IBS, Const, Diarr Flashcards
IBS includes what features? (3)
1) Altered GI motility (↑ motility)
2) Visceral hyperplasia (↑ perception of pain/motility)
3) Psychopath (U accompanying depression)
Types of IBS? (3)
1) Constipation-Predominant
2) Diarrhea-Predominant
3) Pain-Predominant
IBS general presentation?
Abd pain relieved by BM
Pain a/w looser or more BM
(P) dyspepsia, atypical chest pain, bloating
Constipation IBS presentation? (4)
1) Lasts days/months w/ periods of N or diarr
2) Hard stool w/ sense of incomplete evacuation
3) BMs take long time/straining
4) (P) overuse of enema/laxatives
Diarrhea IBS presentation? (4)
1) Freq loose stools
2) (U) in am or post meal
3) Urgency followed by sense of incomplete evac
4) Mucus w/ stool
Pain IBS presentation? (3)
1) Crampy/variable abd pain
2) Alternating Diar/Const
3) (P) exacerbation w/ stress/meals -> relieved w/ BM
IBS DDX?
IBD Colitis Drugs Celiac dz Colon/Pancr CA Parasite Psych dz
IBS diagnostics: ABCs?
Abd pain
Bloating
Change in BMs
IMPROVEMENT WITH BM
Red flags w/ IBS? (4)
1) FHx colon CA, IBD, Celiac
2) Anemia
3) Weight loss
4) >50yo
IBS labs? (7)
No necess u/l red flags
CMP (e-) CBC (if fever) ESR (inflamm cause) CRP TSH (hyperthyroid -> diarr) Hemo (GI bleed) Stool (parasites)
If IBS pt > 50 or FHx, what test?
colonoscopy
IBS management? (6)
Pt edu/reassurance (CHRONIC condition) Meds for sxs: -antichol (all types) -antideprss (all types) -probiotic (all) -immod (diarr) -MiraLAX (const)
IBS lifestyle changes? (3)
Fiber supp (all types)
GERD precautions
Stress mgmt
Constipation: criteria? (3)
Straining
Hard stool
Sense of incomplete evac
Constipation caused by? (3)
DDX? (6)
1) Slow-transit (slow from proximal/right to distal colon)
2) Pelvic floor dysfxn (can’t evacuate)
3) Meds
Colon CA Proctitis DM (gastroparesis) Parkinson's Obstruction Meds
Constipation w/ bloating/pain/fatigue suggestive of?
IBS
Constipation w/ need for digital extraction suggestive of?
pelvic floor dysfxn
Constipation exam includes? (3)
1) Test anal reflex
2) Digital Rectal
3) Pelvic exam (rectocele, pelvic floor dys)
Constipation diagnostics?
CBC (if fever), CMP, TSH (hypothy)
Colonoscopy if high risk, blood, weight change
Constipation management? (6)
Adjust meds Correct metabolics (high Ca2+) Push fluids ↑ exercise ↑ fiber ↓ laxatives
Constipation tx w/ meds? (5 types)
Osmotic laxative Sugar alcohols (non-absorb) Saline Emollient Stimulant
Constipation complications?
Fecal impaction
LBO
Anorexia/N/V/Abd pain
Diarrhea: Acute vs Chronic?
Acute lasts ≤ 14 days
Chronic lasts > 30 days
Acute Diarr caused by?
(U) viral (rota, adeno)
Bacterial U more severe (campylo, salmonella, shigella, e coli)
Protozoa
Acute Diarr DDX?
Drug rxn IBD Impaction Laxative abuse Stress
Acute Diarr must identify b/w what?
Inflamm vs Non-inflamm
Acute Diarr: Non-inflamm is?
(U) caused by?
Watery w/ cramping, N/V, fever
Norwalk v, adenovirus, giardia
Acute Diarr: Inflamm is?
Caused by?
Bloody, fever, LLQ pain, constant need to evacuate
Shigella, Salmonella, Campylo, e coli, c diff
Acute Diarr red flags? (6)
REQUIRE IMMEDIATE ACTION:
Bloody or uncontrolled diarr Fever Abd pain ≥ 6 loose stools in 24hrs Dehydration Elderly, immunocomp
Diarr stool labs?
Leukocytes, Ova/Parasites, Cx
Wet mount r/o amebiasis if hx of travel or MSM
Cytotoxicity assay for c diff if abx use
Rectal swab for STI if proctitis, d/c
Diarr managment?
Hydrate w/ oral e-
Diet
Abx if needed
Acute Diarr: Non-inflamm from Rotavirus
Sxs?
Test?
V/D, fever
rota antigens in feces
Acute Diarr: Non-inflamm from Norwalk
Sxs?
Test?
Most C cause
V/D, fever
none
Acute Diarr: Inflamm from Campylobacter
Can cause what synd?
Sxs?
Test?
Tx?
(U) food-borne, (P) water- or animal-borne
Guillian-Barre
Bloody D, fever, abd pain
Cx for campy
EMC
Acute Diarr: Inflamm from Shigella
Sxs?
Test?
Tx?
Food, water, contact spread
Bloody D, fever, abd pain (dysentery)
Cx for shigella
Bactrim
Acute Diarr: Inflamm from E coil O157:H7
Sxs?
Test?
Complication in kids?
Bloody D, abd pain, NO fever
Cx for specific strain
Hemolytic-uremia synd (renal fail, anemia, thrombo)
Acute Diarr: Inflamm from C diff
Abx that cause this?
Sxs?
Test?
Tx?
(U) PNC, cephalo, clinda
Watery D, cramps, low abd pain
Cytotox assay
Metronidazole
Acute Diarr Summary: Bloody D (U) from what?
e. coli
Acute Diarr Summary: Non-inflam w/ V (U) from what?
viral or food poisoning
Acute Diarr Summary: D w/ HIV or STD (U) from what?
AIDS-associated diarr
Acute Diarr Summary: D w/ rectal d/c and proctitis (U) from what?
gonorr, syph, LGV, HSV
Steatorrhea is?
Fatty stool (blond colored)
