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GI > Disorders of the SI/colon High Yield > Flashcards

Disorders of the SI/colon High Yield Flashcards

1
Q

3 phases of digestion

A
  1. Intraluminal: dietary fats, proteins, carbs, are hydrolyzed and solubilized by pancreatic and biliary secretions
  2. Mucosal: brush border enzymes
  3. Absorptive
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2
Q

What characterizes celiac disease?

A
  • Abnormal response to gluten/gliadin
  • Permanent dietary disorder
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3
Q

MC demographic for celiac disease

A

Caucasian

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4
Q

Key points about celiac pathophys

A
  1. Immune response causing proximal small intestine mucosa and villi to be damaged.
  2. Malabsorption of nutrients
  3. Antibody production
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5
Q

Classic symptoms of celiac

A
  1. Abd distension
  2. Failure to thrive
  3. Chronic diarrhea
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6
Q

Skin finding in celiac

A

Dermatitis herpetiformis

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7
Q

Initial lab test for celiac workup

A

IgA TTG antibody testing

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8
Q

Confirming celiac after positive serologic test

A

Endoscopic mucosal biopsy of both proximal and distal duodenum showing bltuning or a complete loss of intestinal villi.

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9
Q

How to treat celiac

A

dont eat gluten

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10
Q

MC symptom in whipple disease

A

Weight loss

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11
Q

WHIPPLES mnemonic

A
  • Weight loss
  • Hyperpigmentation of skin
  • Infection by tropheryma whippelii
  • PAS positive granules in macrophages
  • Polyarthritis
  • LAN
  • Enteric involvement
  • Steatorrhea
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12
Q

Diagnosis of whipple

A
  1. EGD w/ biopsy showing PAS positive macrophages
  2. PCR can confirm IF EGD is inconclusive
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13
Q

Tx for whipple

A
  1. IV Rocephin or meropenem for 2-4 weeks
  2. Bactrim BID for 1year
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14
Q

Causes of SIBO

A
  1. Motility disorders
  2. Anatomic disorders (adhesions)
  3. Metabolic disorders (Diabetes)
  4. Immune disorders
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15
Q

Diagnosis for SIBO

A
  1. Carbohydrate breath test
  2. Small intestine aspiration with cultures
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16
Q

Tx of SIBO

A

1. Cipro 500mg BID
2. Augmentin
3. Bactrim

7-10d

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17
Q

Cause of SBS

A

Removal of portion of SI

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18
Q

Presentation of SBS w/ terminal ileal resection

A

Malabsorption of B12 and bile salts

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19
Q

Presentation of SBS w/ extensive resection

A
  1. Wt loss
  2. Diarrhea d/t nutrient malabsorption
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20
Q

Management of acute SBS

A
  1. Manage fluids/lytes
  2. PPI
  3. TPN
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21
Q

Management of Adaptation phase of SBS

A
  1. Oral feedings slowly
  2. Complex carbs
  3. Low fat
  4. Fluids
  5. PPI
  6. Antidiarrheals
  7. ABX for SIBO
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22
Q

MC demographic for lactose intolerance

A

Non-europeans ): ): ): ):

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23
Q

Diagnosis of lactose intolerance

A

Hydrogen breath test w/ 50g lactose and rise in 90 mins.

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24
Q

Paralytic ileus description

A

Neurogenic failure or loss of peristalsis W/O mechanical obstruction

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25
Q

MC demographic of paralytic ileus

A

Hospitalized patients

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26
Q

Order of GI function return post-op

A
  1. SI motility
  2. stomach
  3. colon
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27
Q

Key PE findings for paralytic ileus

A
  1. Distension with tympany to percussion
  2. Diminished/absent bowel sounds
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28
Q

Diagnosis of paralytic ileus

A
  1. Plain films showing gas-filled loops of bowel
  2. Clinical dx if > 4 days
  3. CT only to r/o SBO
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29
Q

Treatment of paralytic ileus

A
  • Rest
  • NG tube
  • IV fluids/TPN
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30
Q

Prevention of paralytic ileus

A
  • Chew gum
  • No IV opioids
  • Early ambulation and clear liquids
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31
Q

MCC of SBO

A

Post-op adhesions

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32
Q

Proximal SBO presentation

A

Profuse emesis containing undigested food, upper abd pain

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33
Q

Distal SBO presentation

A
  • Diffuse and poorly localized crampy abd pain
  • Feculent vomiting
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34
Q

