step given the availability of stool toxin assay

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11
Q

antibiotics associated diarrhea - IV vancomycin

A

always wrong –> it will not pass the bowel wall

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12
Q

Diarrhea after antibiotic use - management

A 
C diff positive?
NO: consider alternative causes
YES: oral metronidazole:
- if improvement --> continue 
- if no improvement --> switch to oral vancomycin or fidaxomicin
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13
Q

Malabsorption - etiology

A
  1. Celiac (one of the MCC)
  2. Chronic pancreatitis
  3. tropical sprue (rare)
  4. Whipple disease (rare)
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14
Q

all form of malabsorption present with

A

steatorrhea, deficiency of fat soluble vitamines (and their manifestation), wight loss

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15
Q

steatorrhea - definition

A

oily, greasy, floating an foul smelling stools

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16
Q

VIT D deficiency - manifestation

A

hypocalcemia, osteoporosis

  • rickets in children
  • osteomalacia in adults
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17
Q

VIT K deficiency - manifestation

A

bleeding, easy brusing

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18
Q

VIT B12 -deficiency

A

anemia, hypersegmented neutrophils

neuropathy

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19
Q

Vitamin B12 malabsorption

A

need an intact bowel and pacreatic enzymes to be absrobed

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20
Q

how t distinguish clinically tropical spure from celiac disease

A

no way

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21
Q

celiac disease - is aka

A

gluten sensitive enteropathy

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22
Q

celiac disease - is associated ith

A
  1. dermitis herpetiformis in 10% of cases

2. increased risk of malignancy (eg. T-lemphoma)

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23
Q

celiac disease - affects

A

distal duodenume and/or proximal jejunum

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24
Q

Whipple disease - manifestations beside malabsorption

A
  1. arthralgias 2. ocular findings 3. fever
  2. neurological abnormalities (dementia seizures)
  3. lymphadenpathy
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25
Q

Whipple disease - treatment

A

ceftriaxone followed by TMP/SMZ

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26
Q

one of the main lab distinctions between chronic pancreatitis and celiac spure is the … (explain)

A

presence of iron deficiency in celiac sprue

this is because iron needs an intact bowel wall to be absorbed, but it does not need pancreatic enzymes

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27
Q

celiac sprue - unique tests (which is first)

A
  1. anti-tissue transglutaminase (first)
  2. antiendomysial antibody
  3. IgA antigliadin antibody
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28
Q

celiac spure - the most accurate test

A

small bowel biopsy –> flattening of the vill

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29
Q

Whipple disease - the most accurate test

A

small bowel biopsy –> specific organism

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30
Q

tropic sprue - the most accurate test

A

small bowel biopsy –> specific organism

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31
Q

celiac spure - beside diagnosis, biopsy is essential to

A

exclude lymphoma

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32
Q

Chronic pancreatitis - specific diagnostic tests (only names) (which is the most accurate)

A
  1. abdominal x-ray
  2. abdominal CT
  3. secretin stimulation testing (the most accurate)
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33
Q

Chronic pancreatitis - abdominal x-ray - specificity and sensitivity

A

very specific

50-60% sensitive for calcification of the pancreas

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34
Q

Chronic pancreatitis - abdominal CT scan - sensitivity

A

80-90%

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35
Q

Chronic pancreatitis - secretin stimulation testing - describe

A

place a nasogastric tube –> an unaffected pancreas will release a large volume of bicarbonate-rich fluid after the IV injection of secretin

