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Medicine > GI > Flashcards

GI Flashcards

1
Q

what should you distinguish when a pt has a CC of diarrhea?

A

with or without urgency

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2
Q

what time frame defines acute diarrhea?

A

less than 2 weeks

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3
Q

what time frame defines chronic diarrhea?

A

more than 30 dys

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4
Q

what defines a mild diarrhea?

A

less than 3BMs per day

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5
Q

what defines a moderate diarrhea?

A

more than 4BMs per day with local sxs

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6
Q

what defines a severe diarrhea?

A

more than 4 BMs per day with systemic sxs

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7
Q

what is the MCC of acute diarrhea?

A

infectious process usu. viral and self limited

severe is usu. bacterial in nature

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8
Q

what is the MCC of chronic diarrhea in underdeveloped countries??

A

chronic infection

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9
Q

what is the MCC of chronic diarrhea in developed countries?

A

IBS, IBD, Malabsorption

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10
Q

which viruses are a/w non inflammatory diarrhea?

A

rotavirus

norwalk virus

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11
Q

which protozoa are a/w non inflammatory diarrhea?

A

giardia (streams, water)
cryptosporidium
cyclospora

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12
Q

what virus is a/w inflammatory diarrhea?

A

CMV

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13
Q

what protozoa is a/w inflammatory diarrhea?

A

entamoeba histolytica

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14
Q

what is classic cause of bacillus cereus?

A

fried rice (causes non inflammatory diarrhea)

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15
Q

which bacteria produce enterotoxins and non inflammatory diarrhea?

A 
ETEC (E. coli)
vibrio cholerae (fish)
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16
Q

which bacteria produce cytotoxins and inflammatory diarrhea?

A

O157:H7 (EHEC)
vibrio parahoemolyticus (fish)
c. diff

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17
Q

which bacteria invade the mucosa and cause inflammatory diarrhea?

A 
shigella
Campylobacter jejuni
salmonella
enteroinvasive E. coli
yersinia
18
Q

what are the pathogenic clues when assessing for diarrhea?

A 
well water/farm
ill contacts
occupational exposure
recent travel
pets (reptiles)
hobbies
recent Hospitalizations and abx use
food history
19
Q

what are key food hx questions when assessing for diarrhea?

A

unpasteurized milk, apple joice

raw, undercooked meat, fish

20
Q

why is timing important for diarrhea?

A

length of time between ingestion and sxs can point to the pathogen
1-6hrs (s. aureus, b. cereus)
8-16 hrs (c. perfringens)

21
Q

when would you order O&P?

A 
presistent diarrhea
foreign travel
day care exposure
community water outbreak
MSM or HIV
22
Q

when would you consider an endoscopy in a diarrhea pt?

A

suspected c. diff
suspected ischemic colitis
IBD infectious vs IBD flare
PING

23
Q

when is abx contraindicated for diarrhea?

A

suspected or proven EHEC (toxin of bacteria and abx cause renal failure)

24
Q

when might you give a pt prophylactic abx?

A

PING pts or with need for prevention while travelling

25
Q

which medications can cause chronic diarrhea?

A 
SSRIs
Cholinesterase inhibitors
NSAIDS
PPIs
Angiotensin II receptor blockers
Metformin
Allopurinol
Colchicine
26
Q

what is a cathartic screen?

A

tests for metabolites of laxatives in stool

27
Q

what is secretory diarrhea?

A

intestinal mucosa directly secretes fluid and electrolytes into the stool (pushes)
causes normal or decreased osmotic gap
diarrhea will not change with fasting

28
Q

what is osmotic diarrhea?

A

malabsorption of ingested substance which pulls water into lumen (substances what to be diluted)
causes an increased osmotic gap
will resolve during fasting

29
Q

what is the MCC of osmotic diarrhea?

A

carbohydrate malabsorption
laxative use/abuse
malabsorption syndromes

30
Q

what are causes of secretory diarrhea?

A

endocrine tumors

bile salt malabsorption (stimulates colonic secretion)

31
Q

what osmotic gap would indicate a secretory diarrhea?

A

50 mosm/kg

32
Q

what osmotic gap would indicate an osmotic diarrhea?

A

125 mosm/kg

33
Q

what is a normal osmotic gap?

A

50-125 mosm/kg

34
Q

what are causes of bile salt enteropathy?

A 
drugs
infection
hyperthyroidism
laxative abuse
neuroendocrine tumor
rectal villous adenoma
35
Q

what can cause malabsorptive d/o?

A 
celiac sprue
small bowel resection
carcinoid
chronic pancreatitis
pancreatic carcinoma
36
Q

what can cause motility d/o (peristalsis is inhibited and draws more water in and causes diarrhea)?

A

postsurgical
systemic d/o
IBS

37
Q

what does a crampy pain usu indicate in GI?

A

obstruction

38
Q

what does a steady pain usu indicate in GI?

A

inflammatory process

39
Q

where does gall bladder pain radiate to?

A

right shoulder

40
Q

what is the test of choice for evaluating RUQ pain?

A

ultrasound

41
Q

what is the approach of a GI complaint?

A
  1. complaint based

2. disease state based

42
Q

what does odynophagia imply?

A

inflammation

Medicine (146 decks)

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