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evaluating GI complaints Flashcards

1
Q

Bristol stool scale

separate hard lumps, like nuts (hard to pass)

A

a. Type 1

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2
Q

Bristol stool scale

like a sausage but with cracks on the surface

A

c. Type 3

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3
Q
  • Sausage-shaped but lumpy
A

b. Type 2

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4
Q
  • watery, no solid pieces, entirely liquid
A

d. Type 7

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5
Q

fluffy pieces with ragged edges a mushy stool

A

type 6

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6
Q

soft blobs with clear cut edges

A

type 5

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7
Q

Acute constipation is most commonly seen in what population

A

acute constipation

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8
Q

what do you want to ask with constipation

A

night sweats
weight loss
episodes ? or consistent

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9
Q

bloody stool and abd pain think

A

inflammatory bowel disease

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10
Q

ddx for constipation

A

not really acute in adults: usually just diet and med changes

iron
hemorrhoids
elderly (poor diet and inactivity)
pregnant 
Hypothyroidism
DM
Gut neuropathy
Obstruction/colon cancer
IBS
Meds/drugs (especially opiods)
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11
Q

anatomy and neuro is normal but pt has constipation. You don’t have any anatomical or neurological abnormality that is the cause of constipation

A

Functional constipation

usually due to diet

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12
Q

Rome criteria for constipation

A

presence of 2 or more for more than 3 mo

  1. Straining during at least 25 percent of defecations
  2. Lumpy or hard stools in at least 25 percent of defecations
  3. Sensation of incomplete evacuation for at least 25 percent of defecations
  4. Sensation of anorectal obstruction/blockage for at least 25 percent of defecations
  5. Manual maneuvers to facilitate at least 25 percent of defecations (eg, digital evacuation, support of the pelvic floor)
  6. Fewer than three defecations per week
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13
Q

drugs associated with constipation

A

Analgesics

Anticholinergics (antihistamines, antispasmodics, antidepressants, antipsychotics)

Cation-containing agents (iron supplements, Aluminum, barium)

Neurally active agents (opiates, antihypertensives (CCB), ganglionic blockers, vinca alkaloids, 5HT3 antagonists)

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14
Q

labs for constipation

A
  • for anemia (CBC) w/ bleeding

TSH

electrolyte imbalance (CMP)

tox screen maybe

always want a GUAC of occult blood regardless if they have bleeding

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15
Q

PMH for constipation

A

think about pelvic floor dysfunction
Do they have hypothyroidism? Any warning sx like weight gain/loss, early satiety, not hungry anymore, cancer? Colon cancer screening?

what do they eat?
how much water do you drink?
coffee/alcohol (dehydration)
have you used anything

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16
Q

when do you refer to a GI consult

A

fiber and laxatives w. no evidence of secondary cause

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17
Q

what would you do for the woman with constipation hypothyroid taking lithium

A

Order TSH, Do a rectal exam for any hemorrhoids, anal fissures, occult bleeding, guaiac, Order CBC, CMP (renal fxn, electrolytes), Lithium level

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18
Q

how to prescribe medications for constipation

A

stool softeners are better than laxatives

don’t want to become dependent

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19
Q

v. Hemorrhoid Management

A
  1. Soft stools, avoid straining and constipation
  2. Treat symptoms w/ topicals (pain w/ bowel movement, itching, bright red bleeding, streaks of blood seen when wiping)

a. Topical pads, creams, suppositories, etc
3. Treat bleeding, chronic hemorrhoids w/ banding or other surgical tx
4. Prescription for symptomatic hemorrhoidsí annucort/annusol (topical hydrocortisone rectal cream)
a. Steroids help to shrink the hemorrhoid and inflammation

5.Stool softeners

20
Q

MOA of non bulk forming laxatives

A

causes H20 retention in stool

osmotic effect pulls H20 into gut

21
Q

MOA of bulk forming

A

absorbs water and icnreases fecal mass

22
Q

Acute inflamamtory Diarrhea causes

A

Inflammatory (shigella, salmonella, campylobacter, e coli, c diff

23
Q

non-inflammatory acute diarrhea causes

A

” Non-inflammatory (viral, giardia, parasites, meds, IBD, IBS)

24
Q

what evals would need to be done in pts with diarrhea

A

a. Stool test (O&P)
b. CBC
c. Guaiac
d. CMP
e. Stool culture
f. Giardia antibody
g. If labs normal, then think about IBS