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36
Q

Chronic pancreatitis - most accurate test

A

secretin stimulation testing

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37
Q

rice and wine in celiac sprue

A

safe

38
Q

chronic pancreatitis - treatment

A

enzyme replacement

39
Q

celiac sprue - treatment

A

avoid gluten containing foods such as wheat, oats, rye, barley

40
Q

whipple disease - treatment

A

ceftriaxone followed by TMP/SMZ

41
Q

tropical sprue

A

TMP/SMZ, tetracycline

42
Q

test to distinguish chronic pancreatitis from bowel wall abnormalities

A

D-xylose –> normal in chronic pancreatitis

old test

43
Q

carcinoid syndrome - presentation

A
  1. intermittent diarrhea
  2. flushing
  3. wheezing
  4. cardiac abnormalities of the right side of the heart
44
Q

carcinoid syndrome - best initial diagnostic test

A

5-hydroxyindoleacetic (5-HIAA) test

45
Q

carcinoid syndrome - therapy

A

octreotide –> control diarrhea

46
Q

a symptoms that occurs in almost every malabsorption syndrome, but not in lactose intolerance

A

weight loss –> lactose is only one of several sugars to absorb. Also lactose intolerance does not alter the absorption of any other nutrient such as fat so there is no deficiency in calories

47
Q

lactose intolerance - calories

A

it does not alter the absorption of any other nutrient such as fat so there is no deficiency in calories

48
Q

lactose intolerance - vitamins

A

normal

49
Q

lactose intolerance - diarrhea due to

A

increased stool osmolarity

50
Q

lactose intolerance - the usual way to make diagnosis

A

remove all milk containing products from the diet and wait a single day for resolution of symptoms

51
Q

lactose intolerance - treatment

A
  • avoid milk products except yogurt

- oral lactose replacement is also good and is available over the counter

52
Q

over the counter medications - definition

A

no prescription is needed

53
Q

Irritable bowel syndrome - presentation (like definition)

A

pain syndrome that can have diarrhea, constipation or both

54
Q

Irritable bowel syndrome - weight loss

A

no

pain does not automatically mean malabsorption

55
Q

Irritable bowel syndrome - diagnosis

A

there is no specific test

diagnosis of exclusion in association with a complex of symptoms

56
Q

Irritable bowel syndrome - characteristics of pain

A
  1. relieved by bowel movement
  2. less at night
  3. relieved by a change in bowel habit such as diarrhea
57
Q

Irritable bowel syndrome - treatment

A
  1. fiber in the diet
  2. antispasmodic agents (hyoscyamine, diclomine)
  3. TCA
  4. antimotility agents such as loperamide for diarrhea
  5. Lubiprostone
58
Q

Irritable bowel syndrome - antispasomodic agents such as

A
  1. hyoscyamine

2. diclomine

59
Q

Irritable bowel syndrome - Lubiprostone

A

Cl- channel activator that increases bowel movements frequent –> also treats the constipation that is predominant in IBS

60
Q

inflammatory bowel disease - idiopathic disorder that presents with

A
  1. diarrhea
  2. blood in stool
  3. weight loss
  4. fever
61
Q

iflammatory bowel disesase - both Crohn and ulcerative colitis have extraintestinal manifestations that can be IDENTICAL in both diseases:

A
  1. arthralgias 2. Uveitis, iritis
  2. skin manifestations
  3. sclerosing cholangitis (more frequent in Ulcerative)
62
Q

IBD - cancer

A

bot forms of IBD can lead to colon cancer. The risk of cancer is elated to the duration of involvement of the colon. Crohn that involves the colon has the same risk of as ulcerative colitis

63
Q

differences between crohn and ulcerative colitis

A

crohn –> skp lesions, tranmural granulomas, fistulas and abscess, masses and obstruction, perianal disease
UC –> curable by surgery, entirely mucosal, no fistulas, no abscesses, no obstruction, no perianal

64
Q

IBD - when should screening occur

A

afet 8-10 years of colonic involvement, with colonoscopy every 1-2 years

65
Q

IBD - diagnostic tests - only the names of the tests (most accurate?)

