intestinal disorders Flashcards
What is IBS
Recurrent abdominal discomfort/pain that is chronic >3months
What characteristics does IBS need to be diagnosed
relation to defecation
change in stool frequency
stool consistency change
What is the treatment for IBS
dietary management and meds
(anticholinergics)
What are physiologic factors of IBS
Altered intestinal motility
increased intestinal sensitivity
What is visceral hyperalgesia
intestinal hypersensitivity
When does IBS typically begin
adolescence / early 20s
What is the clinical presentation of IBS
Abdominal discomfort (often in lower abdomen) and can be steady or cramping
What generally helps resolve symptoms of IBS
defecation
What typically triggers IBS
food / stress
What are red flags with an IBS workup
older age
fever
weight loss
rectal bleeding
vomiting
What things should be ruled out before diagnosing someone with IBS
Lactose intolerance
laxative abuse
celiac disease
What is the Rome criteria
standardized symptom based criteria for a diagnosis
*requires abd pain 1x/week for the last 3 months + 2 IBS criteria
What tests should be done in the workup of IBS
CBC, CMP, celiac disease markers, Stool examination, TSH, Calcium
With an IBS workup, when is a sig/colonoscopy recommended
> 50
What are some treatment options for IBS
Treat any psychologic issues
regular physical activity
How should diet be managed with IBS
Small/medium and consumed slowly
drink more fluid
dietary fiber supplements
What pharmacological treatment can be used for IBS-C
Lubiprostone
Linaclotide
plecanatide
What pharmacological treatment can be used for IBS-D
Diphenoxylate / loperamide
Rifamixin
Elosetron
Eluxadoline
What type of probiotics can be beneficial in relieving IBS symptoms
Bifidobacterium
What is lactose intolerance
inability to digest certain carbs due to lack of one or more intestinal enzymes
What are symptoms of lactose intolerance
diarrhea
abdominal distention
flatulence
How can you diagnose lactose intolerance
H2 breath test
How can you treat lactose intolerance
remove causative carb
supplement missing enzyme
What is the most common form of carbohydrate intolerance
acquired lactase deficiency (primary adult hypolactasia)
What is secondary lactase deficiency
conditions that damage the small bowel mucosa
-celiac, acute intestinal infections
How much daily typically needs to be ingested to see the symptoms of lactose intolerance
8-12oz of dairy product
How will lactose intolerance present in children
diarrhea after ingesting significant amounts of milk
not gaining weight
What symptoms suggest a milk allergy
vomiting and GERD
* not consistent with carb intolerance
What will the stool pH be with lactose intolerance
acidic <6
What is functional dyspepsia (non-ulcer dyspepsia)
Dyspeptic symptoms with no abnormalities on PE and EGD
What do those who are lactose intolerance need to take daily
calcium supplement (1200-1500/day)
What are red flags with non-ulcer dyspepsia
acute episodes with dyspnea, diaphoresis, or tachycardia (be concerned for coronary ischemia)
no response to H2 blockers/PPI
If a patient is >60y/o and new onset of functional dyspepsia red flags, how do you treat them
EGD to rule out cancer
If a patient is <60y/o with no red flags with functional dyspepsia, how do you treat them
PPI therapy x4-8 weeks
*EGD if treatment fails
What is constipation
Difficult/infrequent passage of stool, hardness of stool, or feeling of incomplete evacuation
What is normal stool frequency
2-3x/day to 2-3x/week
What is generally the cause of acute constipation
organic causes
When working up constipation, what do you need to ask every patient
presence, amount, duration, any blood in stool
What is anismus
increased anal resting tone
What are red flags with constipation
Distended, tympanic abdomen
vomiting
blood in stool
weight loss
severe constipation of recent onset
What may a patient experience if they have a fecal impaction
cramps, watery mucus, fecal material around mass, overflow diarrhea
What is the first treatment option for constipation
fiber / OTC laxative trial
How can colonic transit times be measured
Sitz marker study
Who is laxative abuse seen in
Anorexia nervosa
bulimia nervosa
