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SUMMED2 > GI-Constipation&Diarrhea > Flashcards

GI-Constipation&Diarrhea Flashcards

1
Q

Mr. Flux has c/c of stomach pain. What are the DDX

A

a. Dyspepsia/GERD
b. IBS/Chronic Pain
c. Colon Cancer Screening
d. Elevated Liver Enzymes
e. Viral Hepatitis
f. Diarrhea
g. “Gas”- colon distension
h Chronic Liver Disease
i. Constipation/Hemorrhoids
j. Emergency-append, perf, blood

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2
Q

What DDX are emergent?

A

Acute GI Bleed- cirrhosis, perfs, NSAIDs, Trauma
Acute Abdomen- rigid
Food/FB Children

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3
Q

What is used to determine stool quality?

A

Bristol stool form scale-IBS

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4
Q

What is most common reason for constipation?

A

MC-obstruction due to stricture or tumor
2/2: Hypothyroidism -post preg
Opiates-major
lithium-Diarrhea, LTC burn thryoid out

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5
Q

What TX is for children and adults acute constipation?

A

Fiber and water

Children MC, Adult-drugs, diet, meds

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6
Q

What are cause of chronic constipation?

A
  1. Functional constipation- anatomy and neuro
  2. Hypothyroidism
  3. DM
  4. Gut neuropathy
  5. Obstruction/colon cancer
  6. IBS
  7. Meds/drugs- opiods)
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7
Q

The following are neurogenic cause of constipation

A

Peripheral: DM, ANS neuropathy, Hirsburg dx, Chagas,

IBS

Drug

Central: MS, Spinal cord, Parkinson

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8
Q

The following are NON neurogenic cause of constipation

A 
Hypothyroidism
HYPOkalemia- Dirurectics, CHF
AN
Preg
Panhypopitutarism
Systemic sclerois
Myontonic dystrophy
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9
Q

What is the work up for chronic constipation?

A 
CBC-anemia, 
TSH
LFTs
VitD
CMP- electrolyte imbalance, renal fx
Tox- lithium levels
Rectal PE- hemorroids, guaiac,
Fistula obstruction-sarcoid, tumor
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10
Q

Should chronic constipation be sent right away to GI?

A

NO, After trial of stool softner
Fiber
Hydration
Once labs and drug R/O

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11
Q

What is a hemorroid?

A

Dilated vein from straining. Bleed bc thin valves, small perforation from pressure and stain. Varicose veins of Anus
SX- pain w/ bowel, itching, healing, BRIGHT RED streaks or in toilet

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12
Q

How are Hemorroids TX?

A
  1. Treat symptoms w/ topicals:pads, creams, suppositories, etc
  2. banding or other surgical tx
  3. annucort/annusol-topical hydrocortisone rectal cream
    shrink the inflammation
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13
Q

What are line agent for constipation?

A

patient education,
dietary change- less red meat
bulk-forming laxatives,
enemas as next line therapy

Avoid stimulant LAX-too much, dependent, crampy

SEVERE
suppositories,
biofeedback,
botulinum toxin injections into the puborectalis muscle

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14
Q

What are the DDX for Diarrhea?

A

Travel Diarrhea

Acute-Inflammatory-shigella, salmonella, campylobacter, e coli, c diff (bloody, fever)

Non-inflammatory-viral, giardia, parasites, meds, IBD, IBS

Chronic Diarrhea >4wks
Infection-Bacteria, parasite
Malabsorb-Celiac, Lactose
IBD, IBS, Hyperthyroidsim, LIver/Bilary tract
AN, Bulemia, METFORMIN
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15
Q

28 yo male c/o intermittent diarrhea x 6 mos. Travel to Central. What is work up?

A

FMHX,

a. Stool test, culture (ONP)
b. CBC-WBC
c. CMP
d. Guaiac -LAX
e. Giardia antibody
f. tTG-celiac
g. TSH

If labs normal, then think about IBS

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16
Q

35yo F has **recurrent abdominal pain plus **constipation/diarrhea. Some days Diarrhea only. Other
“Gas” Only. Labs are normal.

A

Irritable Bowel syndrome

17
Q

What are DDX of NON-IBS

A

DX is exculsion, r/o this

d. Non-ulcer dyspepsia (NUD)
d. Chronic pain syndrome
d. Psychogenic vomiting
d. Pelvic floor dysfunction
d. IBD,
d. Enteric infection (protozoal or bacterial),
d. celiac sprue,
d. malabsorption,
d. diverticular disease,
d. substance abuse (including Etoh and coffee),
d. idiosynchratic food/additive rxn,
d. eating disorder,
d. true psychogenic disorder, somatization

18
Q

The following are related to:

  1. Probably heterogenous
  2. Older theories: Psychogenic, Primary motility disorder
  3. diarrheal infection
  4. History of sexual/physical abuse
A

Theory to idiopathic IBS

**Currently favored: visceral hypersensitivity

19
Q

How does stress affect IBS?

