Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ahmed GI Sadness 1 > DSA Diarrhea > Flashcards

DSA Diarrhea Flashcards

1
Q

Pt. presents with changes in bowel habits after going on hiking trip. She reports packing her own food, but they did drink the stream water. Her VS are normal, but she reports a watery diarrhea, abdominal cramps, and bloating. Based on her history, and description, what casued this infection and what type of stool does she have?

A

Giardia lamblia

Type 7 on Bristol Stool Chart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When assessing a pt with diarrhea, what signs should you look for?

A

signs for malnutrition, IBD, dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do we clinically define diarrhea?

A

3 or more loose stools per day

or

decrease in consistency and increase in frequency of BM of pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do you see in acute diarrhea if non inflammatory? inflammatory?

A

acute diarrhea - lasts less than 2 weeks

a. noninflammatory: watery, mild, self-limited, viral or non invasive bacterial infection, only evaulate if severe for 7+ days
b. inflammatory: bloody, pus, fever, need to look for E. coli O157:H7, invasive or toxin producing bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most likely cause of diarrhea if greater then 14 days, but less than 4 weeks?

A

medications

commonly: NSAIDs, ABs, antidepressants, chemotherapeutic, antacids, laxatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do we treat antibiotic associated diarrhea?

A

discontinue ABs - will resolve spontaneously

*diarrhea occurs during the period of AB exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When is it considered chronic diarrhea?

A

> 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What qualifies osmotic diarrhea?

A

osmotic gap of 50-75 (normal is <50)

diarrhea decreases with fasting

sx: diarrhea, bloating, flatulence, abd distention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the most common causes of osmotic diarrhea?

A

Medications

Disaccharidase def/carb malabsorption

Laxative abuse

Malabsorption syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are clues it is secretory diarrhea?

A

not improved with fasting

normal osmotic gap

increased intestinal secretion or decreased absorption

high volume, watery diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are causes of secretory diarrhea?

A

Endocrine tumor

Bile salt malabsorption

Factitious diarrhea

Villous adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should a stool sample be tested for?

A

secretory vs. osmotic diarrhea - check electrolyes

malabsorption - Sudan stain

inflammatory - ex. fecal occult blood

infections - ex. fecal Ag for giardia and e. histolytica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What invasive test is needed in most cases of chronic diarrhea?

A

colonoscopy with mucosal biopsy

to rule out/in: IBD, microscopic colitis, colinic neoplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When would you do an upper endoscopy?

A
  • a small intestinal malabsorptive disorder is suspected (celiac disease, Whipple disease)
  • It may also be done in patients with advanced AIDS to document
    • Cryptosporidium, Microsporida, and M avium- intracellulare infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When do we see fecal elastase less than 100mcg/g? calcification on a plain abd radiograph?

A

a. pancreatic insufficiency
b. chronic pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can we test for carbohydrate malabsorption?

A

includes lactase deficiency

elimination trial 2-3 wks or hydrogen breath test

17
Q

When you see these, think….?

a. vasoactive intestinal peptide (VIP)
b. calcitonin
c. gastrin
d. urinary 5-hydroxyindoleacetic acid (5-HIAA)

A

a. VIPoma
b. medullary thyroid carcinoma
c. zollinger-ellison syndrome
d. carcinoid

18
Q

The presence of nocturnal diarrhea, weight loss, anemia, or positive results on fecal occult blood test (FOBT) are inconsistent with _____.

A

medications, IBS, lactase deficiency

19
Q

What are the three types of clinical presentation of IBS?

A
  1. spastic colon (chronic abdominal pain and constipation)
  2. alternating constipation and diarrhea
  3. chronic, painless diarrhea
20
Q

If you are suspecting your pt has IBS, and you hear an alarm sx, what should you do?

A

think of a new diagnosis

21
Q

Pt. comes is dx with IBS, what is most likely true of this pt:

A

onset was before age 30

female (2x more then males)

abd pain and irregular bowel habits

22
Q

How do we diagnose IBS?

A
23
Q

Dietary restriction of what can improve IBS?

A

FODMAPS- fermentable oligosaccharides, disaccharides, monosaccharides, and polyols)

includes: fructose, lactose, fructans, wheat-based products, sorbitol, and raffinose

24
Q

What are lactase def pts at risk of?

A

osteoporosis - calcium supplementation is recommended

25
Q

What pathogens are most commonly associated with chronic diarrhea?

A
26
Q

What is the most common cause of ab associated colitits?

A

C. difficile

clindamycin, cephalosporins, ampicillin, amoxicillin, fluoroquinolones

27
Q

Why might a pt with GERD be at a higher risk for c. diff infection?

A

PPIs

28
Q

What is “volcano” exudate a buzzword for?

A

exudate of neutrophils and fibrin seen in pseudomembranous colitis due to c. diff infection

29
Q

What type of diarrhea occurs with ab associated colitis?

A

mild to moderate greenish, foul smelling water diarrhea 5-15 times per day

30
Q

What is lymphocytic colitis and collagenous colitis?

A
31
Q

What are the key features of a malabsorption syndrome?

A

weight loss*

osmotic diarrhea

steatorrhea

nutritional deficiency

*if not present, probably wrong dx

32
Q

What serious signs might be associated with malabsorption

A

neurological –> vit B12 or vit E

hyperkeratosis –> vit A

easy bruising –> vit K

osteomalacia –> vit D

pallor –> anemia

33
Q

What is seen on hx/PE of celiac patients?

A
34
Q

What would the levels of antibodies be in celiac disease after 3-12 months of dietary gluten withdrawal?

A

undetectable

IgA tTG antibody

IgA anti-endomysial antibody

IgG antibody to deamidated gliadin peptides (anti-DGP)

35
Q

What finding on biospy would exclude celiac disease?

A

normal biospy

should see blunting or complete loss of villi

36
Q

What screening is recommended for all celiac pts?

A

dual-energy x-ray densitometry - screens for osteoporosis

37
Q

Which will more likely show nutrient/vit def:

pancreatic insufficiency or bile salt malabsorption

A

bile salt malabsorption - impaired absorption of fat-soluble vitamins (A, D, E, K) is common

Pancreatic insufficiency: micellar function and intestinal absorption are normal so signs of nutrient or vitamin deficiencies are rar. e

38
Q

What three conditions need to be clinically differentiated from chronic diarrhea?

A
39
Q

If a pt has a fecal impaction, what is the only legit reason to not do a DRE?

A

pt has leukopenia

Ahmed GI Sadness 1 (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions