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Jason's MD2 Intersession 1 > Diarrhoea & Malabsorption > Flashcards

Diarrhoea & Malabsorption Flashcards

0
Q

where is most fluid in GI absorbed?

A

proximal small bowel

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1
Q

Why pain with claudication?

A

lactic acid build up from hypoxaemia

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2
Q

iron absorbed where?

A

jejunum

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4
Q

where is B12 absorbed?

A

terminal ileum after binding to intrinsic factor and factor R in presence of acid

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5
Q

diarrhoea is abnormal what?

A

frequency and liquidity of stool that can cause excess fluid and electrolyte loss

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6
Q

when is diarrhoea chronic?

A

more than 4 weeks

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7
Q

3 big things to consider in diarrhoea?

A

volume
at night?
blood and mucous?

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8
Q

normal bowel movement schedule?

A

every second day to 2-3times a day

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9
Q

what if they have diarrhoea at night?

A

might be organic problem, not diet

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10
Q

4 mechanisms of diarrhoea?

A

osmotic
secretory
inflammatory
altered intestinal motility

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11
Q

what can cause osmotic diarrhoea?

A 
mannitol, 
sorbitol
lactose
fructose
magnesium,
 phosphate
excess unabsorbed substrates in gut lumen
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12
Q

what causes secretory diarrhoea?

A

cholera
ETEC
hyperthyroidism
tumours

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13
Q

what causes inflammatory diarrhoea?

A

Ulcerative colitis

Crohn’s

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14
Q

what is faecal calprotectin for?

A

screening to see if need colonoscopy

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15
Q

PCR in stool to check for?

A

Norovirus, C. Diff

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16
Q

what if there are WBCs in stool?

A

indicates inflammatory cause

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17
Q

faecal elastase is a marker of?

A

pancreatic sufficiency

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18
Q

mechanism of secretory diarrhoea?

A

active anion secretion of enterocytes caused by bacterial toxins: ETEC, Cholera

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19
Q

fasting does what to secretory diarrhoea?

A

persists

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20
Q

fasting does what to osmotic diarrhoea

A

helps

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21
Q

mechanism for inflammatory diarrhoea?

A

altered membrane permeability

invasive bacteria: Shigella, salmonella, C Diff, campylobacter, entamoeba histolytica, CMV, IBD

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22
Q

3 causes of rapid transit causing diarrhoea?

A

hyperthyroidism
drugs
IBS

23
Q

2 causes of slow transit?

A
  1. bacterial overgrowth>nutrient consumption»bile salt inactivation»
  2. anatomical: strictures, blind loops, surgical
24
Q

2 kinds of malabsorption:

A
  1. intraluminal

2. intramural/transport

25
Q

where to look for muscle wasting?

A

Thenar eminences

26
Q

mechanism of pernicious anaemia?

A

autoimmune against stomach parietal cells

27
Q

3 causes of luminal phase maldigestion?

A

pancreatic insufficiency
cholestasis
bacterial overgrowth

28
Q

3 causes of mucosal phase/defective transport

A
  1. not enough intestine
  2. coeliac, crohn’s, brush border enzym deficient
  3. transport: lymphoma obstruction, radiation damage
29
Q

tenesmus means?

A

unsatisfactory feeling after defecation

30
Q

common causes of ‘dysentry’?

A

Salmonella
shigella
yersinia
entamoaba histolytica

31
Q

difference in histology between UC and Crohn’s?

A

Crohn’s has granulomas

32
Q

UC affects what?

A

only the mucosa in the large bowel

33
Q

UC has a higher risk of getting what?

A

primary sclerosing cholangitis»bowel cancer

34
Q

how to tell between UC and Crohn’s?

A

UC always affects rectum, get urgency and tenesmus.

UC has no skip lesions

35
Q

anyway to cure UC?

A

surgery

36
Q

anyway to cure Crohn’s?

A

Nope

37
Q

histological features of Crohn’s?

A

focal transmural inflamm, granuloma’s
skip lesions
affect from mouth to anus

38
Q

extra-intestinal features of Crohn’s?

A

arthritis
uveitis
rashes

39
Q

time course of crohn’s?

A

relapsing/remitting over many years

40
Q

what is classic presentation of Giardia?

A

rice-water stool, nausa and small volume

41
Q

typical history of IBS?

A

at least 3 mo hx
abdo pain with:
-better with defecation
-change in stool form and frequency

42
Q

Coeliac disease dx?

A

biopsy with symptoms

biopsy after gluten free diet

43
Q

Coeliac screening?

A

blood test to measure Abs to
transglutaminase
deamidated gliadin peptides

44
Q

what 4 things can show villous atrophy in biopsy?

A

coeliac
tropical sprue
H. pylori
Giardia

45
Q

what gene for coeliac?

A

HLA-DQ2/8

46
Q

how to dx if already on gluten free diet?

A

6-week gluten challenge

47
Q

what is a key mediator in IBS?

A

serotonin (5-HT)

48
Q

IBS, what happens to motility?

A

disordered

49
Q

IBS what kind of hypersensitivity?

A

visceral hypersensitivity of nociceptive stimuli

50
Q

possible triggers of IBS?

A

bacterial overgrowth

‘stress’

51
Q

what are FODMAPS?

A 
Fermentable:
Oligosaccharides: starches in beans
Disaccharides: lactose
Monosaccharides: fructose
POlyols: sorbitol, mannitol
52
Q

FODMAPS contribute to which disease?

A

Irritable Bowel Disease, FODMAPs are poorly absorbed

53
Q

3 main treatment modalities for IBS?

A

dietary: no FODMAPS
pharmacological: probiotics, ABx
Psychological: relaxation

54
Q

how to test for bacterial overgrowth?

A

hydrogen/methane breath test

Jason's MD2 Intersession 1 (14 decks)

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