GI day 2

Question 1

MC diagnosed GI disorder

Answer 1

Irritable bowel syndrome

Question 2

Dx of exclusion- all other diagnostic tests come normal

Answer 2

Irritable bowel syndrome

Question 3

Irritable bowel syndrome

rome criteria

Answer 3

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

Question 4

Irritable bowel syndrome

classification

Answer 4

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

Question 5

which Irritable bowel syndrome category should we restrict gluten

Answer 5

ibs d

Question 6

1st line trmt Irritable bowel syndrome- C

Answer 6

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

Question 7

most imp. trmt for IBS

Answer 7

manage stress

Question 8

Antispasmodics in IBS-D

Answer 8

hyoscyamine, dicyclomine

Question 9

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

Answer 9

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

Question 10

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

Answer 10

FDA withdrew bc of CV side effects

Question 11

ibs laxitives as trmt?

Answer 11

no, only work for short term

Question 12

what food should we restrict in ibs

Answer 12

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

Question 13

Defecation process:

Answer 13

stool formation→ GI motility→ pelvic floor function

Question 14

Functional constipation

types

Answer 14

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

Question 15

Functional constipation

rome criteria

Answer 15

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

Question 16

Functional constipation

dx

Answer 16

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

Question 17

trmt slow transit Functional constipation

Answer 17

Slow transit- treat cause; surgery rare

Question 18

trmt normal transit Functional constipation

Answer 18

treat as IBS-C

Question 19

trmt pelvic outlet Functional constipation

Answer 19

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

Question 20

Celiac disease (Sprue)
cause

Answer 20

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

Question 21

Celiac disease (Sprue)
sx

Answer 21

Start when kids start eating cereal

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

Question 22

Celiac disease (Sprue)
dx

Answer 22

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

Question 23

Celiac disease (Sprue)
biopsy results

Answer 23

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

Question 24

Celiac disease (Sprue)
trmt

Answer 24

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

Question 25

enzyme that digests carbs

Answer 25

panc amylase

Question 26

Primary lactase deficiency? Secondary lactase deficiency-?

Answer 26

Primary lactase deficiency- genetic, no sx | Secondary lactase deficiency- in celiac disease

Question 27

Lactose intolerance | sx

Answer 27

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

Question 28

Lactose intolerance | dx

Answer 28

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

Question 29

Lactose intolerance | trmt

Answer 29

Lactose free diet | Oral lactase supplement not approved

Question 30

stress is a big cause in this

Answer 30

IBS and IBD

Question 31

Ulcerative colitis | sx

Answer 31

Bloody, mucus diarrhea and cramps | Untreated → weight loss and toxic appearance

Question 32

Ulcerative colitis | pe

Answer 32

Usually none | May be tender

Question 33

Ulcerative colitis | dx

Answer 33

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

Question 34

Any part of the GI tract involved

Answer 34

Crohn’s disease

Question 35

Ileocecal area is MC

Answer 35

Crohn’s disease

Question 36

Not in rectum

Answer 36

Crohn’s disease

Question 37

Skipped lesions

Answer 37

Crohn’s disease

Question 38

Anal fistulae and fissures; internal fistulae

Answer 38

Crohn’s disease

Question 39

Must do periodic endoscopies to check for cancer

Answer 39

Crohn’s disease

Question 40

Crohn’s disease sx

Answer 40

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

Question 41

IBD more common in young ppl

Answer 41

UC

Question 42

Indeterminate colitis?

Answer 42

Don't know if its Crohns or UC

Question 43

Indeterminate colitis dx?

Answer 43

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

Question 44

gi tract involved in UC

Answer 44

colon and rectum

Question 45

no skipped lesions

Answer 45

UC

Question 46

thickness in uc

Answer 46

mucosal

Question 47

thickness in crohns

Answer 47

full

Question 48

cancer rick in uc

Answer 48

high

Question 49

cancer rick in cd

Answer 49

low

Question 50

ibd trmt goals

Answer 50

``` Get rid of sx No steroids Improve quality of life No toxicity Prevent neoplasia ```

Question 51

1st line: ibd trmt

Answer 51

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

Question 52

what meds can cause diarrhea

Answer 52

metformin, omeprazole, chemo

Question 53

Pseudomembranous colitis | HA or CA

Answer 53

CA

Question 54

Pseudomembranous colitis cause

Answer 54

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

Question 55

Pseudomembranous colitis sx

Answer 55

Watery diarrhea, fever, leukocytosis Not bloody diarrhea Toxic megacolon

Question 56

Pseudomembranous colitis dx

Answer 56

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

Question 57

Pseudomembranous colitis trmt

Answer 57

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

Question 58

Pseudomembranous colitis risks

Answer 58

ppi omeprazole

Question 59

CD colonoscopy

Answer 59

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

Question 60

stricture: CD or UC?

Answer 60

CD

Question 61

CD biopsy

Answer 61

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

Question 62

CD endoscopy and radiology

Answer 62

look at what part is narrow and distorted

Question 63

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

Answer 63

CD

Question 64

Backwash ileitis-?

Answer 64

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

Question 65

hallmark uc

Answer 65

Hallmark: mucosal inflammation with crypt distortion and crypt abscesses

Question 66

psuedopolyps are in UC or Crohns

Answer 66

uc