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clin med > GI day 2 > Flashcards

GI day 2 Flashcards

1
Q

MC diagnosed GI disorder

A

Irritable bowel syndrome

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2
Q

Dx of exclusion- all other diagnostic tests come normal

A

Irritable bowel syndrome

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3
Q

Irritable bowel syndrome

rome criteria

A

Recurrent abdominal pain at least 3 days a month for the past 3 months
Sx come on 6 mo before dx with 2+ of the following
Sx improve with defecation
Change in frequency of stool
Change in consistency of stool

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4
Q

Irritable bowel syndrome

classification

A 
Diarrhea predominant (IBS-D)- over 25% BM are loose
Constipation predominant (IBS-C)- over 25% of BM are hard 
Mixed (IBS-M)- at least 25% of each stool type
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5
Q

which Irritable bowel syndrome category should we restrict gluten

A

ibs d

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6
Q

1st line trmt Irritable bowel syndrome- C

A 
fiber- results dont help much
Soluble fiber (psyllium) is better than insoluble (bran)
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7
Q

most imp. trmt for IBS

A

manage stress

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8
Q

Antispasmodics in IBS-D

A

hyoscyamine, dicyclomine

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9
Q

IBS-D: 5 HT3 receptor antagonist Alosetron for women ONLY?

A

Good results but can cause Ischemic colitis so was pulled from the market but is starting to make a comeback

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10
Q

IBS-C: 5HT-4 receptor agonist Tegaserod?

A

FDA withdrew bc of CV side effects

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11
Q

ibs laxitives as trmt?

A

no, only work for short term

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12
Q

what food should we restrict in ibs

A

Restrict poorly absorbed short chain carbs like fructose, lactose, fructans (wheats), galactans (legumes), polyols (sweeteners)

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13
Q

Defecation process:

A

stool formation→ GI motility→ pelvic floor function

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14
Q

Functional constipation

types

A

Slow transit
Normal transit- IBS-C
Pelvic outlet- muscle contraction abnormalities

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15
Q

Functional constipation

rome criteria

A 
Straining in at least 25% BM
Lumpy hard stools in at least 25%
Feels like incomplete evacuation in at least 25%
Feels like poop is blocked at least 25% 
Manual maneuvers to poop at least 25%
Less than 3 poops a week
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16
Q

Functional constipation

dx

A 
CBC, chem panel, Ca, thyroid functions
Colonoscopy
Colon transit study
Anal manometry
Anal US
Defecography
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17
Q

trmt slow transit Functional constipation

A

Slow transit- treat cause; surgery rare

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18
Q

trmt normal transit Functional constipation

A

treat as IBS-C

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19
Q

trmt pelvic outlet Functional constipation

A

biofeedback- sensor senses pressure and give you advice on how to poop

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20
Q 
Celiac disease (Sprue)
cause
A

Unknown- Environment, immunologic, genetic
Villi can’t absorb things
HLA DQ2 allele

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21
Q 
Celiac disease (Sprue)
sx
A

Start when kids start eating cereal

Diarrhea, cramps, weight loss, anemia, metabolic bone disease (calcium def.), protein deficiency

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22
Q 
Celiac disease (Sprue)
dx
A

Serum: IgA Ab, antiendomysial antibodies, tissue transglutaminase (tTG) antibodies
SI biopsy in duodenum or jejunum

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23
Q 
Celiac disease (Sprue)
biopsy results
A

Flat villi
Crypt hyperplasia and loss of villi
Cuboidal cells with asymmetric nuclei
Lymphocytes and plasma cells in lamina propria

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24
Q 
Celiac disease (Sprue)
trmt
A

Gluten free diet
Sx will disappear with trmt
Doing well then suddenly deteriorate? Check for lymphoma

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25
Q

enzyme that digests carbs

A

panc amylase

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26
Q

Primary lactase deficiency? Secondary lactase deficiency-?

