Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med III Exam 1 > IBS Diarrhea Constipation > Flashcards

IBS Diarrhea Constipation Flashcards

1
Q

Red flags of bowel issues

A

iron deficiency anemia
weight less
severe/progressive worsening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is IBS?

A

functional bowel disorder characterized by recurrent abdominal pain AND altered bowel habits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

subtypes of IBS

A

C- constipation
D- diarrhea
M- mixed
U- unclassified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Epidemiology of IBS

A

20-39 YO
F>M
~4 years to diagnose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Etiology of IBS

A

physiological - abnormal motility, visceral hypersensitivity
psych - abuse, anxiety, depression, phobia
environmental - diet, post-infectious, gut microbiome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Presentation of IBS

A

chronic/recurrent abdominal pain/discomofort – cramping; diffuse (variable, periodic)

altered bowel habits - D, C, M, U

+/- dyspepsia, atypical CP, vomiting (rare)

+/- extra-intestinal: sexual dysfunction, dysmennorhea, irritative voiding, fibromyalgia sx, somatic/psych complaints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Red flags/alarm features

A 
sx onset after 50 YO
severe/progressively worsening
nocturnal diarrhea
fevers/vomiting
unexplained weight loss
melena, hematochezia, + occult blood
personal or FH of colon CA, IBD, celiac disease
Unexplained Fe def anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PE for IBS

A

usually normal
normal VS
abdominal exam: may be TTP
perianal/DRE (Crohn’s can present as perianal disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dx of IBS

A

Rome IV Criteria:

  • recurrent ab pain at least 1 day/week in last 3 months, a w/ two or more of the following:
  • related to defecation
  • associated w/ change in stool frequency
  • change in stool form (appearance)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describing stool

A

Bristol stool form scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diagnostic tools for IBS

A

often not necessary for non-alarming

+/- CBC (anemia), CMP, TSH, ESR/CRP (elevated in IBD), celiac serologies, stool studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Alarming sx work-up

A

lab/stool study
cross-sectional/small bowel imaging
endoscopy/colonoscopy w/ bx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Types of tx for IBS

A

relieve sx and improve QOL

  • diet/lifestyle
  • psychosocial support
  • pharm
  • therapeutic clinician-pt relationship
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Diet for IBS

A 
food diary
fiber (20-35 g/day) - start low and increase
FODMAP diet *** 
probiotics?
exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tx for abdominal pain

A

Antispasmodics:

  • Levsin (hyoscyamine)
  • Bentyl (dicyclomine)
  • caution anticholinergic effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Tx for constipation

A 
Psyllium fiber
Miralax (polyethylene glycol)
Amitiza 
Linzess
Trulance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tx for diarrhea

A

Imodium
Rifaximin (abx that only works in gut)
Alosetron (women-only-risk management program)
Viberzi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tx of psychosocial tx for IBS

A

TCAs, off-label

* caution AEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which meds exacerbate constipation?

A

Antipsychotics*
Iron*
Opioids*

Anticholinergics
Antacids (calcium, aluminum)
CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Epidemiology of constipation

A

most common digestive complain

F>M

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Risk factors for constipation

A

improper diet/inadequate fluid intake
sedentary lifestyle
polypharmacy
age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Etiology of constipation

A 
functional - chronic idiopathic constipation (constipation), IBS-C (constipation + pain)
meds
slow transit - colonic inertia
obstruction
metabolic/systemic disease
Other: IBD, Volvulus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Systemic diseases that cause constipation

A 
hypercalcemia
hyperparathyroidism
hypothyroidism
DM, pregnancy, Hirschprung
MS, Parkinson
Spinal cord injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hx questions for constipation

A 
acute/chronic
normal bowel pattern
frequency, consistency
laxative use?
need for digital evacuation?
previous colonoscopy
red flag sx
contributing causes - reconcile meds, review PMH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is considered constipation

A

25% of defecations w/:

  • <3 spontaneous BM/week
  • lumpy/hard stool
  • straining
  • manual maneuvers to facilitate
  • anorectal obstruction/blocakge
  • sense of incomplete evacuation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Presentation of constipation

A

above constipation sx

+/- ab pain, bloating, pain on defecation, rectal bleeding, tenesmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

tenesmus

A

feeling of being unable to completely empty bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Red flag sx for constipation

A 
acute onset
sx onset after 50 YO
fever/vomiting
unexplain weight loss
melena, hematochezia, occult blood
family hx of colon CA, IBD, celiac disease
Fe deficiency anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

