Disorders of the small Bowel and Colon CIS Flashcards
acute diarrhea- most lasts?
- most <4 days
- less than 2 wks
persistent diarrhea- lasts?
more than 2 weeks
chronic diarrhea- lasts?
> 1 month
-most likely non-infectious- IBD, IBS, chronic pancreatitis, DKA, diverticulitis
Campylobacter jejuni
- Guillain Barre
- bloody diarrhea!
- chicken, eggs
Giardia lamblia
- pear shaped trophozoite with 2 nuclei and 4 pairs of flagella
- camping
Cytoisospora belli
- protozoan organism that stains positive for acid fast bacilli
- in HIV pts
- watery diarrhea
Staph aureus
- potato salad
- rapid onset- 6 hrs
- self limited
Bacillus cereus
-fried rice
Vibrio cholera
- oysters; poor sanitation
- profuse watery (rice) stools
Clostridium difficile
- foul smelling
- after abx
- complications- colon perforation and toxic megacolon
- wash hands with soap and water
- PPI (omeprazole)- risk
Clostridium difficile- tx
- PO/IV Metronidazole
- PO vancomycin
- PO fidaxomicin
Antibiotic associated colitis- dx
- TCdA (enterotoxin) and TCdB (Cytotoxin)- check stool for toxin assay!!
- abx use- ampicillin, clindamycin, 3rd gen cephalosporins, fluoroquinolones
Salmonella typhimurium
- turtles, eggs
- bloody diarrhea
Salmonella typhi
- typhoid fever
- gram-neg enteric bacillus
- rose spots; relative bradycardia!!
- invades mult RES organs, Peyer’s patches
- high fever
- travel, poor sanitation
- carrier site- Gallbladder! most common
Yersinia
- mimics appendicitis
- bloody diarrhea!
- Hemochromatosis- risk factor!!- HFE gene mutation
Clostridium perfringens
- ham
- watery diarrhea
Strongolyoides
- rhabditiform larvae in stool
- HTLV1- risk factor
- barefoot in soil
Cryptosporidium
-swimming pools
Entamoeba histolytica
- bloody diarrhea
- flask shaped ulcer
- liver abscess
Vibrio vulnificus
- coastal salt water
- bullous skin lesion
- cirrhotic pt
Listeria monocytogenes
- deli meat
- pregnancy
Aeromonas hydrophila
-freh water
Echinococcus granulosus
- dog tapeworm
- liver cysts
ETEC E coli
-travelers’ diarrhea!- most common cause
Ascaris lumbricoides
-small intestine obstruction
Schistosoma mansoni
- liver cysts
- esophageal varices
- Africa
- snails
- bladder cancer
EHEC
-hemolytic uremic syndrome
Vibrio parahemolyticus
- bloody diarrhea
- oysters
most common infectious causes of BLOODY diarrhea
- salmonella
- shigella
- EHEC (0157 H7)
- campylobacter
- Yersinia enterocolitica
most incidental finding of appendix
-carcinoid tumor
MEN1
- parathyroidism- constipation
- zollinger ellison- gastrin
- pituitary adenoma
- pancreatic tumors
chronic diarrhea- most common causes
- medication adverse effects
- IBS
- lactose intolerance
- none of these have nocturnal diarrhea, weight loss, anemia or +FOBT
5-HIAA
-carcinoid
breath test
-glucose/lactose- small bowel overgrowth
IBS
- idiopathic, >6months, abd pain with altered BMs
- no structural or biochemical abnormalities
Rome III criteria for IBS dx
- abd discomfort for 3 days/month for past 3 months, with sx onset >6 months
- at least 2/3:
- relieved w/ defecation
- change in frequency of stool
- change in form of stool
low FODMAPS diet
- (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols)- fermentable monosaccharides and short-chain carbohydrates
- ex- fructose, lactose, fructans, wheat-based products, sorbitol
- for IBS pts!!
