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Gastro > Diarrhea, Lymphocytic colitis > Flashcards

Diarrhea, Lymphocytic colitis Flashcards

1
Q

Clinical definition of diarrhea?

A

Incr in frequency, volume, or urgency of defecation

+/- change in consistency

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2
Q

Nml stool frequency?

A

3 BM per week up to 3 BM per day

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3
Q

Physiologic definition of diarrhea?

A

> 200 gm stool output per day

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4
Q

Normal amount (liters) of input into the gut?

A

8.5L

2L from ingestion, 6.5L from secretions

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5
Q

The small intestine absorbs __L of fluid, and the colon absorbs __L.

A

7L

1.4L

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6
Q

How much fluid is excreted form the gut?

A

0.1L

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7
Q

What is the basis of nml fluid absorption?

A

Na+ uptake

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8
Q

Receptors in small intestinal villi?

A

Na+ / glucose co-transporter

Na+ / H+ exchanger (NHE)

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9
Q

Receptors in Large intestinal crypts?

A

epithelial Na+ channel (ENaC)

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10
Q

Pathophysiology of Diarrhea?

A
  1. Increased intraluminal fluid

2. More rapid transit through GIT

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11
Q

Increased Intraluminal Fluid: Pathophysiologic Mechanisms?

A
  1. decr absorption (osmotic mechanism, fluid drawn into gut)
  2. incr secretion (active secretion of electrolytes + fluid into lumen)
  3. inflammation (inflammatory mediators stimulate secretion)
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12
Q

comprise most stool osmolality

A

electrolytes

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13
Q

What causes compromise of epithelial barriers?

A

cell death, caused by inflammation

**results in incr intraluminal fluid

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14
Q

How does ingestion of unabsorbable solutes affect the GIT?

A

incr intraluminal fluid via osmotic mechanism

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15
Q

Causes of Osmotic Diarrhea:

A

Non-absorbable carbohydrates

Non-absorbable electrolytes (laxatives)

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16
Q

Types of Non-absorbable carbohydrates?

A

lactose (milk, yogurt, cheese, etc.)

sorbitol, mannitol (diet soda, gum, candy)

lactulose (Rx for hepatic encephalopathy)

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17
Q

Types of Non-absorbable electrolytes?

A

Mg2+ compounds (MOM, Maalox, Epsom salts)

Golytely (PEG)

Fleets phosphosoda prep

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18
Q

The key to all secretory diarrheas is:

A

excessive Cl- secretion into the gut

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19
Q

oral rehydration formula for the treatment of cholera and other secretory diarrheas is based on:

A

exploitation of the Na/glucose co-transporter

By including glu in high salt drink, Na+ absorption can continue despite cAMP inhibition of Na+ absorption by NHE

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20
Q

Secretory Diarrhea Mediators:

Bacterial Enterotoxins?

A

Cholera toxin (cAMP)
E. coli LT (cAMP)
E. coli STa (cGMP)
Yersinia toxin (Ca2+)

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21
Q

Secretory Diarrhea Mediators:

Neurohumoral agents?

A

VIP (cAMP)
ACh (Ca2+)
Serotonin (Ca2+)

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22
Q

Secretory Diarrhea Mediators:

Immune mediators?

A

Histamine (cAMP)

Prostaglandins (cAMP)

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23
Q

Chemical irritants that cause secretory diarrhea?

A

Bile, arsenic, caffeine, ETOH

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24
Q

Neuroendocrine tumors that cause secretory diarrhea?

A

VIPoma
carcinoid
medullary carcinoma of thyroid

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25
Q

How does fasting affect osmotic diarrhea?

How does fasting affect secretory diarrhea?

A

O: resolves with fasting

S: persists with fasting

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26
Q

Which form of diarrhea is associated with flatulence?

A

osmotic

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27
Q

pH of stool in osmotic diarrhea?

pH of stool in secretory diarrhea?

A

O: <5.3

S: 6-7

28
Q

osmolar gap in osmotic diarrhea?

osmolar gap in secretory diarrhea?

A

O: >125

S: <50

**=230-2(Na+K)

29
Q

Pathophysiology of Inflammatory Diarrhea:

Stimuli?

A 
Parasites 
Food allergy 
Celiac sprue
Salmonella 
Whipples 
IBD
GVH
Shigella 
Rotavirus
30
Q

Pathophysiology of Inflammatory Diarrhea:

Immune-mediated mechanisms causing enterocyte cell death?

A

complement, cytokines,
cytotoxic T-cells, mast
cells, neutrophils, etc.

31
Q

inflammatory mediators induce…

A

Intestinal Secretion

32
Q

what stimuli directly induce enterocyte death?

A 
Amoeba
Shigella
Rotavirus
Giardia
Cryptosporidium
33
Q

What are the consequences of inflmm diarrhea?

A

Villous atrophy

Malabsorption

34
Q

Acute Diarrhea:
Duration?
Etiology?
Prognosis?

