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GI > Final Exam Qs > Flashcards

Final Exam Qs Flashcards

1
Q

How many stools per day is considered acute diarrhea?

A

> 3 large volume stools per day

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2
Q

Sx are present for how long with acute diarrhea?

A

<2 weeks

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3
Q

What % of acute diarrhea is due to infectious agents?

A

90%

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4
Q

What is the 2nd MC cause of acute diarrhea?

A

Medications

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5
Q

Pt has acute diarrhea with fever and/or chills. Your next question is “did you notice any have blood or mucous in the diarrhea?” And what does it mean if they say yes vs no?

A

No: gastroenteritis AKA stomach flu
Yes: dysentery

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6
Q

What is gastroenteritis?

A

Stomach flu

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7
Q

Sx of gastroenteritis?

A 
Nausea/vomiting
Large watery NON-blood stools
Low grade fever
Diaphoresis
Abdominal cramps
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8
Q

What is Diaphoresis

A

Sweating

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9
Q

MC cause of gastroenteritis (GE)?

A

Viruses e.g. norovirus and rotavirus

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10
Q

How long before viral gastroenteritis sx improve?

A

24-48 hours

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11
Q

Gastroenteritis “food poisoning” is due to what?

A

Ingesting a toxin produced by bacteria e.g. staphylococcus aureus

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12
Q

How long before food poisoning gastroenteritis sx improve?

A

12 hours

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13
Q

How do you treat gastroenteritis?

A

Supportive care when its acute, non-bloody diarrhea

  • frequent sips of liquid
  • BRAT diet (banana, rice, applesauce, toast)
  • avoid dairy
  • anti-diarrheal are soft for pts w/o dystentery
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14
Q

T/F stool studies and blood tests are NOT usually necessary/useful in acute gastroenteritis

A

True

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15
Q

Sx of dysentery

A

Bloody diarrhea (or mucous) of any cause

  • fever
  • nausea/vomiting
  • abdominal pain
  • tenesmus
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16
Q

What is tenesmus

A

Urge to have bowel movement even when colon is empty

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17
Q

If dysentery is caused by infection, what is it called?

A

Infectious colitis

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18
Q

Bacterial causes of infectious dysentery include

A

*Salmonella
*Shigella
*Campylobacter
*Enterohemorrhagic escherichia coli (EHEC) aka shiga toxin producing e coli (STEC)
E coli = travelers’ diarrhea in Asia, Africa, Central/South America
Entamoeba histolytica = parasitic cause for travelers in India and tropical locations

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19
Q

How is Travelers’ diarrhea transmitted? What about in the US?

A

*Fecal-oral via contaminated food/water

  • US: more likely from pathogens in undercooked foods
  • poultry/eggs: salmonella
  • hamburger: E. coli
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20
Q

T/F patients with dysentery need to be referred for stool studies

A

True

  • fecal leukocytes (may be helpful in deciding which patients are more likely to have positive stool cultures)
  • stool cultures
  • stool O&P if parasite suspected
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21
Q

How do you Tx dysenery if pt is tolerating liquids? If pt is severely dehydrated (dizzy, severe fatigue, tachycardic)?

A

Refer to PCP urgently for stool studies and antibiotics

Refer to ED for IV fluids and antibiotics

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22
Q

Do you give antidiarrheal meds to patients with dysentery?

A

NO! Can cause prolonged fever, may lead to toxic megacolon and perforation and increases risk of hemolytic uremic syndrome (HUS) in pt with STEC: Shiga toxin producing E. coli

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23
Q

What is the fxn of the small intestine?

A

Nutrient digestion and absorption

Deliver undigested food/waste to the colon for elimination

Protect against external environment with the GALT - gut associated lymphoid tissue

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24
Q

What % of GALT - gut associated lymphoid tissue is in small intestine?

A

70%

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25
Q

Majority of digestion occurs where?

A

Duodenum - duodenal brush border has enzymes that combine with bile from the liver and the enzymes and bicarb from the pancreas to breakdown all macronutrients into simple forms

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26
Q

The majority of nutrient absorption happens where?

A

Jejunum

27
Q

What happens when the small intestine goes rogue?

A

Malabsorption

  • lactase deficiency
  • celiac disease
28
Q

What is the MC Sx with Malabsorption?

A

Diarrhea

29
Q

What is the difference b/w the 2 main watery types of diarrhea?

A

Osmotic
- water drawn into gut lumen by nondigested particles
- stops when patient fasts
E.g. lactase def.

Secretory
- intestinal crypt cells secrete too much water
- does NOT stop when pt fasts
E.g. ibd

30
Q

What is the MC maldigestion syndrome of the intestines?

A

Lactase deficiency (aka lactose intolerance)

It’s a deficiency in the small intestinal brush border enzyme lactase (NOT allergy to lactose)

31
Q

What ethnic group gets lactase def most often?

A

Asians

32
Q

Fxn of lactase? Lifespan of lactase?

A

Breaks down milk sugar (lactose) into glucose + galactose

Lactase levels are highest at birth and start to decline by 3.5-5 yo

33
Q

What is the pathophysiology of lactase deficiency?

A

Unabsorbed lactose draws water into the small bowel causing diarrhea

Unabsorbed lactose enters colon, is metabolized by colonic bacteria = excess gas production

34
Q

Sx of lactase deficiency?

A
  1. Dairy intake, then:
Bloating
Flatulence
Cramping abdominal pain
Foul smelling stools
Osmotic diarrhea

**NO weight loss

35
Q

DDX list for lactase deficiency (5)?