PE for constipation

A

usually normal
ab ex – distention, mass?
DRE - fissures, hemorrhoids, tenderness, mass, stool, anal stricture, sphincter tone, perineal descent, dyssynergic defecation
Pelvic exam (rectocele)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Dx of constipation

A

limited labs: +/- CBC, CMP, TSH

alarm features: imaging, colonoscopy or Flex sig/BE (lesions that narrow/occlude bowel)

Refractory:

  • colonic transit (radipague marker) study- evaluates rate of residue moving through colon
  • defecography- anatomical/functional changes
  • anorectal manometry- measures anal sphincter pressure/function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Diet/lifestyle for constipation

A

increase fluid/fiber
increase activity/exercise
bowel habit training
biofeedback helpful w/ defecatory dyfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

meds for constipation

A

fiber supplements
stool softener
osmotic/stimulant laxative
Rx agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

SE of fiber supplement

A

flatulence
bloating
distention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

SE of stool softener

A

GI cramping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Osmotic laxative SE (pulls water in)

A

GI discomort
bloating

Caution: Mg-containing laxative and hypermagnesemia in pts wiht renal insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Stimulant laxative

A

q 3 days
Cramping, rarely lyte disturbance

melanosis coli- color change in colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Rx agents for constipation SE

A

diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Fiber supplements

A

Psyllium (Metamucil) Methylcellulose (Citrucel) Polycarbophil (Fiber Con) Benefiber

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Stool softener

A

Docusate

40
Q

Osmotic laxative

A

Polyethylene glycol (Miralax), Milk of magnesia, Mag citrate, Lactulose

41
Q

Stimulant laxatives

A

Bisacodyl

Senna

42
Q

Rx agents

A
  • Lubiprostone (Amitiza)
    • Linaclotide (Linzess)
    • Plecanatide (Trulance)
43
Q

Complications of constipation

A

hemorrhoid/anal fissure
fluid and lyte abnormalities from laxative abuse
fecal impaction –> bowel obstruction

44
Q

high risk for bowel obstruction

A

dimentia
neuro disease
immobile
on hypomotility meds

45
Q

Sx of fecal impaction

A

N/V
ab pain
distention
paradoxical “diarrhea”

46
Q

Tx for fecal impaction

A

disimpaction followed by maintenance bowel prep as appropriate

47
Q

Most likely associated w/ acute diarrhea

A

Norovirus

48
Q

What is diarrhea

A

passage of >3 unformed stools/day

49
Q

Timing for diarrhea

A

acute: <14 days
Persistent: >14-30 days
Chronic: >30 days

50
Q

Etiology of acute diarrhea

A 
infections- most likely viral; bacterial, protozoal
meds
paradoxical diarrhea
food intolerance
radiation/ischemic colitis
appendicits 
diverticulitis
intussusception
emotional stress
IBD, Celiac disease
51
Q

Warning sx for diarrhea

A
  • Fever
  • Unexplained weight loss
  • Melena, hematochezia, + occult blood
  • Persistent/progressive/nocturnal symptoms
  • Immunocompromised
  • Personal or FH of Colon cancer, IBD, Celiac disease
  • Fe deficiency anemia •Signs of volume depletion
52
Q

Exposure to acute diarrhea questions

A 
recent hospitalization/abx use
travel
ingestion of improperly stored/prepped foods
sick person exposure
pet/animal
new meds/dose changes
public health risk
53
Q

Presentation of non-inflammatory diarrhea

A

watery nonbloody diarrhea
n/v cramps, bloating/flatulence
+/- low grade fever

54
Q

Etiology of noninflammatory acute diarrhea

A

viral: norovirus*, rotavirus

Bacterial: v. cholera, C. perfringens, s. aureus, bacillus cereus

Protozoa: Giardia*, crypto, cyclcospora

55
Q

Presentation of inflammatory diarrhea

A

fever
bloody diarrhea
severe abdominal pain

56
Q

Etiology of Acute inflammatory diarrhea

A

Viral: CMV

Bacterial: Salmonella, Campylobacter, Shigella, Enterohemorrhagic E. coli 0157:H7, Clostridioides (formerly Clostridium) difficile Vibrio parahemolyticus (rare), Yersinia (rare)

protozoal: entamoeba histolytica

57
Q

PE for diarrhea

A

focus on volume status and complications

  • vitals
  • skin turgor
  • oral mucous membrane
  • HR
  • ab: distention, BS, tenderness, peritoneal signs, mass
  • rectal: tenderness, stool guaic, perianal disease
  • neuro: mental status
58
Q