A

Primary lactase deficiency- genetic, no sx

Secondary lactase deficiency- in celiac disease

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27
Q

Lactose intolerance

sx

A

Primary has no sx
Diarrhea, cramps, abd pain, flatus when ingesting lactose
Ppl react to any carbs- starch, disaccharides, glucose

28
Q

Lactose intolerance

dx

A

Hydrogen breath test- detect colonic bacteria on lactose make H2… over 20ppm is positive

29
Q

Lactose intolerance

trmt

A

Lactose free diet

Oral lactase supplement not approved

30
Q

stress is a big cause in this

A

IBS and IBD

31
Q

Ulcerative colitis

sx

A

Bloody, mucus diarrhea and cramps

Untreated → weight loss and toxic appearance

32
Q

Ulcerative colitis

pe

A

Usually none

May be tender

33
Q

Ulcerative colitis

dx

A

Colonoscopy is best- mucosal inflammation from rectum up (except SI)
Friable mucosa with superficial ulcers and pseudopolyps

34
Q

Any part of the GI tract involved

A

Crohn’s disease

35
Q

Ileocecal area is MC

A

Crohn’s disease

36
Q

Not in rectum

A

Crohn’s disease

37
Q

Skipped lesions

A

Crohn’s disease

38
Q

Anal fistulae and fissures; internal fistulae

A

Crohn’s disease

39
Q

Must do periodic endoscopies to check for cancer

A

Crohn’s disease

40
Q

Crohn’s disease sx

A

Chronic diarrhea and no cramps
Weight loss, malnutrition
Stunted growth in PEDS
Anal fistulae- may have this 2 years before sx of Crohn’s

41
Q

IBD more common in young ppl

A

UC

42
Q

Indeterminate colitis?

A

Don’t know if its Crohns or UC

43
Q

Indeterminate colitis dx?

A

Serum antibody assays (ELISA)
pANCA- anti neutrophil cytoplasmic antibodies→ UC
pASCA-anti saccharomyces cerevisiae antibodies → CD
Dont screen with these bc they are in vasculitis and RA as well

44
Q

gi tract involved in UC

A

colon and rectum

45
Q

no skipped lesions

A

UC

46
Q

thickness in uc

A

mucosal

47
Q

thickness in crohns

A

full

48
Q

cancer rick in uc

A

high

49
Q

cancer rick in cd

A

low

50
Q

ibd trmt goals

A 
Get rid of sx
No steroids
Improve quality of life
No toxicity
Prevent neoplasia
51
Q

1st line: ibd trmt

A

aminosalicylates (5 ASA)- PO suppositories; this is long term trmt

52
Q

what meds can cause diarrhea

A

metformin, omeprazole, chemo

53
Q

Pseudomembranous colitis

HA or CA

A

CA

54
Q

Pseudomembranous colitis cause

A

C diff- gram + spore forming anaerobe
Toxin A and B affect mucosa and causes disease
ATB use- Cephalosporins, clindamycin, ampicillin, amoxicillin
no dose correlation

55
Q

Pseudomembranous colitis sx

A

Watery diarrhea, fever, leukocytosis
Not bloody diarrhea
Toxic megacolon

56
Q

Pseudomembranous colitis dx

A

Stool culture- toxins A and B is most useful and practical
Colonoscopy- yellow plaque like lesions
Confirm with biopsy

57
Q

Pseudomembranous colitis trmt

A 
Stop ATB
No antidiarrheals
Wash hands- with soap and water is most imp.
1st line Vancomycin- must do PO 
2nd line Fidaxomicin- PO
58
Q

Pseudomembranous colitis risks

A

ppi omeprazole

59
Q

CD colonoscopy

A

Colonoscopy- linear ulcers with normal mucosa in between; cobblestone appearance; pseudopolyps

60
Q

stricture: CD or UC?

A

CD

61
Q

CD biopsy

A

may have noncaseating granuloma; transmural inflammation; plasma cells and lymphocytes in lamina propria

62
Q

CD endoscopy and radiology

A

look at what part is narrow and distorted

63
Q

Fat at mesenteric edge of colon, thickening of bowel, shortening of mesentery, transmural involvement

A

CD

64
Q

Backwash ileitis-?

A

Backwash ileitis- inflammation in the terminal ileum as well in UC

65
Q

hallmark uc

A

Hallmark: mucosal inflammation with crypt distortion and crypt abscesses

66
Q

psuedopolyps are in UC or Crohns

A

uc

clin med (35 decks)

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