Hallmark sign of SBO

A

Dehydration leading to tachycardia and hypotension

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35
Q

Bowel sound types in SBO

A
  1. Early = hyperactive
  2. Late = hypoactive
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36
Q

Signs of intestinal ischemia

A
  1. Fever > 100F
  2. Tachycardia
  3. Peritoneal signs: guarding, rigidity, rebound tenderness, pain out of proportion
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37
Q

Diagnosis of SBO

A
  • Dilated small bowel loops with air-fluid levels
  • Air fluid levels with a ladder-like appearance

Plain XRAYs

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38
Q

Tx of SBO

A
  • Surgical consult for bowel compromise
  • Fluids/lytes
  • NG tube
  • TPN
  • ABX for bowel compromise
39
Q

Ileus vs SBO chart

A
40
Q

MC demographic for Ogilvie syndrome

A

Severely ill, hospitalized patients (post-op esp)

41
Q

First sign of ogilvie

A

Massive abd distension w/o pain

42
Q

Diagnosis of Ogilvie

A
  • XRAY with dilated colon
  • CT
43
Q

Tx of Ogilvie

A
  1. Conservative tx
  2. Colon decompression via NG tube and rectal tube
  3. NPO, IV fluids
  4. Serial X-rays
  5. Neostigmine for severe
44
Q

Essentials of diagnosis of Ogilvie

A
  • Severe distension
  • Post-op or severe medical illness
  • Precipitated by lyte imbalances
  • Absent/mild abd pain; minimal tenderness
  • Massive dilation of cecum or right colon
45
Q

MC demographic of IBS

A

Young women

46
Q

4 etiologies for IBS

A
  1. Abnormal motility
  2. Visceral hypersensitivity
  3. Intestinal inflammation
  4. Psychosocial abnormalities
47
Q

How long must IBS symptoms be present for diagnosis?

A

3 months

48
Q

IBS classifications

A
  1. IBS w/ diarrhea
  2. IBS w/ constipation
  3. IBS w/ mixed diarrhea and constipation
  4. IBS w/o subtype
49
Q

Rome IV criteria for IBS

A

1 day per week in last 3 months + 2 of the following:

  1. Related to defecation
  2. Associated with a change in stool frequency
  3. Associated with a change in stool appearance
50
Q

Manning criteria for IBS

A
  • Pain relieved with defecation
  • More frequent stools at the onset of pain
  • Looser stools at onset of pain
  • Visible distension
  • Passage of mucus
  • Sensation of incomplete evacuation
51
Q

Who needs a colonoscopy for IBS?

A
  • > 50 yo
  • Fail conservative tx
  • Alarm symptoms
52
Q

What labs are ordered for IBS workup?

A
  • CBC
  • CRP
  • Celiac
  • Stool studies
53
Q

Management of IBS

A
  • FODMAP
  • Eduation
  • Relax
  • Exercise
54
Q

IBS subtype for antispasmodics and anticholinergics

A

Diarrhea with predominant pain and bloating

55
Q

Alosetron MOA, indication, drug class, BBW

A
  • MOA: inhibit serotonin from binding = decreased motility
  • Indication: IBS diarrhea or 6+ months
  • Drug class: 5HT-3 receptor antagonist (zofran cousin)
  • BBW: severe constipation & ischemic colitis
  • Need consent prior to use
56
Q

Linaclotide MOA, indication, drug class, BBW

A
  • MOA: Stimulates intestinal fluid secretion and transit
  • Indication: IBS w/ constipation in women, chronic constipation
  • Drug class: Guanylate cyclase agonist
  • BBW: DNU < 18yo or dehydration

PRICEY AF

L = lubing intestines for constipation

57
Q

Lubiprostone MOA, indication, drug class, CIs

A
  • MOA: Chloride channel activator increasing fluid secretion, motility, and reduced permeability
  • Indication: IBS w/ constipation in women, chronic constipation
  • Drug class: Selective chloride activator
  • CI: diarrhea, GI obstruction

PRICEY AF

L = lubing intestines for constipation

58
Q

What IBS type are TCAs for?

