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Gastroenterology - Step 2 - Pathology > Disorders of the Small Bowel > Flashcards

Disorders of the Small Bowel Flashcards

1
Q

Technical definition of diarrhea?

A

> 200 grams of dry stool and change in stool consistency

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2
Q

Technical definition of diarrhea?

A

> 200 grams of dry stool and change in stool consistency

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3
Q

Definition of acute diarrhea?

A
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4
Q

Most common cause of acute diarrhea?

A

Viral gastroenteritis. Self-limited.

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5
Q

Two categories of acute diarrhea?

A

Enterotoxic and invasive

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6
Q

Common pathogens of enterotoxic acute diarrhea?

A 
C. Diff
Enterotoxic E.coli
Vibrio cholerae
Staph Aureus
Bacillus Cereus
Giardia
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7
Q

C. diff association?

A

Recent abx/hospitalization.

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8
Q

Enterotoxic E. Coli association?

A

traveler’s diarrhea, central america

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9
Q

V. cholera association?

A

fecal oral, contaminated water, 3rd world

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10
Q

Staph aureus association?

A

Proteinaceous foods - egg salad, potato salad, etc.

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11
Q

Giardia association?

A

freshwater. (camping, etc).

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12
Q

Giardia association?

A

freshwater. (camping, etc).

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13
Q

What are the most common pathogens of invasive diarrhea?

A

Salmonella, Shigella, EHEC E. Coli, Campylobacter, E. Histolytica

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14
Q

Most common cause of acute diarrhea?

A

Viral gastroenteritis. Self-limited.

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15
Q

Two categories of acute diarrhea?

A

Enterotoxic and invasive

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16
Q

Common pathogens of enterotoxic acute diarrhea?

A 
C. Diff
Enterotoxic E.coli
Vibrio cholerae
Staph Aureus
Bacillus Cereus
Giardia
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17
Q

Association of E. Histolytica?

A

HIV/AIDs/immunocompromised

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18
Q

Enterotoxic E. Coli association?

A

traveler’s diarrhea, central america

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19
Q

Presentation of invasive acute diarrhea?

A

Bloody diarrhea, fever, elevated WBCs, fecal white blood cells, lactoferrin

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20
Q

Staph aureus association?

A

Proteinaceous foods - egg salad, potato salad, etc.

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21
Q

B. Cereus association?

A

Reheated rice.

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22
Q

Treatment of C. Diff?

A

Oral metronidazole, Oral vanc, or, if very very sick, PO vanc + IV metronidazole.

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23
Q

Presentation of enterotoxic acute diarrhea?

A

Absorptive/secretory, watery non-bloody diarrhea. Usually no fever or WBCs or fecal leuks.

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24
Q

What would colonoscopy show in C. diff?

A

“psuedomembranous” colitis.

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25
Q

Association of salmonella?

A

Raw chicken/eggs

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26
Q

Association of shigella?

A

hemolytic uremic syndrome - thrombocytopenia, thrombotic purpura.

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27
Q

Association of EHEC E. Coli

A

uncooked red meat

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28
Q

What do you do with refractory C. Diff?

A

fecal TX

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29
Q

What is the supportive treatment of diarrhea?

A

Oral fluids, electrolyte replacement as needed, antidiarrheals such as loperamide and bismuth salicylate.

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30
Q

If infection is suspected, what is the treatment of acute diarrhea?

A

Abx - no antimotility agents.

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31
Q

Common cause of pediatric diarrhea?

A

Rotavirus infection (winter).

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32
Q

What is the definition of chronic diarrhea?

A

> 6 weeks, usually not infectious.

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33
Q

Treatment of C. Diff?

A

Oral metronidazole, Oral vanc, or, if very very sick, PO vanc + IV metronidazole

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34
Q

Under what circumstances would you treat c. diff with PO vanc and IV metronidazole?

A

Fever, leuks, megacolon, elev BUN/Cr.

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35
Q

What would colonoscopy show in C. diff?

A

“psuedomembranous” colitis.

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36
Q

What are you looking for in stool studies for acute diarrhea?

A

WBCs, RBCs in stool –> if yes, stool culture for infectious source

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37
Q

With osmotic diarrhea that is neg for fecal fat, what are some etiologies?

A

lactose intolerance
Sorbitol, lactulose
Laxative abuse

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38
Q

What does a normal or low osmotic gap mean?

A

Electrolytes are high causing a low gap.

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39
Q

What do you do with refractory C. Diff?

A

fecal TX

40
Q

What is the supportive treatment of diarrhea?

A

Oral fluids, electrolyte replacement as needed, antidiarrheals such as loperamide and bismuth salicylate.

41
Q

If infection is suspected, what is the treatment of acute diarrhea?