25
Q

ddx for IBS

A 
IBD
Enteric infection (protozoal or bacterial)
celiac sprue
malabsorption
diverticular disease
substance abuse (including Etoh and coffee)
 idiosynchratic food/additive rxn
eating disorder
true psychogenic disorder
somatization
26
Q

proposed mechanisms for IBS

A

CNS
mucosal inflammation
peripheral nervous system
gas formation

27
Q

PE and albs with IBS

A
  1. Physical findings: normal except sigmoid loop sometimes tender and palpable LLQ
  2. Normal pelvic exam in females
  3. Laboratory and imaging: Normal by definition
  4. Baseline lab: CBC, thyroid, stool OB, O&P, and WBC, culture (recent diarrhea), TTG (to r/o celiac dz)
  5. (+/-flex sigmo or colonoscopy)
28
Q

features supporting dx IBS

A
  1. Rome Criteria
  2. Long history with relapse/remissions = CLASSIC
  3. Triggered by stress or life events
  4. Variability of Sx
  5. Multiple somatic complaints
  6. Associated anxiety or depression
  7. Sx provoked by eating - not true in everyone
  8. Distress “out of proportion” to Sx
  9. Attachment to “trendy” explanations, eg
29
Q

REDFLAGS with suspected IBS

A 
"	Recent onset, particularly over 40 yo
"	Blood or occult blood in stool
"	Anemia
"	Fever
"	Weight loss or anorexia
"	Progressive symptoms
"	Localized pain other than LLQ
"	Vomiting
"	Painless diarrhea
30
Q

Rome for IBS

A
  1. At least 3 month Hx of continuous or intermittent abdominal pain/discomfort AND
  2. At least 2 of 3 below:
    a. Relief with defecation
    b. Onset associated with change in frequency of stool
    c. Onset associated with change in form of stool
  3. Additional symptoms supporting Dx include: bloating, mucus, incomplete evacuation
31
Q

evaluation for IBS pts

A
  1. All patients: Hx, PE, CBC, ESR, thyroid panel, glucose, TTG (CD), stool OB, O&P, WBC (or Calprotectin)
  2. If symptoms severe or predominantly diarrhea:
    a. sigmoidoscopy or colonoscopy
    b. serology for celiac sprue and/or malabsorption work-up
  3. Therapeutic trial of Metronidazole if Hx suggests infectious exposure and “recent” onset
32
Q

dietary restriction for IBS

A

a. One thing at a time
b. Reduce coffee, alcohol, tobacco, gum
c. List of “gassy’ foods
d. Specific elimination of milk or
e. Wheat products in selected patients
no gum

33
Q

medication adjunct to behavioral management and

A

“Antispasmodic” and anti-diarrheal drugs
Stool bulking agents and other BM facilitators
Tricyclics or SSRI’s in selected patients (related to seratonin)
Peripherally active opioids – not yet approved

34
Q

epigastric pain, worse on empty stomach or offending foods

all sxs of

A

PUD

35
Q

heartburn, regurgitation, dysphagia

Sxs

A

GERD

36
Q

Postprandial belching, epigastric fullness, early satiation, fatty food intolerance, nausea, and occasional vomiting

sxs

A

PUD

37
Q

MC epigastric pain

A

Nonulcer dyspepsia/functional

38
Q

postprandial fullness, early satiety, epigastric pain

A

Nonulcer dyspepsia

39
Q

epigastric pain, fatigue, wt loss, anemia; progressive symtpoms

A

Gastric tumor (rare

40
Q

alarm sxs for epigastric pain

A 
>55
fhx of GI cancer
GIB
Weight loss
odynophagia
progressive dyspahgoa
unexplained iron deficiency anemia
persistent vomiting
palpable mass 
jaundice
41
Q

dyspepsia is seen with

A

i. GERD >20%
ii. Peptic Ulcer 10-20%
iii. Non-ulcer dyspepsia (Irritable Bowel Syndrome variant) >60%
iv. Cancer (esophagus, stomach) <2%
v. R/O biliary Sx and NSAID use!

42
Q

tx of epigastric pain

A

usually due a PPI trial

if it continues send to specialist

43
Q

pathophysiology of Non-ulcer dyspepsia

A

: stasis, reduced gastric compliance, duodenal/gastric hypersensitivity

etiology unknown must distinguish from chronic pain syndrome

44
Q

when do you treat with H pylori

A

always treat for H pylori for epigastric pain but don;t expect it to get any better in GERD

sometimes helps with nUD

45
Q

pepsin test

A

should not have pepsin in our saliva

should be in our stomach

46
Q

tx for GERD off label

A

gavisgon advance and pepsin test off label

47
Q

plan for functional dyspepsia

A 
PPI trial (8 weeks)
dietary changes

no milk at bed time
don’t eat close to bed
no alcohol or caffeine after 4

GI (13 decks)

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