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Emma GI > Diarrhea, Malabsorption, Small Intestinal Neoplasia > Flashcards

Diarrhea, Malabsorption, Small Intestinal Neoplasia Flashcards

1
Q

inflammatory diarrhea features

A
  • small volume
  • frank or occult blood
  • rectal urgency
  • abd pain
  • NOCTURNAL DIARRHEA
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2
Q

examples of inflammatory diarrhea

A

inflammatory bowel disease
ischemic colitis
radiation colitis
microscopic colitis

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3
Q

microscopic colitis usually presents with bloody or non-blood diarrhea?

A

non-bloody diarrhea

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4
Q

T/F

osmotic diarrhea resolves with eating

A

F

resolves w/o eating

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5
Q

exp of osmotic diarrhea

A
  • carb malabsorption (lactose intolerance)
  • ingestion of poorly absorbed sugars (sorbitol, xylitol)
  • laxatives w/ Mg
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6
Q

secretory diarrhea

A

large volume watery diarrhea, minimal resolution w/ fasting

bile acid malabsorption
endocrine disorders
meds (abx, chemo, PPIs)
neoplasms (carcinoid, gastrinoma)

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7
Q

dysmotility

A

intermittent, small volume, watery diarrhea

irritable bowel syndrome
postvagotomy

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8
Q

causes of steatorrhea

A
  • impaired fat solubilization (bile salt deficiency/inactivation)
  • defective nutrient hydrolysis (exocrine pancreatic insufficiency)
  • mucosal disease (celiac, chronic mesenteric ischemia, Chron’s)
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9
Q

celiac disease

A

-immune mediated enteropathy triggered by gluten in genetically susceptible patients

  • type IV HS
  • Abs to tissue transglutaminase (TTG)
  • T cell chronic inflamm in SI; proximal small intestine > distal
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10
Q

predisposing genetics of celiac

A

HLA-DQ2

HLA-DQ8

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11
Q

celiac epidemiology

A
  • usu dx during childhood, but can be any age

- Northern Europe comm but everywhere

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12
Q

Celiac pathogenesis

A
  • gluten proteins resist degradation, lg peptides pass epithelium
  • CD4+ T mediate disease
  • TTG Abs
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13
Q

celiac presentation

A 
crampy abd pain
chronic diarrhea
Fe deficiency
osteoporosis
easy bruising
peripheral neuropathy 
seizures
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14
Q

dermatitis herpetiformis

A

celiac

  • IgA deposits, pruritis, blistering
  • resolves w/ gluten free diet
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15
Q

celiac assoc conditions

A

SI adenocarcinoma
SI intestinal adenocarcinoma
lymphocytic gastritis and colitis (microscopic colitis)

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16
Q

tissue transglutaminase Abs

dx for

A

celiac

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17
Q

celiac histo

A

increased intraepithelial lymphocytes

villous atrophy

crypt hyperplasia

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18
Q

Celiac tx

A

gluten free diet

Fe, vitamin D/B12, Ca supp

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19
Q

SI bacterial overgrowth syndrome

A

Intestinal stasis

Abnormal connections between proximal/distal bowel (fistulas)

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20
Q

bacterial overgrowth

A
  • reduced nutrient availability

- bile salt inactivation

21
Q

dx of SI bacterial overgrowth syndrome

A
  • direct aspiration of jejunal contents

- H breath tests

22
Q

early peak in elevation of H2 concentration (in H breath test)

A

bacterial overgrowth syndrome

23
Q

inc bile salt losses

A

mucosal disease in terminal ileum (Chron’s)

surgical resection/bypass of ileum

overwhelmed absorptive capacity of ileum

24
Q

bile acid sequestrations

A

+ charged resin bunds to - bile salts and inc excretion

leads to liver inc bile acid synthesis which completes w/ CHL synthesis and ultimately lowers CHL levels

diarrhea tx

25
Q

most common cause of chronic pancreatitis

A

EtOH

26
Q

cystic fibrosis is a cause of ___ pancreatitis

A

chronic

27
Q

most sensitive/specific test for pancreatic insufficiency

A

fecal elastase (low in exocrine insufficiency)

28
Q

fat malabsorption tests

A

clinical hx

measure fat soluble vitamins

29
Q

atrophy of intestinal villi with inc intraepithelial lymphocytes

A

celiac

30
Q

late peak in H+ breath test

A

lactose intolerance

31
Q

fecal osmotic gap

A

osmotic diarrhea > 125

32
Q

osmotic diarrhea

A

lactose intolerance

lactose –> bacteria –> fermentation products –> water drawn in

33
Q

secretory diarrhea

A

abnormal ion transport in intestinal epithelial cells

dec absorption of electrolytes or inc secretion of electrolytes

major solutes in intestinal lumen

account for most of luminal osmolality

34
Q

most common location of GI neuroendocrine tumors

A

ileum

35
Q

type 1 gastric NET

A

assoc w/ atrophic gastritis

36
Q

type 2 gastric NETs

A

assoc w/ multiple endocrine neoplasia syndrome (MEN-1)

37
Q

type 3 gastric NETs

A

sporadic

no underlying risk fx

38
Q

carcinoid syndrome

A
  • uncommon in pts w/ carcinoid tumors
  • diarrhea, cutaneous flushing, bronchoconstriction, R sided HF

flushing/diarrhea due to secretion of amines (serotonin) and peptides (bradykinin, tachykinins)

39
Q

carcinoid syndrome is often seen in metastatic disease to

A

liver

40
Q

carcinoid syndrome dx

A

labs: serotonin level, serum chromogranin A

Imaging (CT, ocreotide scans)

tx: surgical resection

41
Q

positive stains for carcinoid tumor

A

synaptophysin

chromogranin

42
Q

ocreotide

A

analog of somatostatin

  • somatostatin receptors found on carcinoid cells
  • inhibits secretion of serotonin, gastrin, vasoactive intestinal polypeptide, insulin, other hormones
  • improves diarrhea, flushing
  • also a splanchnic vasoconstrictor (used in GI bleeds)
43
Q

benign neoplasms of small bowel

A

adenomas
puetz-jeghers hamartomas
GIST

44
Q

malignant tumors of small bowel

A 
adenocarcinoma
ampullarf carcinoma
primary intestinal lymphoma (MALT)
carcinoid (neuroendocrine) tumor
metastatic tumors ** most comm
45
Q

irritable bowel syndrome

A

functional GI disorder
abd pain + altered bowel habits
no biochemical or structural abnormalities

46
Q

IBS hx

A

older adult
nocturnal wakening

labs: anemia, inc WBC, inc ESR, CRP

+ fecal occult blood

47
Q

pathophys of IBS

A
  • poorly understood
  • altered intestinal motility
  • heightened visceral sensitivity
  • visceral hyper responsiveness to luminal GI events
48
Q

IBS tx

A
  • diet adjustments
  • antispasmodics (hyoscyamine and dicyclomine)
  • bulking agents
  • antidiarrheals
  • antidepressants
  • alosetron
  • behavioral therapy
  • probiotics
  • antibiotics
49
Q

rifaximin

A
  • antimicrobial agent that interferes w/ bacterial protein synthesis
  • use: IBS-diarrhea

Emma GI (18 decks)

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