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clin med III, exam 1 > IBS > Flashcards

IBS Flashcards

1
Q

Irritable bowel syndrome is a combination of the three following factors

A
  1. altered GI motility
    • smooth muscle hypermotility
  2. visceral hyperalgesia
    • increased perception of visceral pain
    • increased perception of normal motility
  3. psychopathology
    • co-morbid psychological issues
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2
Q

Irritable bowel syndrome comes in what 3 types

A
  1. constipation-predmoninant
  2. diarrhea-predominant
  3. pain-predominant
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3
Q

hallmark signs/symptoms of Irritable bowel syndrome

A
  • abd pain relieved by defecation
  • pain associated with looser or more frequent stools
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4
Q

clinical presentation

  • lasts for days/months with periods of normal bowel function or diarrhea
  • stools are hard and may be followed by sensation of incomplete evacuation
  • strain with defecation
A

constipation predominant IBS

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5
Q

clinical presentation

  • frequent loose stools
  • typically occurs in morning and after meals
  • preceeded by urgency and may be followed by sensation of incomplete evacuation
  • mucus discharge with stool
A

diarrhea-predominant IBS

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6
Q

clinical presentation

  • crampy abd pain of variable intensity with periodic exacerbations
  • alternating diarrhea and constipation
  • stress and eating may exacerbate, defecation provides relief
A

pain-predominant IBS

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7
Q

what criteria can be used to evaluate IBS

A
  • Rome criteria III: recurrent abd pain at least 3 days per month in the last 3 months and associated with 2 or more of the following
    1. improvement with defecation
    2. change in frequency of stool
    3. onset associated with a change in form (appearance) of stool
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8
Q

ABC diagnosis of IBS

A
  • Abdominal pain
  • Bloating
  • Change in bowel habits/stool consistency
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9
Q

red flags when assessing for IBS

A
  • FHx of colon CA, IBD, or celiac disease
  • Anemia, GI bleed
  • Weight loss
  • fever, vomiting
  • dysphagia
  • steatorrhea
  • nocturnal symptoms
  • h/o abx use
  • recent travel
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10
Q

are labs/diagnostics usually done to assess IBS

A
  • not routinely recommended unless there are alarm features
    • CBC
    • CMP
    • ESR, CRP
    • TSH
    • Hemocult
    • Stool studies: ova and parasites
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11
Q

management options for all types of IBS

A
  • reassurance: legitimize complaint
    • large placebo effect
  • anticholinergic (antispasmotic)
    • Bentyl
  • Fiber supplement
  • stress management
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12
Q

rome criteria for diagnosis of constipation

A
  • stool frequency (< or = 2 stools per week), straining, hard stools, and a feeling ofi ncomplete evacuation
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13
Q

3 common causes of constipation

A
  • slow-transit constipation
    • slow movement from proximal to distal colon
  • pelvic floor dysfunction
  • medication
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14
Q

physical exam for constipation should include

A
  • anal reflex: anal “wink” -> as finger touches anus, it closes
  • DRE
  • pelvic exam: evaluate for rectocele -> evidence of pelvic floor dysfunction
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15
Q

managment of constipation

A
  • increase activity/exercise
  • increase fiber to 20-30g/d
  • minimize laxative use
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16
Q

complications of constipation

A
  • fecal impaction
  • large bowel obstruction
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17
Q

differentiate betwee acute and chronic diarrhea

A
  • acute: < or = 14 days in duration
  • chronic: > 30 days in duration
18
Q

most common etiology of acute diarrhea

A
  • viral
    • ​rotavirus, adenovirus, norwalk-like virus
    • bacterial causes tend to be more severe
19
Q

How does Noninflammatory diarrhea present

A
  • diffuse, watery diarrhea with abdominal cramping, N/V and fever
20
Q

list the pathogens that causes of Noninflammatory diarrhea

A
  • norwalk-like virus
  • rotavirus
  • adenovirus
  • Giardia
21
Q

how does inflammatory diarrhea present

A
  • fever and bloody diarrhea, LLQ pain and tenesmus
22
Q

list pathogenic causes of inflammatory diarrhea

A
  • shigella
  • salmonella
  • campylobacter
  • enterohemorrhagic Ecoli
  • C diff
23
Q

list the red flags of diarrhea

A
  • bloody diarrhea
  • uncontrolled diarrhea
    • passage of > or = 6 unformed stools in 24 hr
  • fever
  • dehydration
  • elderly
  • immunocompromised
24
Q

List the stool studies

A
  • fecal leukocytes
  • ova and parasites
    • done if symptoms > 7 d
  • bacterial culture (salmonella, campylobacter, shigella)
    • blood or fever
25
Q

what lab test is done when assessing diarrhea in patients with a h/o travel or MSM

A

stool wet mount (r/o amebiasis)

26
Q

what lab test is done when assessing diarrhea in patients with a h/o recent abx

A
  • stool cytotoxicity assay for C-diff
27
Q

what pathogen commonly causes viral gastroenteritis in children < 2 yo

A

rotavirus

28
Q

transmission of campylobacter

A
  • food borne ilness
29
Q

campylobacter can increase risk of what condition

A

guillian-barre syndrome

30
Q

tx for camplylobacter cause of acute diarrhea

A

erythromycin

31
Q

how is shigella transmitted

A
  • food
  • water
  • direct contact
32
Q

tx of acute diarrhea caused by shigella

A

bactrim

33
Q

clinical presentation

  • bloody diarrhea
  • abdominal pain
  • no fever
A
  • enterhemorrhagic ecoli O157:H7
34
Q

what lab must you request when assessing for Ecoli O157:H7

A

stool culture for E coli O157:H7

35
Q

Ecoli O157:H7 can cause what complication in children

A
  • hemolytic uremic syndrome
36
Q

hemolytic uremic syndrome presents in what triad

A
  • acute renal failure
  • mircoangiopathic hemolytic anemia
  • thrombocytopenia
37
Q

most significant risk factor of C-diff

A
  • abx use within the past 3 months
38
Q

C-diff produces a toxin that does what

A
  • binds to epithelial lining of GI tract to form pseudomembranes
39
Q

how is C-diff diagnosed

A

cytotoxicity assay

40
Q

managment of C-diff

A
  • stop offending abx
  • avoid antimotiltiy agents to allow toxin to clear
  • metronidazole
41
Q

bloody diarrhea is most commonly associated with which pathogen

A

enterohemorrhagic Ecoli

42
Q

noninflammatory diarrhea with vomiting suggests what condition

A
  • viral enteritis
  • food poisoning

clin med III, exam 1 (5 decks)

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