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Unit 1 Clin Med III > L5: IBS, C/D > Flashcards

L5: IBS, C/D Flashcards

1
Q

IBS age epidemiology

A

F>M

20-39 years

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2
Q

3 etiologies of IBS

A

Physiological
Psychosocial
Environmental

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3
Q

IBS presentation

A

Chronic/recurrent abdominal pain/discomfort
Cramping, diffuse lower abdominal pain→ variable intensity, periodic exacerbations
+/- dyspepsia, atypical chest pain, vomiting (rare)

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4
Q

IBS categories:

A

Constipation predominant
Diarrhea predominant
Mixed
Unclassified

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5
Q

Extraintestinal symptoms of IBS

A 
Sexual dysfunction
dysmenorrhea
Irritative voiding symptoms
Fibromyalgia
somatic or psychological complaints
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6
Q

Rome IV criteria for IBS

A

Recurrent abdominal pain 1 or more days/week in last 3 months + 2 or more:

  1. Related to defecation
  2. Change in stool frequency
  3. Change in stool form
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7
Q

IBS, C/D alarm symptoms

A 
Onset >50 years
Severe/progressively worsening
Nocturnal diarrhea
Fevers/vomiting
Unexplained weight loss
Melena, hematochezia, (+) occult blood
Personal or family history of colon cancer, IBD, Celiac
Iron deficiency anemia
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8
Q

Labs for IBS

A 
Not usually indicated
\+/-
CBC, CMP, TSH
ESR/CRP
Celiac serologies
stool studies
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9
Q

Further workup for IBS is indicated in cases of…

A

Atypical history
alarm features
refractory

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10
Q

Further workup for concerning IBS cases includes

A

Laboratory/stool studies
Cross sectional/small bowel imaging
Endoscopy/colonoscopy with biopsies

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11
Q

How much fiber should an IBS patient be taking?

A

20-35 g daily→ start low, increase slowly

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12
Q

Diet for IBS

A

FODMAP diet:

Eliminate sugars and fibers that cause pain and bloating

Eliminate x 4-8 weeks→ gradually reintroduce 1-2 foods at a time→ assess tolerance

Trained dietician to avoid unnecessary over-restriction, may not be appropriate for everyone

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13
Q

Levsin

A

anticholinergic for abdominal pain

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14
Q

Bentyl

A

anticholinergic for abdominal pain

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15
Q

Side effects of anticholinergic meds

A

Dry eyes
Dry mouth
Constipation

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16
Q

Miralax

A

Constipation medication

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17
Q

Amitiza

A

Constipation medication

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18
Q

Linzess

A

Constipation medication

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19
Q

Psyllium fiber

A

Constipation medication

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20
Q

Trulance

A

Constipation medication

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21
Q

Rifaximin

A

Diarrhea meds

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22
Q

Imodium

A

Diarrhea meds

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23
Q

Alosetron

A

Diarrhea meds

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24
Q

Viberzi

A

Diarrhea meds

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25
Q

Which diarrhea med can only be prescribed to women and needs a risk management program?

A

Alosetron

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26
Q

Psychosocial meds for IBS

A

TCAs

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27
Q

Increased risk of constipation

A 
Improper diet
Inadequate fluid intake
Sedentary lifestyle
Polypharmacy
Age
F>M
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28
Q

Most common digestive complaint

A

Constipation

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29
Q

Functional constipation is

A

Chronic idiopathic constipation

IBS-C (pain)

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30
Q

Medication induced constipation

A 
opioids
anticholinergics
antipsychotics
iron
antacids (calcium, aluminum)
CCBs
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31
Q

Slow transit constipation

A

Colonic inertia

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32
Q

Constipation caused by defecation/obstructive disorders

A 
pelvic floor dysfunction
anorectal disease
rectal prolapse
rectocele
colon cancer
polyp
stricture/stenosis, fecal impaction/obstruction
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33
Q

Other causes of constipation

A

IBD

Volvulus

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34
Q

Metabolic/systemic causes of constipation

A 
hypercalcemia
hyperparathyroidism
hypothyroidism
DM
pregnancy
Hirschsprung
Multiple Sclerosis
Parkinson
Spinal cord injuries
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35
Q

Further workup for constipation patients with alarm features or refractory to medical therapy

A

Imaging studies

Colonoscopy or Flex sig/BE→ identify lesions than narrow or occluded bowel

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36
Q

Constipation labs

A

+/- CBC, CMP, TSH

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37
Q

Constipation definition

A

25% of defecations associated with
<3 spontaneous bowel movements/week
Lumpy or hard stools
Straining
Manual maneuvers to facilitate defecation (digital evacuation, support of pelvic floor)
Sensation of anorectal obstruction/blockage
Sense of incomplete evacuation

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38
Q

Possible GI symptoms of constipation

A

Abdominal pain/bloating
Pain on defecation
Rectal bleeding
Tenesmus

39
Q

Evaluate for ____ on abdominal exam for constipation

A

Distention

Mass

40
Q

Evaluate for _____ on DRE for constipation

A 
evaluate for fissures
hemorrhoids
tenderness,
masses
stool
anal stricture
anal sphincter tone
perineal descent
dysynergic defecation
41
Q

Evaluate for _____ on pelvic exam for constipation

A

Rectocele

42
Q

Lifestyle modifications for constipation

A

Increase fluid/fiber intake
Increase activity/exercise
Bowel habit training
Biofeedback helpful with defecatory dysfunction