A

Persistent stress= release of cortisol, INC sugars, INC inflam
Dampen inflammation response
INC mast cells
INC bacterial growth-gas
Malabsorbtion of lactose,fructose,sorbitol-sits
Dampen pain perception-sensitive, habituate
Sensitive nerve gut endings-plexus dfx, spasm
Stress levels relate w/ sx. stress hormones, CRF ANS.
Serotonin=INC stress=PNS=INC motility

20
Q

What condition is 2/2 infection leading to IBS?

A

Post-Infectious Irritable Bowel Syndrome

  1. follows bacterial dysentery cases
  2. 25% of all IBS cases
  3. indistinguishable from other forms of IBS
21
Q

What is main difference in IBS vs IBD?

A

IBS physical lab finding are normal
except sigmoid loop sometimes tender and palpable LLQ
CBC, thyroid, stool, ova and parasite (OP), WBC, TTG normal.
Calprotectin- POS IBD
IBS +/- colonscopy-severe

22
Q

How is IBS DX?

A 
Relapse remission
Stress
Somatic complaints
1.3 month Hx of continuous or intermittent abdominal pain/discomfort AND 2 of 3 below:
a.	Relief with defecation
b.	change in frequency of stool
and form of stool
3.	 bloating, mucus, incomplete evacuation
23
Q

What are the RED FLAGS of IBS?

A
  • wakes them up from sleep = BAD
  • Recent onset > 40 yo
  • Blood or occult blood in stool
  • **Anemia
  • Fever and vomiting
  • **Weight loss or anorexia
  • Progressive symptoms
  • Localized pain other than LLQ
  • Painless diarrhea w/Blood
24
Q

14you M c/c of diarrhea and gas past 4 months, intermittent every time he goes to school?What is TREATMENT?

A 
Antispasmodic, anti diarrheal drugs
Stool bulk
Tricyclic#!,  SSRI
Amitiza
Biofeedback, Acupunture
Biome
25
Q

What can be used for PIBS?

A

Metronidazole if Hx suggests infectious exposure and “recent” onset. HIGH C. diff risk

26
Q

What is important w/ IBS results?

A

Pt education- IBS + IBD poss. Flare us or changing, concern-CA

Review labs w/ Pt
Validate
Psych
NO risk of cancer or other dz
NO cure-
27
Q

What foods should be avoided?

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

28
Q

What are DDX of indigestion, stomach pain?

A 
MC- Non-ulcer dyspepsia: Epigastric pain, fullness early
GERD-heartburn, regurgitation, dysphagia
PUD- worse on empty stomach
NSAIDS
Gastric tumor-
29
Q

What are the red flag so gastric Tumor?

A 
Pain at night
fatigue
Wt loss
Anemia
FH,>55
Vomiting
Mass
Jaundice
30
Q

What is the MC form of IBS and dyspepsia?

A

Non ulcer dyspepsia

31
Q

What is the workup for dyspepsia

A

DX w/ endoscopy
Exclude ulcer
NO H.pylori
Pts still not happy

32
Q

This etiology is unknown, multiple variants such as stasis, reduced gastric compliance, hypersensitivity, post-pranidal epigastric fullness w/ no bowel changes?

A

Dyspepsia

33
Q

Mrs. Ulcer 40y has epigastric pain, fullness after meals.? What is acute treatment?

A

NO Alarm sx-Test H.pylori
IF NEG. then Tx PPI 8wks.
IF Test POS TREAT H. pylori.

IF Alarm SX >55= EGD GI
(FH, wt loss, GIB, swallowing, anemia, vomit, mass, jaundice)

PT education, 
LTC H2blocker and PPI
Prokinetic
Tryx and SSRI
Stress reduction/psych
DEC Fat, NO ETOH caffeine, loose clothes, upright
34
Q

Ms. Gas has burning sensation and fullness, epigastric pain. What is tx and plan?

A

Dyspepsia d/t

NUD w/IBS- no H. Pylori test

GERD- NO H. PYlori test, 5-10yr endoscopy to check for Barret’s esophagus

PUD- H.pyloir route

R/O biliary and NSAID

SUMMED2 (38 decks)

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