Neuroendocrine
- VIP-oma
- medullary thyroid carcinoma (calcitonin)
- zollinger-ellison syndrome (gastrin)
- carcinoid syndrome (5-HIAA)
causes constipation
- inadequate fiber and fluid intake
- hypothyroidism
- Ca channel blocker use
- Ca supplementation
Lesar-Trelat sign
- many pigmented lesions
- colon cancer assoc
constipation/fecal impaction- dx, tx
- dx- digital rectal exam
- tx- enemas, digital disruption
microscopic colitis- causes
- idiopathic- medications can cause it
- W>M; 5-6 decade
- watery diarrhea
- lymphocytic- lymphocytes and plasma cells
- collagenous- thickened band of subepit colagen
diverticulitis- sx, tx
risk for perforation so dont do scope!!!
- ttp in LLQ,fever, FOBT positive, elevated WBC count
- tx- start antibiotics; NPO/clear liquid diet
- after sx resolution- diagnostic imaging to rule out colonic neoplasms
diverticulosis bleed
painless bloody poops
diverticular dz of the colon- risk factors, sx, dx, complications
- inc age, CT dz, low fiber diet or chronic constipation (Debated)
- sx- asymptomatic
- dx- colonoscopy or barium enema
- complications- GI bleed, diverticulitis
types of polyps
- adenomatous (70%)
- serrated- sessile serrated, serrated adenoma
- nonneoplastic- juvenile, hamartomas, infl
colorectal cancer screening
- FH
- if 1st degree relative dx at 60 yo- begin screening at 40!!
- begin screening at age 40 or 10 yrs younger than diagnosis of affected relative
95% of colon adenocarcinoma- come from?
- adenomas and serrated polyps!
- advanced- higher risk of progressing to malignancy- if > 1 cm, high-grade dysplasia
- asymptomatic- FOBT positive, iron def anemia
ways to detect polyps
- barium enema- poor diagnostic accuracy
- CT colonosgraphy- less sensitive at catching < 10 mm
- colonoscopy- gold standard!!!
Cowden disease
- PTEN mult hamartoma syndrome
- hamartomatous polyps and lipomas thruout GI tract!
- hair follicle tumors (around lips)- Trichilemmomas
- cerebellar lesions
- inc rate of malignancy
lynch syndrome
-endometrial cancer- transvaginal US
FAP- caused by, tx
- 100-1000s of adenomatous polyps and adenocarcinoma
- APC gene or MUTYH gene mutation
- tx- prophylactic colectomy
Peutz-Jeghers Syndrome
- Hamartomatous polyposis syndrome- AD
- mucocutaneous pigmented macules around lips
- GI malignancy- 40%
Familial juvenile polyposis
- hamartomatous polyposis syndrome- AD
- > 10 hamartomatous polyps- in colon
- inc risk of adenocarcinoma!!
Lynch syndrome (HNPCC)
- AD
- MMR gene mutation- MLH1, MSH2!
- inc risk of CRC, endometrial cancer!!!
- rapid polyp transformation to malignant- 1-2 yrs
Gardner’s syndrome
- adenomatous colon polyps
- 95% develop colorectal polyps
- osteomas of mandible, skull, long bones
- supernumerary teeth, thyroid and adrenal tumors, desmoid tumors
- AD
Turcot’s syndrome
- adenomatous colon polyps
- brain tumors
- colorectal cancer- 100% at 40 yo
- AD
Celiac dz- ab’s
-IgA tTG
-if IgA def- anti-DGP
(HLA-DQ2/8)
celiac dx- sx
- wgt loss, chronic diarrhea
- dermatitis herpetiformis, iron def anemia, osteoporosis
celiac dz- at risk for?
malabsorption!
- type 1 DM
- osteoporosis- DEXA scan
celiac dz- biopsy
- complete loss of intestinal villi
- intraepit lymphocytes
- plasma cells with hypertrophy of intestinal crypts
Whipple disease- dx, sx, tx
- biopsy- PAS + macrophages with gram + bacilli (Tropheryma whipplei)
- lose ADEK
- fever, LAD, arthralgias, malabsorption
- tx- antibiotics
Short bowel syndrome- if <200 cm left of jejunum and no colon
-total parental nutrition!!!
bacterial overgrowth- sx, caused by? dx?
- malabs of fat soluble vitamins; steatorrhea
- PPI, gastric surgery of small bowel, small intestine motility disorders, gastrocolic or coloenteric fistula
- dx H breath test
- tx- antibiotics
TI resection
- bile salts and vit B12 malabs
- give calcium supplementation- inc risk of oxalate kidney stones
