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Clin med GI > intestinal disorders > Flashcards

intestinal disorders Flashcards

1
Q

What is IBS

A

Recurrent abdominal discomfort/pain that is chronic >3months

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2
Q

What characteristics does IBS need to be diagnosed

A

relation to defecation
change in stool frequency
stool consistency change

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3
Q

What is the treatment for IBS

A

dietary management and meds
(anticholinergics)

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4
Q

What are physiologic factors of IBS

A

Altered intestinal motility
increased intestinal sensitivity

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5
Q

What is visceral hyperalgesia

A

intestinal hypersensitivity

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6
Q

When does IBS typically begin

A

adolescence / early 20s

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7
Q

What is the clinical presentation of IBS

A

Abdominal discomfort (often in lower abdomen) and can be steady or cramping

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8
Q

What generally helps resolve symptoms of IBS

A

defecation

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9
Q

What typically triggers IBS

A

food / stress

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10
Q

What are red flags with an IBS workup

A

older age
fever
weight loss
rectal bleeding
vomiting

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11
Q

What things should be ruled out before diagnosing someone with IBS

A

Lactose intolerance
laxative abuse
celiac disease

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12
Q

What is the Rome criteria

A

standardized symptom based criteria for a diagnosis

*requires abd pain 1x/week for the last 3 months + 2 IBS criteria

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13
Q

What tests should be done in the workup of IBS

A

CBC, CMP, celiac disease markers, Stool examination, TSH, Calcium

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14
Q

With an IBS workup, when is a sig/colonoscopy recommended

A

> 50

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15
Q

What are some treatment options for IBS

A

Treat any psychologic issues
regular physical activity

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16
Q

How should diet be managed with IBS

A

Small/medium and consumed slowly

drink more fluid

dietary fiber supplements

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17
Q

What pharmacological treatment can be used for IBS-C

A

Lubiprostone
Linaclotide
plecanatide

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18
Q

What pharmacological treatment can be used for IBS-D

A

Diphenoxylate / loperamide
Rifamixin
Elosetron
Eluxadoline

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19
Q

What type of probiotics can be beneficial in relieving IBS symptoms

A

Bifidobacterium

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20
Q

What is lactose intolerance

A

inability to digest certain carbs due to lack of one or more intestinal enzymes

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21
Q

What are symptoms of lactose intolerance

A

diarrhea
abdominal distention
flatulence

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22
Q

How can you diagnose lactose intolerance

A

H2 breath test

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23
Q

How can you treat lactose intolerance

A

remove causative carb
supplement missing enzyme

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24
Q

What is the most common form of carbohydrate intolerance

A

acquired lactase deficiency (primary adult hypolactasia)

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25
Q

What is secondary lactase deficiency

A

conditions that damage the small bowel mucosa
-celiac, acute intestinal infections

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26
Q

How much daily typically needs to be ingested to see the symptoms of lactose intolerance

A

8-12oz of dairy product

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27
Q

How will lactose intolerance present in children

A

diarrhea after ingesting significant amounts of milk

not gaining weight

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28
Q

What symptoms suggest a milk allergy

A

vomiting and GERD
* not consistent with carb intolerance

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29
Q

What will the stool pH be with lactose intolerance

A

acidic <6

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30
Q

What is functional dyspepsia (non-ulcer dyspepsia)

A

Dyspeptic symptoms with no abnormalities on PE and EGD

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31
Q

What do those who are lactose intolerance need to take daily

A

calcium supplement (1200-1500/day)

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32
Q

What are red flags with non-ulcer dyspepsia

A

acute episodes with dyspnea, diaphoresis, or tachycardia (be concerned for coronary ischemia)

no response to H2 blockers/PPI

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33
Q

If a patient is >60y/o and new onset of functional dyspepsia red flags, how do you treat them

A

EGD to rule out cancer

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34
Q

If a patient is <60y/o with no red flags with functional dyspepsia, how do you treat them

A

PPI therapy x4-8 weeks
*EGD if treatment fails

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35
Q

What is constipation

A

Difficult/infrequent passage of stool, hardness of stool, or feeling of incomplete evacuation

36
Q

What is normal stool frequency

A

2-3x/day to 2-3x/week

37
Q

What is generally the cause of acute constipation

A

organic causes

38
Q

When working up constipation, what do you need to ask every patient

A

presence, amount, duration, any blood in stool

39
Q

What is anismus

A

increased anal resting tone

40
Q

What are red flags with constipation

A

Distended, tympanic abdomen
vomiting
blood in stool
weight loss
severe constipation of recent onset

41
Q

What may a patient experience if they have a fecal impaction

A

cramps, watery mucus, fecal material around mass, overflow diarrhea

42
Q

What is the first treatment option for constipation

A

fiber / OTC laxative trial

43
Q

How can colonic transit times be measured

A

Sitz marker study

44
Q

Who is laxative abuse seen in

A

Anorexia nervosa
bulimia nervosa
elderly

45
Q

What are the main challenges in treating laxative abuse

A

the rebound symptoms
-weight gain
-edema
-constipation

46
Q

What does chronic laxative use put you at higher risk of

A

colon cancer

47
Q

What needs to be given with opioids to avoid constipation

A

laxatives

48
Q

Why do opioids lead to constipation

A

they inhibit gastric emptying and peristalsis in GI tract which causes excess fluid absorption