A 
Celiac
IBS
Inflammatory bowel disease (IBD)
Diverticulitis
Acute gastroenteritis
36
Q

You suspect your patient has lactase def, what do you do to evaluate?

A

1 - trial of going off dairy OR
2 - lactose hydrogen breath test: pt eat lactose, measure breath hydrogen concentration 3-8 hrs later, increased hydrogen suggests lactose def

37
Q

Tx for lactase def?

A

Avoid lactose foods

Take lactase enzyme replacement with dairy

38
Q

What is an AI disorder of small intestine with an abnormal response to foods containing gluten?

A

Celiac disease

39
Q

Epidemiology of celiac disease

A

W>M
Family history increases risk
Associated with other AI conditions

40
Q

What is the pathophysiology of celiac disease?

A

1 - GALT determines that gliadin is the enem

Gliadin is a glycoproteins within gluten and is found in wealth and other grains: oats, rye, barley, millet

2 - GALT triggers an enhanced lymphocyte response to gliadin and autoantibodies are produced

3 - autoantibodies trigger inflammatory cascade which causes villous atrophy and decreased absorptive ability

41
Q

Sx of celiac?

A 
Diarrhea (85%)
Fatigue (80%)
Weight loss (45%)
Abdominal distention  (33%)
Excessive flatus or eructation (28%)
Large, bulky, foul smelling stools

35% are asymptomatic

42
Q

Eructation?

A

A belch

43
Q

What are signs of malabsorption? What about a pathognomonic sign for celiac disease from the PE?

A 
Anemia 50%
Vitamin malabsorption (esp fat soluble vitamins a, d, e, k)

PE sign: dermatitis herpetiformis 10-20% of cases is pathognomonic for celiac disease

44
Q

How do you diagnose celiac disease? Name and describe the gold standard procedure

A

Antibody testing for
1 - anti-tissue transglutaminase (TTG) antibody and
2 - IgA levels (because TTG is IgA antibody)

Procedure: endoscopic biopsy of distal duodenum showing villous atrophy

45
Q

How do you manage celiac disease?

A

Check labs for sequelae of Celiac’s
DEXA for osteoporosis

Tx is STRICT GF diet

46
Q

How long after going GF does it take for clinical Sx to heal? For the gut lining to heal?

A

2-7 days for clinical sx

3-12 months for healing

47
Q

What is inflammatory bowel disease? What are 2 subtypes of this disease

A

Chronic inflamm process in GI

  • Crohn’s disease
  • ulcerative colitis (UC)
48
Q

Who gets IBD?

A 
Caucasians
Teen-30 yo and 60-80yo
M=W
Industrialized nations
SMOKING increases risk of Crohn’s, decreases risk of UC
49
Q

Pathophysiology

A

Inappropriate inflammatory response to normal intestinal flora

50
Q

Where does IBD happen?

A

Crohn’s = skip lesions happen anywhere except rectum

UC = continuous lesions happen at sigmoid colon

51
Q

85% of crohn’s cases involve ________; 1/2 cases involve _______ (location)

A

Terminal ileum; small and large intestine

Spares the rectum

52
Q

What do the ulcers look like in crohn’s disease? How deep can ulcers be?

A

Linear ulcers: cobblestone

Crohn’s is transmural: may affect entire depth of bowel wall

53
Q

Sx for chron’s

A 
Constant abdominal pain
Weight loss
Chronic diarrhea (if bloody, suggests UC)
54
Q

PE Signs of Crohn’s

A

Vitals = occasional low grade fever
RLQ abdominal tenderness
Possible abdominal mass
Perineal abnormalities common

55
Q

What imaging study/studies would you chose to see the ileum for crohn’s? What labs would be abnormal?

A

Barium contrast xray

Abdominal ct and capsule endoscopy

Elevated ESR/CRP

CBC = anemia

56
Q

How do you diagnose Crohn’s disease?

A

Colonoscopy ONLY done when not in acute flare-up

57
Q

What, if seen on biopsy, is pathognomonic for crohn’s?

A

Granulomas

58
Q

Tx for crohn’s

A

Anti inflammatory meds
Nutritional support
Surgery in refractory cases/complications BUT disease can recur after surgery

59
Q

Flashcards on UC

A

UC

60
Q

What is the classic pain radiation pattern
associated with pancreatitis?

A. Back pain that radiates to the abdominal RUQ
B. RUQ abdominal pain that radiates to the scapula
C. Epigastric abdominal pain that radiates straight through to the back

A

C. Epigastric abdominal pain that radiates straight through to the back

61
Q

What is the classic area of referred pain for a
patient with gallstones?

A. Back pain that radiates to the abdominal RUQ
B. RUQ abdominal pain that radiates to the scapula
C. Epigastric abdominal pain that radiates straight through to the back

A

B. RUQ abdominal pain that radiates to the scapula

62
Q

Which of the following conditions on the RUQ
abdominal pain DDx is often associated with postprandial pain?

A. nephrolithiasis
B. hepatitis
C. cholecystitis
D. all of the above

A

C. cholecystitis

63
Q

Which of the following conditions on the RUQ
abdominal pain DDx might be associated with
nausea and vomiting?

A. nephrolithiasis
B. hepatitis
C. cholecystitis
D. all of the above

A

D. all of the above

64
Q

Which of the following conditions on the RUQ
abdominal pain DDx is likely to present with
jaundice and itching?

A. nephrolithiasis
B. hepatitis
C. cholecystitis
D. all of the above

A

B. hepatitis

GI (11 decks)

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