elderly
What are the main challenges in treating laxative abuse
the rebound symptoms
-weight gain
-edema
-constipation
What does chronic laxative use put you at higher risk of
colon cancer
What needs to be given with opioids to avoid constipation
laxatives
Why do opioids lead to constipation
they inhibit gastric emptying and peristalsis in GI tract which causes excess fluid absorption
What are alarming symptoms with OIC
weight loss
+fecal occult blood test
Fe deficient anemia
fhx colon cancer
How do you treat OIC
Increase fluid intake, increase dietary fiber, exercise
What is the best treatment for refractory cases of OIC
methylnaltrexone (SQ)
Which patients should methylnaltrexone NOT be used in
PUD, diverticulosis, colon CA or obstruction
What is constipation
Difficult/infrequent passage of stool, hardness of stool, or feeling of incomplete evacuation
What symptoms suggest functional dyspepsia
Ulcer like symptoms
dysmotility like symptoms
reflux like symptoms
What gender is at highest risk of esophageal cancer
What is the median age at diagnosis
Men
68
What is the most common type of esophageal cancer
What is it secondary to
Adenocarcinoma from barretts
SCC is more common in asai and sub-sahrara
What are late stage presentations of esophageal cancer
progressive dysphagia
weightloss
What is the test of choice to diagnose esophageal cancer
EGD with biopsy
What is the treatment for esopahgeal cancer
Localized = esophagectomy
lymph spread = chemo/radiation +esophagectomy
stenting and palliative treatment if there is large metastesis
How can you prevent esophageal cancer
Close monitoring of Barretts
NSAIDs + Antacids for protection
lifestyle modification
What gender is at higher risk of gastric cancer
what is the median age of diagnosis
Men
68
What is the strongest risk associated with gastric cancer
H.Pylori
gastritis
What is the most common type of gastric cancer
proximal vs distal
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
Where do most gastric cancer begin
Antrum
What are the different morphologies of gastric cancer
fungating
polypoid
ulcerating
diffuse spreading
superficial spreading
What are the later symptoms of gastric cancer
dyspepsia
early satiety
spigastric pain
anorexia
weight loss
What does neo-adjuvent mean
Chemo/radiation before surgery
What are some characteristic PE findings with gastric cancer
Virchow node: palpable L. supraclavicular lymph node
Sister Mary Joseph nodule: Unbilical nodule
What is the test of choice to gastric cancer dx
Who should get this
EGD with biopsy
over 55 w/ new epigastric issues, persistent dyspepsia
How do you treat localized gastric cancer
Laprascopic or open gastrectomy
B12 supp s/p gastrectomy
How do you treat advanced gastric cancer
Palliative resection
gastrojejunostomy
chemo/radiation
embo
stenting
How can you prevent gastric cancer
Close surveillance on those with hereditary tumor syndrome
properly treat H. Pylori infections
What is the most common malignancy of the biliary tract
gallbladder cancer
women most effected
What gender is more effected by cholangiocarcinomas
Men
What are the risk factors for gallbladder cancer
Cholelithiasis
salmonella typhii
GB polyps
porcelain GB
genetics (P53 mutation)
What decreases the risk of bile duct cancer
intra-hepatic cholangiocarcinoma?
ASA and statin
metformin
What are the risk factors of cholangiocarcinomas
heavy ETOH consumption
smoking
What is the presenting symptom of biliary cancer
progressive jaundice signaling obstruction
What are some PE findings with biliary cancer
Jaundice (if severe)
palpable GB
hepatomegaly
What is courvoisier sign
What is it indicative of
palpable non-tender GB + obstructive jaundice
suggests malignancy
What tumor marker will be elevated with biliary cancer
CA 19-9
What is the diagnostic test of choice for biliary cancer
What is seen
MRI w/ MRCP
-visualize entire biliary tree
-defines extent of involvment
-elucidates vascular involvment
What test can confirm a biliary cancer diagnosis
EUS w/ FNA
What is the mainstay treatment of biliary cancer
surgery
What are general risk reduction strategies with bilairy cancer
Avoid HCV + HIV
maintain healthy weight
limit ETOH
smoking cessation/avoidance