49
Q

What are alarming symptoms with OIC

A

weight loss
+fecal occult blood test
Fe deficient anemia
fhx colon cancer

50
Q

How do you treat OIC

A

Increase fluid intake, increase dietary fiber, exercise

51
Q

What is the best treatment for refractory cases of OIC

A

methylnaltrexone (SQ)

52
Q

Which patients should methylnaltrexone NOT be used in

A

PUD, diverticulosis, colon CA or obstruction

53
Q

What is constipation

A

Difficult/infrequent passage of stool, hardness of stool, or feeling of incomplete evacuation

53
Q

What symptoms suggest functional dyspepsia

A

Ulcer like symptoms
dysmotility like symptoms
reflux like symptoms

53
Q

What gender is at highest risk of esophageal cancer

What is the median age at diagnosis

A

Men

68

53
Q

What is the most common type of esophageal cancer

What is it secondary to

A

Adenocarcinoma from barretts

SCC is more common in asai and sub-sahrara

53
Q

What are late stage presentations of esophageal cancer

A

progressive dysphagia
weightloss

53
Q

What is the test of choice to diagnose esophageal cancer

A

EGD with biopsy

53
Q

What is the treatment for esopahgeal cancer

A

Localized = esophagectomy
lymph spread = chemo/radiation +esophagectomy

stenting and palliative treatment if there is large metastesis

54
Q

How can you prevent esophageal cancer

A

Close monitoring of Barretts
NSAIDs + Antacids for protection
lifestyle modification

55
Q

What gender is at higher risk of gastric cancer

what is the median age of diagnosis

A

Men

68

56
Q

What is the strongest risk associated with gastric cancer

A

H.Pylori
gastritis

57
Q

What is the most common type of gastric cancer

proximal vs distal

A

Gastric adenocarcinoma
proximal is secondary to metaplasia
distal is ssecondary to H. Pylori

intestinal is most common

diffuse is more hereditary and less H.pylori related

58
Q

Where do most gastric cancer begin

A

Antrum

59
Q

What are the different morphologies of gastric cancer

A

fungating
polypoid
ulcerating
diffuse spreading
superficial spreading

60
Q

What are the later symptoms of gastric cancer

A

dyspepsia
early satiety
spigastric pain
anorexia
weight loss

61
Q

What does neo-adjuvent mean

A

Chemo/radiation before surgery

62
Q

What are some characteristic PE findings with gastric cancer

A

Virchow node: palpable L. supraclavicular lymph node
Sister Mary Joseph nodule: Unbilical nodule

63
Q

What is the test of choice to gastric cancer dx

Who should get this

A

EGD with biopsy

over 55 w/ new epigastric issues, persistent dyspepsia

64
Q

How do you treat localized gastric cancer

A

Laprascopic or open gastrectomy

B12 supp s/p gastrectomy

65
Q

How do you treat advanced gastric cancer

A

Palliative resection
gastrojejunostomy
chemo/radiation
embo
stenting

66
Q

How can you prevent gastric cancer

A

Close surveillance on those with hereditary tumor syndrome

properly treat H. Pylori infections

67
Q

What is the most common malignancy of the biliary tract

A

gallbladder cancer

women most effected

68
Q

What gender is more effected by cholangiocarcinomas

A

Men

69
Q

What are the risk factors for gallbladder cancer

A

Cholelithiasis
salmonella typhii
GB polyps
porcelain GB
genetics (P53 mutation)

70
Q

What decreases the risk of bile duct cancer

intra-hepatic cholangiocarcinoma?

A

ASA and statin

metformin

71
Q

What are the risk factors of cholangiocarcinomas

A

heavy ETOH consumption
smoking

72
Q

What is the presenting symptom of biliary cancer

A

progressive jaundice signaling obstruction

73
Q

What are some PE findings with biliary cancer

A

Jaundice (if severe)
palpable GB
hepatomegaly

74
Q

What is courvoisier sign

What is it indicative of

A

palpable non-tender GB + obstructive jaundice

suggests malignancy

75
Q

What tumor marker will be elevated with biliary cancer

A

CA 19-9

76
Q

What is the diagnostic test of choice for biliary cancer

What is seen

A

MRI w/ MRCP
-visualize entire biliary tree
-defines extent of involvment
-elucidates vascular involvment

77
Q

What test can confirm a biliary cancer diagnosis

A

EUS w/ FNA

78
Q

What is the mainstay treatment of biliary cancer

A

surgery

79
Q

What are general risk reduction strategies with bilairy cancer

A

Avoid HCV + HIV
maintain healthy weight
limit ETOH
smoking cessation/avoidance

Clin med GI (9 decks)

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