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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
MC demographic of paralytic ileus
Hospitalized patients
26
Order of GI function return post-op
1. SI motility 2. stomach 3. colon
27
Key PE findings for paralytic ileus
1. Distension with **tympany to percussion** 2. **Diminished/absent bowel sounds**
28
Diagnosis of paralytic ileus
1. Plain films showing gas-filled loops of bowel 2. Clinical dx if > 4 days 3. CT only to r/o SBO
29
Treatment of paralytic ileus
* Rest * NG tube * IV fluids/TPN
30
Prevention of paralytic ileus
* Chew gum * No IV opioids * Early ambulation and clear liquids
31
MCC of SBO
Post-op adhesions
32
Proximal SBO presentation
Profuse emesis containing undigested food, upper abd pain
33
Distal SBO presentation
* Diffuse and poorly localized crampy abd pain * Feculent vomiting
34
Hallmark sign of SBO
Dehydration leading to tachycardia and hypotension
35
Bowel sound types in SBO
1. Early = hyperactive 2. Late = hypoactive
36
Signs of intestinal ischemia
1. Fever > 100F 2. Tachycardia 3. Peritoneal signs: guarding, rigidity, rebound tenderness, pain out of proportion
37
Diagnosis of SBO
* Dilated small bowel loops with air-fluid levels * Air fluid levels with a ladder-like appearance | Plain XRAYs
38
Tx of SBO
* Surgical consult for bowel compromise * Fluids/lytes * NG tube * TPN * ABX for bowel compromise
39
Ileus vs SBO chart
40
MC demographic for Ogilvie syndrome
Severely ill, hospitalized patients (post-op esp)
41
First sign of ogilvie
Massive abd distension w/o pain
42
Diagnosis of Ogilvie
* XRAY with dilated colon * CT
43
Tx of Ogilvie
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
Essentials of diagnosis of Ogilvie
* 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
MC demographic of IBS
Young women
46
4 etiologies for IBS
1. Abnormal motility 2. Visceral hypersensitivity 3. Intestinal inflammation 4. Psychosocial abnormalities
47
How long must IBS symptoms be present for diagnosis?
3 months
48
IBS classifications
1. IBS w/ diarrhea 2. IBS w/ constipation 3. IBS w/ mixed diarrhea and constipation 4. IBS w/o subtype
49
Rome IV criteria for IBS
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
Manning criteria for IBS
* 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
Who needs a colonoscopy for IBS?
* > 50 yo * Fail conservative tx * Alarm symptoms
52
What labs are ordered for IBS workup?
* CBC * CRP * Celiac * Stool studies
53
Management of IBS
* FODMAP * Eduation * Relax * Exercise
54
IBS subtype for antispasmodics and anticholinergics
Diarrhea with predominant pain and bloating
55
Alosetron MOA, indication, drug class, BBW
* 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
Linaclotide MOA, indication, drug class, BBW
* 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 ## Footnote L = lubing intestines for constipation
57
Lubiprostone MOA, indication, drug class, CIs
* 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 ## Footnote L = lubing intestines for constipation
58
What IBS type are TCAs for?
IBS w/ predominant pain and bloating or diarrhea
59
Worst kind of abx colitis
C. Diff
60
Mild-mod CDI presentation
* Greenish, foul-smelling watery diarrhea 5-15 times * Normal/mild LLQ tenderness * WBC > 15k
61
Severe/fulminant CDI
* Fever, hemodynamic instability, distension, pain, tenderness * 30+ stools/day * WBC > 30k
62
What would make us suspect CDI?
3 >= stools in 24 hrs
63
Risk factors for CDI
* Recent ABX use * Hospitalization * Advanced age
64
Diagnosis of CDI
* Positive NAAT * Positive stool test
65
Tx of mild-mod CDI
* Fidaxomicin 200mg BID * Vanco 125mg PO QID | Either
66
Tx of severe CDI
Vanco 500mg PO QID + Metronidazole 500mg IV q8h
67
Surgical consultindications for CDI
68
Surgeries for CDI (if sx is needed)
* Total abdominal colectomy (procedure of choice for severe) * Diverting loop ileostomy/colonic lavage (less mortality)
69
Tx for first episode relapse for CDI
Repeat same regimen or prolonged vanco 125mg
70
Tx for double relapse CDI
1. QID 2 weeks 2. BID 1 week 3. QD 1 week 4. QOD 1 week 5. Q3D 2 weeks | Vanco 125mg
71
3 major arteries for ischemic colitis
* Superior mesenteric * Inferior mesenteric * Internal iliacs
72
MC areas for ischemic colitis
* Splenic flexure * Rectosigmoid junction
73
MC demographics for ischemic colitis
* Older patients * Atherosclerotic disease * Post surgery
74
4 risk factors for young patients with ischemic colitis
1. Vasculitis 2. Coag disorders 3. Estrogen therapy 4. Long distance running
75
Classic clinical presentation of acute ischemic colitis
Abdominal pain out of proportion to the physical examination
76
MC complaint of chronic mesenteric ischemia
Recurrent abdominal pain after eating | Insufficient blood flow
77
Labs routinely ordered for ischemic colitis
* CBC * CMP * Coags * Elevated LDH and CPK * Stool studies
78
1st line imaging for ischemic colitis
CT of abdomen w/ con showing target, thumbprinting or double halo
79
Diagnosis of ischemic colitis
Colonoscopy | Within 48h
80
Tx of ischemic colitis
* Rest, NPO, fluids * Surgery if bad * Empiric ABX * Anticoag if mesenteric venous thrombosis
81
Somewhat uncommon complication of ischemic colitis
Gangrene
82
MC congenital abnormality of small bowel
Meckel's diverticulum
83
Rule of 2s for true congenital meckel's
* 2% of population * 2ft from ileocecal valve * 2% of patients are symptomatic
84
Meckel's sign
Ectopic gastric mucosa on nuclear medicine scan
85
Treatment of Meckel's
Surgery is definitive
86
MC location for diverticulosis
Sigmoid/left colon
87
MC presentation of diverticulosis
Asymptomatic
88
Hallmark sign of acute diverticulitis
Acute LLQ Abdominal pain
89
Primary imaging for diverticular disease
CT of abd to check for complications
90
When to get colonoscopy for diverticular disease?
4-8 weeks after resolution of symptoms due to risk of perf
91
Tx of mild/uncomplicated diverticular disease
1. Clear liquid diet + oral antacids + oral abx (esp if immuncompromised) 2. Once symptoms done, go on high-fiber diet
92
Tx of severe diverticular disease
1. Piptazo IV 5-7d 2. Cipro + metronidazole PO 10-14d 3. Surgery if really bad
93
Inpatient tx criteria for diverticulitis
94
MCC of lower GI Bleed
Diverticular Bleed

GI (17 decks)

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