Dx for diarrhea

A

not routine

+/- CBC, CMP, CRP; stool culture, imaging, culture for E.coli, Giardia, O&P, C.diff, hemoccult

59
Q

Stool culture includes

A

salmonella
shigella
campylobacter

60
Q

Acute diarrhea needing prompt eval

A

•Signs of inflammatory diarrhea (Fever ≥ 101.3°F, leukocytosis, bloody diarrhea, severe abdominal pain
•Intractable vomiting
•Profuse watery diarrhea and dehydration •AKI/Lyte abnormalities
•Elderly or nursing home residents
• Immunocompromised
•Hospital-acquired diarrhea, exposure to
antibiotics

61
Q

Management of diarrhea

A 
supportive/symptomatic
- oral rehydration
-lactose free diet
- probiotics
\+/- antidiarrheal (never w/ blood)
62
Q

SE of bismuth subsalicylate (pepto-bismol)

A

black stool

63
Q

Antidiarrheal agents

A 
Loperamide (imodium)
bismuth subsalicylate (pepto-bismol)

safe and effective in those w/o dysentery

64
Q

Norovirus

A

older children, adults
food, cruise ship, camp, etc.

duration: abrupt onset, resolves 24-72 hrs
tx: supportive

65
Q

Rotavirus

A

6mo-2YO
fecal contaminated food/water
sick contact (daycare)

duration: self-limited

Tx: supportive

66
Q

“rice-water”

A

vibrio cholerae

67
Q

V. cholera

A

rice water stool

unsanitary conditions, food/water, travel hx

tx: supportive; +/- Doxy, macrolide, Tetracycline, FLQ

68
Q

C. perfringens (entertoxin)

A

food born; home-canned goods (poutry, gravy, meat)

supportive

69
Q

S. aureus (entertoxin)

A

VOMITING!

food born: creamy foods, egg/potoato salad, dairy, processed meat

illness w/i hours of exposure

supportive

70
Q

Bacillus cereus (entertoxin)

A

VOMITING

food born (GRAINS-rice!)

illness w/i hours

supportive

71
Q

rice

A

B. cereus

72
Q

vomiting

A

s. aureus

b. cereus

73
Q

Giardia lamblia source

A

Waterborne, foodborne, fecal-oral transmission (camping, lakes, streams, ponds, daycares, pools)

74
Q

Tx for giardia

A

metronidazole (tinidazole, albendazole)

75
Q

Cryptosporidium (self limited, serious in AIDS)

A

recreational water outbreaks
daycares

supportive; tx if immunocompromised

76
Q

Cyclospora source

A

imported foods (fruits/veggies)

77
Q

Tx for cyclospora

A

TMP-SMX

78
Q

Salmonella source/tx

A

poultry/livestock; reptiles

supportive; abx in some

79
Q

Campylobacter jejuni linked to

A

Guillain-Barre

80
Q

Source of campylobacter

A

undercook poultry

unpasteurized milk

81
Q

Tx for campylobacter

A

supportive

severe: macrolide or FLQ

82
Q

“classic dysentery”

A

shigella

83
Q

Source of shigella

A

fecal contamination of food/water (daycares, crowded living)

84
Q

Tx of shigella

A

supportive

abx shorten course (FLQ, macrolide, bactrim)

85
Q

severe afebrile blood diarrhea

A

E.coli

86
Q

Source of e.coli

A

undercooked ground beef or unpasteurized products

87
Q

Tx of e.coli

A

supportive
NO ANTIDIARRHEAL
NO ABX- RISK OF HUS

88
Q

RISK OF HUS

A

e. coli

89
Q

C. diff source

A

Recent hospitalization /antibiotic use, community acquired

Fluoroquinolones, clindamycin, cephalosporins

90
Q

meds associated w/ c. diff

A

FLQ
Clindamycin
Cephalosporin

91
Q

Tx for c. diff

A

dicontinue abx
Vancomycin*
Fidazomicin*
Metronidzaole*

92
Q

Vibrio parahemolyticus source

A

raw seafood/shellfish*

travel

93
Q

Tx for v. parahemolyticus

A

supportive

FLQ, Doxy if severe

94
Q

Mimics appendicitis

A

Yersinia enterocolitica

95
Q

Source of Yersinia

A

Undercooked pork, unpasteurized milk, fecally contaminated water

supportive

96
Q

E. histolytica (intraluminal and disseminated disease)

A

fecal contaminated food/water
travel

Metronidazole + iodoquinol

97
Q

inflammatory protozoa

A

e. histolytica

Clin Med III Exam 1 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions