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Clinical Med III > Exam 1 - IBS, Constipation, Diarrhea > Flashcards

Exam 1 - IBS, Constipation, Diarrhea Flashcards

1
Q

What is the definition of IBS?

A

Function bowel disorder characterized by recurrent abdominal pain AND altered bowel habits.

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2
Q

What are the different sub-classifications of IBS?

A
  • IBS-C (constipation predominant)
  • IBS-D (diarrhea predominant)
  • IBS-M (mixed)
  • IBS-U (unclassified)
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3
Q

What are some red flag symptoms/alarm features that should prompt evaluation/referral to GI for condition other than IBS?

A
  • Symptoms onset after age 50
  • Severe or progressively worsening symptoms
  • Nocturnal symptoms
  • Fevers/vomiting
  • Unexplained weight loss
  • Melena, hematochezia, + occult blood
  • Personal or family hx of colon cancer, IBD, or Celiac disease
  • Unexplained iron deficiency anemia
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4
Q

What is the clinical presentation associated with IBS?

A
  • Chronic diffuse and cramping lower abdominal discomfort with periodic exacerbations
  • Altered bowel habits
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5
Q

What is the diagnostic criteria for IBS?

A

Rome IV Criteria:
Recurrent abdominal pain on at least one day per week in the last three months associated with two or more of the following:
- Related to defecation
- Associated with change in stool frequency
- Associated with a change in stool form/appearance

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6
Q

What is the general management outline for IBS?

A
  • Dietary/lifestyle/behavioral modifications (initial)
  • Psychosocial support
  • Pharmacological therapy
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7
Q

What are some dietary/lifestyle/behavioral modifications for IBS management?

A
  • Reconcile offending medications
  • Food diary/symptom log to help identify triggers
  • High fiber (20-35 g/day)
  • Adequate hydration (8-10, 8oz glasses water daily)
  • Low FODMAP diet
  • Toileting behavior
  • Mindful eating
  • Physical activity
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8
Q

What is a low FODMAP diet?

A
  • Focuses on eliminating foods that contain sugars and fibers that cause pain and bloating
  • Eliminate x 4-8 weeks than gradually reintroduce 1-2 foods at a time and assess tolerance
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9
Q

What are the different drug classes that may be prescribed to help with abdominal pain/discomfort associated with IBS?

A
  • Antispasmodics

- Antidepressants

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10
Q

What are the different drug classes that may be prescribed to help with constipation associated with IBS?

A
  • Fiber
  • Stool softeners
  • Laxatives
  • Polyethylene glycol (PEG)
  • Prosecretory Agents (Lubiprostone, Linaclotide)
  • 5-HT4 agonist
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11
Q

What are the different drug classes that may be prescribed to help with diarrhea associated with IBS?

A
  • OTC Anti-diarrheal (Loperamide)
  • Bile acid sequestrants
  • Rifaximin
  • 5-HT3 antagonist
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12
Q

What is the most common digestive complaint in the general population?

A

Constipation

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13
Q

What are some examples of medications that can exacerbate constipation?

A
  • Antipsychotics
  • Iron
  • Opioids
  • Anticholinergics
  • Antacids
  • CCBs
  • TCAs
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14
Q

What defines constipation?

A

25% of defecations associated with:

  • < 3 spontaneous BMs/week
  • Lumpy or hard stools
  • Straining
  • Manual maneuvers to facility defacation
  • Sensation of anorectal obstruction/blockage
  • Sense of incomplete evacuation
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15
Q

What are symptoms may accompany constipation?

A
  • Abdominal pain and bloating
  • Pain on defecation
  • Rectal bleeding
  • Tenesmus
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16
Q

What is the general management outline for constipation?

A

1: Treat secondary/contributing causes of constipation such as reconcile offending meds

  • Dietary, lifestyle, behavioral modifications
  • Medication therapies
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17
Q

What are some dietary, lifestyle, behavioral modifications that you can recommend to patients suffering from constipation?

A
  • Increase fluid intake (8-10, 8 oz glasses of water per day)
  • Increase fiber (20-35 g/day; start slow)
  • Bowel habit training
  • Biofeedback (for defecatory dysfunction)
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18
Q

What are medication options for constipation?

A
  • Fiber supplements
  • Stool softeners
  • Osmotic laxatives
  • Stimulant laxatives
  • Rx agents (Lupiprostone, Linaclotide, Plecanatide)
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19
Q

What are some adverse effects of fiber supplements?

A

Flatulence, bloating, distention

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20
Q

What are some adverse effects of stool softeners?

A

GI cramping

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21
Q

What are some adverse effects of osmotic laxatives?

A

GI discomfort, bloating

Caution with Mg-containing laxatives and hypermagnesemia in patients with renal insufficiency

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22
Q

What are some adverse effects of stimulant laxatives?

A

GI cramping, rarely lyte disturbances, melanosis coli

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23
Q

What are some adverse effects of Rx agents for constipation?

A

Diarrhea

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24
Q

What are some possible complications of constipation?

A
  • Hemorrhoids
  • Anal fissures
  • Fluid and electrolyte abnormalities from laxative abuse
  • Fecal impaction which can lead to bowel obstruction
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25
Q

What are some signs/symptoms of a possible fecal impaction/bowel obstruction?

A
  • Nausea and vomiting
  • Abdominal pain
  • Distention
  • Paradoxical “diarrhea”
26
Q

When performing a DRE, what specific etiology should you test for as a cause of the patient’s constipation?

A

Dyssynergic defecation

27
Q

What is the definition of diarrhea?

A

Passage of 3 or more unformed stools per day

28
Q

What is the difference between acute diarrhea and chronic diarrhea?

A

Acute: < 14 days duration

Chronic: > 30 days duration

29
Q

What is the most common cause of acute diarrhea?

A

Viral infection

30
Q

What are red flag symptoms/alarm features of diarrhea?

A
  • Fever
  • Unexplained weight loss
  • Melena, hematochezia, + occult blood
  • Persistent/progressive/nocturnal symptoms
  • Immunocompromised
  • Personal or family hx of colon cancer, IBD, Celiac disease
  • Iron deficiency anemia
  • Signs of volume depletion (dry mucus membranes, orthostatic, tachycardia, dark urine, decreased skin turgor)
31
Q

What are some possible risk exposure for acute diarrhea?

A
  • Recent hospitalization or antibiotic use
  • Travel history
  • Ingestion of improperly stored or prepared food
  • Sick contact exposure/Community outbreaks
  • Pets/Animal exposure
  • New medication or dose changes
  • Public Health Risk: Healthcare worker, Daycare employees, Food-Handlers
32
Q

What is the clinical presentation associated with acute non-inflammatory diarrhea?

A
  • Watery, non-bloody diarrhea
  • Nausea/Vomiting
  • Mild diffuse abdominal cramping, bloating/flatulence
  • (+/-) low grade fever
33
Q

What are the most common viral and protozoal causes of acute non-inflammatory diarrhea?

A

Viral: Norovirus

Protozoal: Giardia

34
Q

What is the clinical presentation associated with acute inflammatory diarrhea?

A
  • Fever
  • Blood diarrhea
  • Severe abdominal pain
35
Q

What are the common bacterial causes of acute inflammatory diarrhea?

A
  • Salmonella
  • Campylobacter
  • Shigella
  • Enterohemorrhagic E. coli
  • C. diff
36
Q

What does the diagnostic evaluation consist of for acute diarrhea?

A

Other than H and P, diagnostic evaluation is not routinely warranted for most patients as most cases are infectious and self-limiting

37
Q

With acute diarrhea, what signs warrant a need for prompt evaluation?

A
  • Signs of inflammatory diarrhea (fever 101.3F or greater, leukocytosis, bloody diarrhea, severe abdominal pain)
  • Intractable vomiting
  • Profuse watery diarrhea and dehydration
  • AKI/Lyte abnormalities
  • Elderly or nursing home residents
  • Immunocompromised
  • Hospital-acquired diarrhea, exposure to antibiotics
38
Q

What is the management for acute diarrhea?