A

IBS w/ predominant pain and bloating or diarrhea

59
Q

Worst kind of abx colitis

A

C. Diff

60
Q

Mild-mod CDI presentation

A
  • Greenish, foul-smelling watery diarrhea 5-15 times
  • Normal/mild LLQ tenderness
  • WBC > 15k
61
Q

Severe/fulminant CDI

A
  • Fever, hemodynamic instability, distension, pain, tenderness
  • 30+ stools/day
  • WBC > 30k
62
Q

What would make us suspect CDI?

A

3 >= stools in 24 hrs

63
Q

Risk factors for CDI

A
  • Recent ABX use
  • Hospitalization
  • Advanced age
64
Q

Diagnosis of CDI

A
  • Positive NAAT
  • Positive stool test
65
Q

Tx of mild-mod CDI

A
  • Fidaxomicin 200mg BID
  • Vanco 125mg PO QID

Either

66
Q

Tx of severe CDI

A

Vanco 500mg PO QID + Metronidazole 500mg IV q8h

67
Q

Surgical consultindications for CDI

A
68
Q

Surgeries for CDI (if sx is needed)

A
  • Total abdominal colectomy (procedure of choice for severe)
  • Diverting loop ileostomy/colonic lavage (less mortality)
69
Q

Tx for first episode relapse for CDI

A

Repeat same regimen or prolonged vanco 125mg

70
Q

Tx for double relapse CDI

A
  1. QID 2 weeks
  2. BID 1 week
  3. QD 1 week
  4. QOD 1 week
  5. Q3D 2 weeks

Vanco 125mg

71
Q

3 major arteries for ischemic colitis

A
  • Superior mesenteric
  • Inferior mesenteric
  • Internal iliacs
72
Q

MC areas for ischemic colitis

A
  • Splenic flexure
  • Rectosigmoid junction
73
Q

MC demographics for ischemic colitis

A
  • Older patients
  • Atherosclerotic disease
  • Post surgery
74
Q

4 risk factors for young patients with ischemic colitis

A
  1. Vasculitis
  2. Coag disorders
  3. Estrogen therapy
  4. Long distance running
75
Q

Classic clinical presentation of acute ischemic colitis

A

Abdominal pain out of proportion to the physical examination

76
Q

MC complaint of chronic mesenteric ischemia

A

Recurrent abdominal pain after eating

Insufficient blood flow

77
Q

Labs routinely ordered for ischemic colitis

A
  • CBC
  • CMP
  • Coags
  • Elevated LDH and CPK
  • Stool studies
78
Q

1st line imaging for ischemic colitis

A

CT of abdomen w/ con showing target, thumbprinting or double halo

79
Q

Diagnosis of ischemic colitis

A

Colonoscopy

Within 48h

80
Q

Tx of ischemic colitis

A
  • Rest, NPO, fluids
  • Surgery if bad
  • Empiric ABX
  • Anticoag if mesenteric venous thrombosis
81
Q

Somewhat uncommon complication of ischemic colitis

A

Gangrene

82
Q

MC congenital abnormality of small bowel

A

Meckel’s diverticulum

83
Q

Rule of 2s for true congenital meckel’s

A
  • 2% of population
  • 2ft from ileocecal valve
  • 2% of patients are symptomatic
84
Q

Meckel’s sign

A

Ectopic gastric mucosa on nuclear medicine scan

85
Q

Treatment of Meckel’s

A

Surgery is definitive

86
Q

MC location for diverticulosis

A

Sigmoid/left colon

87
Q

MC presentation of diverticulosis

A

Asymptomatic

88
Q

Hallmark sign of acute diverticulitis

A

Acute LLQ Abdominal pain

89
Q

Primary imaging for diverticular disease

A

CT of abd to check for complications

90
Q

When to get colonoscopy for diverticular disease?

A

4-8 weeks after resolution of symptoms due to risk of perf

91
Q

Tx of mild/uncomplicated diverticular disease

A
  1. Clear liquid diet + oral antacids + oral abx (esp if immuncompromised)
  2. Once symptoms done, go on high-fiber diet
92
Q

Tx of severe diverticular disease

A
  1. Piptazo IV 5-7d
  2. Cipro + metronidazole PO 10-14d
  3. Surgery if really bad
93
Q

Inpatient tx criteria for diverticulitis

A
94
Q

MCC of lower GI Bleed

A

Diverticular Bleed

GI (17 decks)

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