43
Q

Methylcellulose

A

Fiber supplement for constipation

44
Q

Psyllium

A

Fiber supplement for constipation

45
Q

Benefiber

A

Fiber supplement for constipation

46
Q

Polycarbophil

A

Fiber supplement for constipation

47
Q

Docusate

A

stool softener

48
Q

Fiber supplements side effects

A 
***
Flatulence
bloating
distention
***
49
Q

Docusate side effect

A

GI cramping

50
Q

Osmotic laxatives side effects

A

GI discomfort, bloating
**
Caution: Mg→ hypermagnesemia in patients with renal insufficiency
**

51
Q

Polyethylene glycol (Miralax)

A

Osmotic laxative

52
Q

Lactulose

A

Osmotic laxative

53
Q

Milk of magnesia

A

Osmotic laxative

54
Q

Mag citrate

A

Osmotic laxative

55
Q

Bisacodyl

A

Stimulant laxative

56
Q

Senna

A

Stimulant laxative

57
Q

Stimulant laxative side effects

A

GI cramping
Electrolyte disturbances (rarely)
Melanosis coli

58
Q

Rx agents for constipation side effects

A

Diarrhea

59
Q

Lubiprostone

A

Rx agent for constipation

60
Q

Linaclotide

A

Rx agent for constipation

61
Q

Plecanatide

A

Rx agent for constipation

62
Q

Complications of constipation

A

Hemorrhoids/anal fissures

Laxative abuse→ fluid and electrolyte abnormalities

Fecal impaction→ bowel obstruction

63
Q

More at risk for fecal impaction

A

dementia
neurologic disease
immobile
hypomotility meds

64
Q

Fecal impaction symptoms

A

N/V
abdominal pain
distention
paradoxical “diarrhea” (only fluid passes)

65
Q

Fecal impaction management

A

disimpaction then maintenance bowel prep

66
Q

Diarrhea

A

Passage of >3 unformed stools/day

67
Q

Diarrhea is most commonly

A

infectious
viral
self-limiting

68
Q

Acute diarrhea

A

<14 days

69
Q

Persistent diarrhea

A

14-30 days

70
Q

Chronic diarrhea

A

> 30 days

71
Q

Red flag for diarrhea (but not IBS or constipation)

A

Signs of volume depletion

72
Q

Exposures that could cause diarrhea

A

Recent hospitalization or abx
Travel
Ingestion of improperly stored/prepared food
Sick contact exposure, community outbreaks
Pets/animals
New meds or dose changes

73
Q

Public health risk

A

healthcare worker
daycare worker
food-handlers

74
Q

Physical exam for diarrhea

A

Volume status + complications
Temp, HR, orthostatic BP
Skin turgor, mucous membranes
Abdominal distention, bowel sounds, tenderness, peritoneal signs, masses
Rectal tenderness, stool guaiac, perianal disease
Mental status

75
Q

Noniflammatory diarrhea symptoms

A 
Watery nonbloody diarrhea
N/V
Mild diffuse abdominal cramps
bloating/flatulence
\+/- Low grade fever
76
Q

Inflammatory diarrhea symptoms

A

Fever
bloody diarrhea
severe abdominal pain

77
Q

Viral causes of NONinflammatory diarrhea

A

Norovirus

Rotavirus

78
Q

Viral causes of inflammatory diarrhea

A

Cytomegalovirus

79
Q

Bacterial causes of NONinflammatory diarrhea

A

Vibrio cholera
Clostridium perfringens
Staph aureus
Bacillus cereus

80
Q

Bacterial causes of inflammatory diarrhea

A 
***Salmonella
Campylobacter
Shigella, Enterohemorrhagic E coli 0157:H7
Clostridioides difficile***
Vibrio parahaemolyticus
Yersinia
81
Q

Protozoal causes of NONinflammatory diarrhea

A

Giardia
Cryptosporidium
Cyclospora

82
Q

Protozoal causes of inflammatory diarrhea

A

Entamoeba histolytica

83
Q

Diarrhea diagnostics

A 
*Not routinely warranted for most patients*
\+/- CBC, CMP, CRP
Stool cultures→ Salmonella, Shigella, Campylobacter
E coli 0157:H7 culture
Ovum + Parasites (
Giardia, C diff
Hemoccult
Imaging
84
Q

Diarrhea patients who need prompt evaluation

A

Signs of inflammatory diarrhea: Fever >101.3 F, leukocytosis, bloody diarrhea, severe abdominal pain

Intractable vomiting
Profuse watery diarrhea + dehydration
AKI/Lyte abnormalities
Elderly or nursing home residents
Immunocompromised
Hospital-acquired diarrhea, exposure to abx
85
Q

Supportive care for acute diarrhea

A

Oral rehydration therapy

Trial of lactose free diet

Probiotics

+/- Antidiarrheal agents→ safe + effective for patients without dysentery

86
Q

Loperamide

A

Antidiarrheal agen

87
Q

Bismuth subsalicylate

A

Antidiarrheal agen

88
Q

Bismuth subsalicylate side effect

A

black stool

89
Q

Antibiotic treatment for acute diarrhea

A

generally not indicated as most cases are self-limited

Some organisms require specific antibiotics→ Reference Sanford Guide

Empiric abx→ Fluoroquinolone or Azithromycin x3-5 days

90
Q

Vibrio cholerae

A

Non-inflammatory bacterial diarrhea

Causes “rice-water” diarrhea

91
Q

Norovirus

A

Non-inflammatory viral diarrhea

92
Q

Giardia lamblia

A

Non-inflammatory protozoal diarrhea found in camping, lakes, streams, ponds, daycares, and pools

93
Q

Clostridiodides difficile

A

Inflammatory bacterial diarrhea

Causes: recent abx use or community acquired

Tx: discontinue inciting abx.
Vancomycin
Fidaxomicin
Metronidazole

94
Q

Yersinia enterocolitica

A

Inflammatory bacterial diarrhea that can mimic appendicitis

Unit 1 Clin Med III (7 decks)

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