A

Abx - no antimotility agents.

42
Q

Common cause of pediatric diarrhea?

A

Rotavirus infection (winter).

43
Q

What is the definition of chronic diarrhea?

A

> 6 weeks, usually not infectious.

44
Q

What is the osmolar gap?

A

Gap = Measured osms - Calculated Osms

= 290 - 2 (Na+K).

45
Q

What does a high osmolar gap mean?

A

Low electrolytes, >100 = osmotic diarrhea; caused by something in the GI tract that can’t be absorbed, causes diarrhea.

46
Q

With known osmotic chronic diarrhea, what step can you take next?

A

Check fecal fat

47
Q

With osmotic diarrhea that is + for fecal fat, what are some etiologies?

A

Malabsorption syndromes, pancreatic insufficiency, bacterial overgrowth

48
Q

Treatment of carcinoid tumor?

A

CT C/A to stage, octreotide for sx, resection of tumor.

49
Q

If fecal RBCs + WBCs present in chronic diarrhea then what?

A

Colonoscopy to eval for IBD or cancer.

50
Q

Irritable bowel syndrome?

A

“Functional” disorder associated with abdominal pain and changes in bowel habits that increase w/ stress and are relieved by a bowel movement.

51
Q

Treatment of IBS?

A

Reassurance. Maybe TCAs, fiber supplements, antidiarrheals. Tegaserod for constipation-predominant IBS.

52
Q

Test for Zollinger-Ellison syndrome?

A

Gastrin level, if between 250-1600, secretin stim test. If below 250, not ZE, if above 1600, def ZE.

53
Q

treatment for ZE syndrome?

A

resection

54
Q

What is a carcinoid tumor?

A

Tumor that secretes serotonin and substance P. From enterochromaffin cells.

55
Q

When is a carcinoid tumor evident?

A

When it mets to the liver and therefore serotonin gets dumped into circulation w/out being processed.

56
Q

What does carcinoid tumor of the GI tract cause?

A

Flushing, diarrhea, wheezing, fibrosis and valve issues with the RIGHT side of heart, as the lung will break down.

57
Q

What does carcinoid tumor in the lung cuase?

A

fibrosis of hte LEFT side of the heart, + flushing, diarrhea, wheezing, etc.

58
Q

Diagnosis of carcinoid tumor?

A

Urine 5-HIAA.

59
Q

Treatment of carcinoid tumor?

A

CT C/A to stage, octreotide for sx, resection of tumor.

60
Q

If fecal RBCs + WBCs present in chronic diarrhea then what?

A

Colonoscopy to eval for IBD or cancer.

61
Q

Irritable bowel syndrome?

A

“Functional” disorder associated with abdominal pain and changes in bowel habits that increase w/ stress and are relieved by a bowel movement.

62
Q

Treatment of IBS?

A

Reassurance. Maybe TCAs, fiber supplements, antidiarrheals. Tegaserod for constipation-predominant IBS.

63
Q

Common causes of malabsorption?

A

Celiac disease (sprue), Whipple’s disease, short bowel syndrome, lactose intolerance, infection, pancreatic insufficiency.

64
Q

What is tropical sprue?

A

Infectious ! Carribean farmer. Doesn’t improve with gluten avoidance. Treat w/ abx.

65
Q

How is d-xylose helpful in malabsorption testing?

A

If it is absorbed, you know the problem is in the enzymes that should normally be breaking things down. Likely pancreatic etiology. If not, then the issue is the intestinal luminal border. (EGD + bx).

66
Q

What is celiac sprue?

A

Gluten allergy. Auto-immune, IgA mediated.

67
Q

Presentation of celiac sprue?

A

Diarrhea, bloating, +/- weight loss, +/- dermatitis herpetiformis.

68
Q

TX of whipples?

A

trimethoprim sulfa or doxycycline.

69
Q

What is a small bowel obstruction?

A

Defined as blocked passage of bowel contents through the small bowel. Fluid and gas can build up proximal to the obstruction → fluid and electrolyte im- balances and significant abdominal discomfort. The obstruction can be com- plete or partial, and strangulation of the bowel may occur.

70
Q

What is absorbed in the prox duodenum?

A

folate, iron, calcium.

71
Q

What should you worry about in malabsorption affecting duodenum?

A

Anemia, hypocalcemia (osteoporosis).

72
Q

What is absorbed int he terminal ileum?

A

bile salts w/ fat soluble vitamins (ADEK).

73
Q

What problems are associated w failure to absorb fat-soluble vitamins?

A

A - night blindness
D - osteoporosis
E - nystagmus
K - bleeding

74
Q

Treatment of celiac sprue?

A

No gluten. Takes 3-4 months of work.

75
Q

What makes SBO an emergency?

