IBS, Const, Diarr

Question 1

IBS includes what features? (3)

Answer 1

1) Altered GI motility (↑ motility)
2) Visceral hyperplasia (↑ perception of pain/motility)
3) Psychopath (U accompanying depression)

Question 2

Types of IBS? (3)

Answer 2

1) Constipation-Predominant
2) Diarrhea-Predominant
3) Pain-Predominant

Question 3

IBS general presentation?

Answer 3

Abd pain relieved by BM
Pain a/w looser or more BM
(P) dyspepsia, atypical chest pain, bloating

Question 4

Constipation IBS presentation? (4)

Answer 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

Question 5

Diarrhea IBS presentation? (4)

Answer 5

1) Freq loose stools
2) (U) in am or post meal
3) Urgency followed by sense of incomplete evac
4) Mucus w/ stool

Question 6

Pain IBS presentation? (3)

Answer 6

1) Crampy/variable abd pain
2) Alternating Diar/Const
3) (P) exacerbation w/ stress/meals -> relieved w/ BM

Question 7

IBS DDX?

Answer 7

IBD
Colitis
Drugs
Celiac dz
Colon/Pancr CA
Parasite
Psych dz

Question 8

IBS diagnostics: ABCs?

Answer 8

Abd pain
Bloating
Change in BMs
IMPROVEMENT WITH BM

Question 9

Red flags w/ IBS? (4)

Answer 9

1) FHx colon CA, IBD, Celiac
2) Anemia
3) Weight loss
4) >50yo

Question 10

IBS labs? (7)

Answer 10

No necess u/l red flags

CMP (e-)
CBC (if fever)
ESR (inflamm cause)
CRP
TSH (hyperthyroid -> diarr)
Hemo (GI bleed)
Stool (parasites)

Question 11

If IBS pt > 50 or FHx, what test?

Answer 11

colonoscopy

Question 12

IBS management? (6)

Answer 12

Pt edu/reassurance (CHRONIC condition)
Meds for sxs:
-antichol (all types)
-antideprss (all types)
-probiotic (all)
-immod (diarr)
-MiraLAX (const)

Question 13

IBS lifestyle changes? (3)

Answer 13

Fiber supp (all types)
GERD precautions
Stress mgmt

Question 14

Constipation: criteria? (3)

Answer 14

Straining
Hard stool
Sense of incomplete evac

Question 15

Constipation caused by? (3)

DDX? (6)

Answer 15

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

Question 16

Constipation w/ bloating/pain/fatigue suggestive of?

Answer 16

IBS

Question 17

Constipation w/ need for digital extraction suggestive of?

Answer 17

pelvic floor dysfxn

Question 18

Constipation exam includes? (3)

Answer 18

1) Test anal reflex
2) Digital Rectal
3) Pelvic exam (rectocele, pelvic floor dys)

Question 19

Constipation diagnostics?

Answer 19

CBC (if fever), CMP, TSH (hypothy)

Colonoscopy if high risk, blood, weight change

Question 20

Constipation management? (6)

Answer 20

Adjust meds
Correct metabolics (high Ca2+)
Push fluids
↑ exercise
↑ fiber
↓ laxatives

Question 21

Constipation tx w/ meds? (5 types)

Answer 21

Osmotic laxative
Sugar alcohols (non-absorb)
Saline
Emollient
Stimulant

Question 22

Constipation complications?

Answer 22

Fecal impaction
LBO
Anorexia/N/V/Abd pain

Question 23

Diarrhea: Acute vs Chronic?

Answer 23

Acute lasts ≤ 14 days

Chronic lasts > 30 days

Question 24

Acute Diarr caused by?

Answer 24

(U) viral (rota, adeno)
Bacterial U more severe (campylo, salmonella, shigella, e coli)
Protozoa

Question 25

Acute Diarr DDX?

Answer 25

``` Drug rxn IBD Impaction Laxative abuse Stress ```

Question 26

Acute Diarr must identify b/w what?

Answer 26

Inflamm vs Non-inflamm

Question 27

Acute Diarr: Non-inflamm is? (U) caused by?

Answer 27

Watery w/ cramping, N/V, fever Norwalk v, adenovirus, giardia

Question 28

Acute Diarr: Inflamm is? Caused by?

Answer 28

Bloody, fever, LLQ pain, constant need to evacuate Shigella, Salmonella, Campylo, e coli, c diff

Question 29

Acute Diarr red flags? (6)

Answer 29

REQUIRE IMMEDIATE ACTION: ``` Bloody or uncontrolled diarr Fever Abd pain ≥ 6 loose stools in 24hrs Dehydration Elderly, immunocomp ```

Question 30

Diarr stool labs?

Answer 30

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

Question 31

Diarr managment?

Answer 31

Hydrate w/ oral e- Diet Abx if needed

Question 32

Acute Diarr: Non-inflamm from Rotavirus Sxs? Test?

Answer 32

V/D, fever rota antigens in feces

Question 33

Acute Diarr: Non-inflamm from Norwalk Sxs? Test?

Answer 33

Most C cause V/D, fever none

Question 34

Acute Diarr: Inflamm from Campylobacter Can cause what synd? Sxs? Test? Tx?

Answer 34

(U) food-borne, (P) water- or animal-borne Guillian-Barre Bloody D, fever, abd pain Cx for campy EMC

Question 35

Acute Diarr: Inflamm from Shigella Sxs? Test? Tx?

Answer 35

Food, water, contact spread Bloody D, fever, abd pain (dysentery) Cx for shigella Bactrim

Question 36

Acute Diarr: Inflamm from E coil O157:H7 Sxs? Test? Complication in kids?

Answer 36

Bloody D, abd pain, NO fever Cx for specific strain Hemolytic-uremia synd (renal fail, anemia, thrombo)

Question 37

Acute Diarr: Inflamm from C diff Abx that cause this? Sxs? Test? Tx?

Answer 37

(U) PNC, cephalo, clinda Watery D, cramps, low abd pain Cytotox assay Metronidazole

Question 38

Acute Diarr Summary: Bloody D (U) from what?

Answer 38

e. coli

Question 39

Acute Diarr Summary: Non-inflam w/ V (U) from what?

Answer 39

viral or food poisoning

Question 40

Acute Diarr Summary: D w/ HIV or STD (U) from what?

Answer 40

AIDS-associated diarr

Question 41

Acute Diarr Summary: D w/ rectal d/c and proctitis (U) from what?

Answer 41

gonorr, syph, LGV, HSV

Question 42

Steatorrhea is?

Answer 42

Fatty stool (blond colored)