A

<3 weeks

infectious

self-limited

35
Q

Acute Diarrhea:
Pathophys?
Management?

A

secretory or inflammatory

supportive

36
Q

Most Common Causes of Infectious Diarrhea in the US?

A 
Viral
E. coli  
Campylobacter
Salmonella, Shigella
Giardia
Cryptosporidium (AIDS) 
C. difficile (antibiotics)
37
Q

Most Common Causes of Infectious Diarrhea in the 3rd world?

A 
Viral (rotavirus, norovirus)
Campylobacter
E. coli
Vibrio cholerae
Entameba histolytica
Salmonella, Shigella
Cryptosporidium (infants)
38
Q

Most common cause of traveler’s diarrhea?

A

enterotoxigenic E coli

39
Q

Who is affected by traveler’s diarrhea?

A

travelers to third world

40
Q

Prophylaxis Recommendations for traveler’s diarrhea?

A

eat only cooked foods

drink only bottled beverages, avoid ice

wash hands before meals

consider peptobismol QID

41
Q

Trx for traveler’s diarrhea?

A

po fluids + anti-diarrheals for symptom control

if severe, ciprofloxacin 500 mg BID x 3 days

42
Q

What type of acute diarrhea is likely viral or toxin mediated?

A

Non-bloody diarrhea without dehydration

43
Q

What type of acute diarrhea is likely bacterial?

A

bloody (dysentery) diarrhea without dehydration

44
Q

Treatment of diarrhea without dehydration?

A

fluids and peptobismol

45
Q

Treatment for bloody diarrhea with dehydration?

A

IV fluoroquinolone (cipro)
hospitalization
IV fluids

46
Q

C. diff risk factors?

A

Antibiotic usage

Extremes of age

Hospitalization or institutionalization

47
Q

How does C. diff induce diarrhea?

A

Cytotoxins A & B

48
Q

How is C diff diagnosed?

A

pseudomembraneous colitis on endoscopy

Stool assay for Toxin A (+/- B)

49
Q

How is C diff treated?

A

stop the offending abx (if possible)

metronidazole or vancomycin po

cholestyramine to bind toxins

50
Q

Chronic diarrhea:
Duration?
Etiology?

A

> 3 weeks

infectious
immune-mediated
malabsorption

51
Q

Chronic diarrhea:

Pathophys?

A

osmotic, secretory (no mucosal injury)

Inflammatory (mucosal injury)

52
Q

What types of chronic diarrheas are associated with NO mucosal injury?

A
  1. maldigestion/malabsorption syndromes
  2. hypermotility (thyroid, IBS, etc)
  3. Neuroendocrine malignancies
  4. factitious (laxative abuse)
53
Q

Clinical features of lactase deficiency?

A
  1. osmotic diarrhea
  2. flatulence
  3. acidic stool pH
54
Q

Clinical features of bacterial overgrowth?

A

secretory diarrhea (due to conversion to unconjugated bile acids)

osmotic diarrhea

gas

55
Q

IBS is a disorder of

A

motility and pain perception

56
Q

Symptoms of IBS?

A
  1. abdominal pain
  2. bloating
  3. no weight loss, bleeding, malnutrition, anemia
57
Q

Treatment of:
IBS w/ diarrhea?
IBS w/ const?

A

anti-cholinergic medications (diarrhea)

5-HT receptor antagonists (constipation)

58
Q

What types of chronic diarrheas are associated with mucosal injury?

A
  1. chronic infections (HIV, parasites, sprue)
  2. allergic/immune-mediated (celiac, Crohn’s, ulc colitis, etc)
  3. malignancies (colon CA, lymphoma)
59
Q

What are the 2 types of microscopic colitis?

What are the associated symptoms?

A

Collagenous colitis
Lymphocytic colitis

Chronic watery, non-bloody diarrhea in adults

60
Q

Treatment for microscopic colitis?

A

Bismuth
Aminosalisylates
steroids

61
Q

What are the features of Behcet’s disease?

A
  1. generalized vasculitis
  2. Oral and genital aphthous ulcers
  3. Uveitis
  4. GI tract ulcers
  5. Non-erosive arthritis
62
Q

Trx of Behcet’s?

A

immunosuppressants

63
Q

What are “red flags” in a patient with chronic diarrhea?

A
  1. Unintentional weight loss
  2. Nocturnal diarrhea
  3. Signs of malnutrition (muscle wasting)
  4. Rectal bleeding
64
Q

What is the ddx of there are no red flags + flatulence?

A

lactose intol

bac overgrowth

65
Q

What is the ddx of there are no red flags + pain with BMs?

A

IBS

66
Q

What is the ddx if Red Flags Present or Initial Studies Abnormal + weight loss?

A

IBD
hyperthyroidism
malabs
malignancy

67
Q

What is the ddx if Red Flags Present or Initial Studies Abnormal + bleeding?

A

malignancy
infection
IBD

Gastro (25 decks)

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