A

Later in the disease, peristalsis may disappear. Fever, hypotension, re- bound tenderness, and tachycardia suggest a surgical emergency. Also lactic acidosis.

76
Q

What is whipple’s disease?

A

Infection w/ T. Whippeli.

77
Q

Radiographic findings w/ SBO?

A

Abdominal films often demonstrate a stepladder pattern of dilated small-
bowel loops, air-fluid levels, and a paucity of gas in the colon. The presence of radiopaque material at the cecum is suggestive of gallstone ileus.

78
Q

Dx of whipples?

A

EGD + bx. PAS+ microscopy. Organisms on electron microscope.

79
Q

Surgical TX of SBO?

A

Surgery is required in cases of complete SBO, vascular compromise (necrotic bowel), or symptoms lasting > 3 days without resolution. Strangulated SBO associated with 25% mortality rate.

80
Q

What is a small bowel obstruction?

A

Defined as blocked passage of bowel contents through the small bowel. Fluid and gas can build up proximal to the obstruction → fluid and electrolyte im- balances and significant abdominal discomfort. The obstruction can be com- plete or partial, and strangulation of the bowel may occur.

81
Q

What causes SBO?

A

SBO may arise from adhesions from a prior abdominal surgery (60% of cases) or from hernias (10–20%), neoplasms (10–20%), intussusception, gallstone ileus, stricture due to IBD, volvulus, or cystic fibrosis (CF).

82
Q

Risk factors for ileus?

A

Recent surgery/GI procedures, severe medical illness, immobility, hypokalemia or other electrolyte imbalances, hypothyroidism, DM, and medications that slow GI motility (e.g., anticholinergics, opioids).

83
Q

Emesis w/ SBO?

A

early emesis is bilious and nonfeculent if the obstruction is proximal but feculent if it is distal.

84
Q

Physical exam findings of ileus?

A
  • Examination may reveal diffuse tenderness and abdominal distention, no peritoneal signs, and ↓ or absent bowel sounds.
  • A rectal examination is required to rule out fecal impaction in elderly patients.
85
Q

Physical exam findings w/ SBO?

A
  • Abdominal exam often reveals distention, tenderness, prior surgical scars,
    or hernias.
  • Bowel sounds are characterized by high-pitched tinkles and peristaltic
    rushes.
86
Q

Treatment of ileus?

A

stop narcs or antichols, fix hypokalemia as needed, decr or d/c oral feeds, NG suction

87
Q

Lab findings w/ SBO?

A
  • CBC may demonstrate leukocytosis if there is strangulation of bowel.
  • Chemistries often reflect dehydration and metabolic alkalosis due to vomiting.
  • Lactic acidosis is particularly worrisome, as it suggests necrotic bowel and the need for emergent surgical intervention.
88
Q

Radiographic findings w/ SBO?

A

Abdominal films often demonstrate a stepladder pattern of dilated small-
bowel loops, air-fluid levels, and a paucity of gas in the colon. The presence of radiopaque material at the cecum is suggestive of gallstone ileus.

89
Q

Treatment of SBO? Partial:

A

Supportive care may be sufficient and should include NPO status, NG suction, IV hydration, correction of electrolyte abnormal- ities, and Foley catheterization to monitor fluid status.

90
Q

Surgical TX of SBO?

A

Surgery is required in cases of complete SBO, vascular compromise (necrotic bowel), or symptoms lasting > 3 days without resolution. Strangulated SBO associated with 25% mortality rate.

91
Q

F/u after surgical tx of SBO?

A

A second-look laparotomy or laparoscopy may be performed 18–36 hours after initial surgical treatment to reevaluate bowel viability.

92
Q

What is ileus?

A

Loss of peristalsis without structural obstruction.

93
Q

Risk factors for ileus?

A

Recent surgery/GI procedures, severe medical illness, immobility, hypokalemia or other electrolyte imbalances, hypothyroidism, DM, and medications that slow GI motility (e.g., anticholinergics, opioids).

94
Q

Presentation of ileus?

A

Presenting symptoms include diffuse, constant, moderate abdominal dis- comfort; nausea and vomiting (especially with eating); and an absence of flatulence or bowel movements.

95
Q

Physical exam findings of ileus?

A
  • Examination may reveal diffuse tenderness and abdominal distention, no peritoneal signs, and ↓ or absent bowel sounds.
  • A rectal examination is required to rule out fecal impaction in elderly pa- tients.
96
Q

Imaging to dx ileus?

A

Diffusely distended loops of small and large bowel on supine AXR with air-fluid levels on upright view.

97
Q

Treatment of ileus?

A

stop narcs or antichols, fix hypokalemia as needed, decr or d/c oral feeds, NG suction

Gastroenterology - Step 2 - Pathology (10 decks)

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