A
  1. endoscopy (most accurate when can be reached)
  2. radiologic studies (barium)
  3. serologic testing
66
Q

IBD - endoscopy

A

the most accurate when the disease can be reached by a scope

67
Q

IBD - radiologic studies

A

For crohn that is mainly in the small bowel, radiologic tests such as BARIUM will detect the lesions

68
Q

IBD serologic testing

A

if unclear. All IBD is associated with anemia. also:

  • ANCA: UC
  • ASCA: Crohn
69
Q

IBD - ANCA?

A

antineutrophil cytoplasmic antibody –> ulcerative colitis (not in corhn)

70
Q

IBD - ASCA?

A

antisaccharomyces cerevesiae antibody –> Crohn (not in ulcerative)

71
Q

IBD - treatment of acute exacerbations

A

steroids in both IBD and UC

prednisone or budesonide

72
Q

IBD - chronic maintenance or remission

A

5-ASA derivatives:
UC –> asacol, rowasa (if limited to the rectum)
CD –> pentasa

73
Q

IBD - how to wean patients off of steroids

A
  1. azathiprine
  2. 6-mercaptopurine
    when the disease is so severe that severe recurrence develop as the steroids are stop
74
Q

every IBD needs … (additional treatment)

A

calcium and vit D

75
Q

perianal CD is tread with

A
  1. ciprofloxacin + metronidazole
76
Q

IBD - TNF agents

A

FISTULAE and severe disease unresponsive to other agents is treated with TNF agents such as infiximab

77
Q

IBD - fistulae treatment?

A

TNF agents such as infiximab

If no response –> surgery

78
Q

IBD - surgery?

A

neither form is routinely treated with surgery. UC can be cured, however, with colectomy. In CD, surgery is used exclusively for bowel obstruction. CD will tend to recur at the site of surgery

79
Q

Budesonide - IBD

A

budesonide is a steroid sepcific for IBD. First pass effect is good

80
Q

Divrticulosis - epidemiology

A

outpocketing of the colon are so common on a standard meat-filled diet as to be routinely expected in those above 65-70. Vegeterians rarely develop diverticulosis

81
Q

diverticulosis - presentation

A
  • asymptomatic most of the time
  • left lower quadrant abdominal pain
  • constipation
  • bleeding
  • sometimes infection (diverticulitis
82
Q

diverticulosis - most accurate test

A

colonoscopy

83
Q

diverticulosis - Barium

A

acceptable, but not as accurate

84
Q

diverticulosis - treatment

A

Bran (πίτουρο), psyllium, methylcelluose (μεθυλοκυτταρίνη) and increased dietary fiber are used to decrease the rate of progression and complications

85
Q

diverticulitis - presentation

A
  1. LLQ pain and TENDERNESS
  2. fever
  3. Leukocytosis
  4. palpable mass (sometimes)
  5. nausea, constipation, bleeding (nonspecific)
86
Q

Diverticulitis - best initial test

A

diverticulitis

87
Q

Colonoscopy and barium - diverticulitis

A

both are DANGEROUS in acute diverticulitis because of increased risk of perforation
infection weakens the colonic wall

88
Q

Treatment of diverticulitis is with antibiotics that cover …

A

E. coli and anaerobes of the bowel

89
Q

Treatment of diverticulitis - antibiotics

A
  1. ciprofloxacin + metronidazole OR
  2. beta lactam + lactamase (amoxicillin/clavulanate)
  3. ticarcillin / clavulanate
  4. ertapenem (carbapenems)
90
Q

diverticulitis - surgery indications

A
  1. no response to medical therapy
    2 frequent recurences of infection
  2. perforation, fistula formation, absecess, strictures or obstruction (complications)
91
Q

surgery of devirticulitis - who is more likely to get recommendation of surgery - young or old

A

younger should have the colon resected more often because of the greater total number of recurrent episodes that will occur. Diverticular disease does not disappear despite treating episodes of diverticulitis or the use of fiber on the diet

92
Q

diverticulitis - food

A

patients with acute diverticulitis should not be fed

Gastrointestinal STEP 2 (8 decks)

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