A
  • Oral rehydration/lyte management
  • Trial of lactose free diet
  • (+/-) Anti-diarrheal agents

Antibiotics are generally not indicated as most cases are self-limited, but for some cases empiric antibiotics are appropriate
- FLQ x 3-5 days or Azithromycin as alternative

39
Q

What are the anti-diarrheal agents that you may suggest for acute diarrhea?

What is an adverse effect of one of the medications?

A
  • Loperamide (Imodium)
  • Pepto-Bismol

Pepto-Bismol can cause black stool

40
Q

Norovirus:

Source?

Duration?

Therapy?

A

Source: Prepared foods, sick contacts (Cruise ships, camps, restaurants)

Duration: Abrupt, self-limited, 24-72 hours

Therapy: Supportive, hand washing

41
Q

Rotovirus:

Population?

Source?

Duration?

Therapy?

A

Population: 6 months - 2 years old

Source: Fecally contaminated food/water, sick contacts (Daycares)

Duration: Self-limited

Therapy: Supportive, hand washing

42
Q

Vibrio cholerae (“rice-water” diarrhea):

Source?

Therapy?

A

Source: Unsanitary conditions, food and waterborne, travel hx

Therapy: Supportive; Doxy, macrolide, tetracycline, FLQ if severe

43
Q

What is the source/exposure of Clostridium perfringens (enterotoxin)?

A

Food-borne: inadequately heated/reheated meats; home-canned goods

44
Q

What is the source/exposure of Staphylococcus aureus (enterotoxin and vomiting predominant)?

A

Food-borne: creamy foods, egg/potato salad

45
Q

What is the source/exposure of Bacillus cereus (enterotoxin and vomiting predominant)?

A

Food-borne: Grains (rice)

46
Q

Giardia lamblia:

Source?

Therapy?

A

Source: Waterborne, foodborne, fecal-oral transmission (camping, lakes, streams, ponds, daycares, pools)

Therapy: Metronidazole

47
Q

What can chronic giardiasis cause?

A

Profound weight loss

48
Q

Cryptosporidium:

Source?

Therapy?

A

Source: Recreational water outbreaks, daycares

Therapy: Supportive; Treat if immunocompromised

49
Q

While Cryptosporidium is self-limiting, in which population can it lead to serious disease?

A

Patients with AIDS

50
Q

Cyclospora:

Source?

Therapy?

A

Source: Imported foods (fresh fruits/vegetables)

Treatment: TMP-SMX

51
Q

Salmonella:

Source?

Therapy?

A

Source: Poultry and livestock; reptiles

Treatment: Supportive; abx in appropriate patietns

52
Q

What can Campylobacter jejuni be linked to?

A

Guillain-Barre Syndrome

53
Q

What is the therapy for Campylobacter jejuni?

A

Supportive; Macrolide or FLQ if severe

54
Q

What inflammatory bacterial etiology is known as “classic dysentery”?

A

Shigella

55
Q

What inflammatory bacterial etiology causes severe afebrile bloody diarrhea and is only treated with supportive measure due to risk of HUS?

A

Enterohemorrhagic E. coli

56
Q

Clostridioides difficile:

Source?

Therapy?

A

Source: Recent hospitalization/antibiotic use, community acquired

Therapy: Discontinue inciting abx; Vancomycin, Fidaxomicin, Metronidazole

57
Q

Vibrio parahemolyticus:

Source?

Therapy?

A

Source: Raw seafood/shellfish

Treatment: Supportive; FLQ or Doxy if severe

58
Q

Which inflammatory bacterial etiology can mimic appendicitis?

A

Yersinia enterocolitica

59
Q

E. histolytica:

Source?

Therapy?

A

Source: Fecally contaminated food/water, travel

Therapy: Metronidazole + Iodoquinol

60
Q

What is significant about E. histolytica?

A

Can lead to intraluminal and disseminated disease

Clinical Med III (12 decks)

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