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Gastrointestinal > MDT Lower GI > Flashcards

MDT Lower GI Flashcards

1
Q

What is the definition of diahhrea?

A
  • Increased stool frequency
  • More than 3 BM’s daily
  • Liquidity of feces
  • Classified as either chronic or acute
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2
Q

Acute onset of diahhrea and persisting for less than 2 weeks is commonly caused by what?

A

Bacterial toxins (either pre-formed or produced in gut)

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3
Q

How can infectious sources of diahhrea be transmitted and what is the incubation period?

A
  • Transmitted through fecal-oral contact

- Incubation periods between 12-72 hours

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4
Q

What percentage of water is absorbed by the small intestine? Which portion has most absorption?

A
  • > 90%

- Jejunum

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5
Q

What illness is most common diarrheal illness in the operational setting?

A

Acute Infectious Gastroenteritis

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6
Q

How is acute gastroenteritis defined?

A

Diarrheal disease (3+ times/day at least 200 g/day) of rapid onset that lasts less than 2 weeks

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7
Q

How is acute viral gastroenteritis treated with?

A
  • Self-limiting

- Treated with supportive measures (fluid repletion and unrestricted nutrition)

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8
Q

What anatomy does gastritis include?

A

ONLY stomach

  • do not confuse gastritis with gastroenteritis *
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9
Q

What are two common causes of gastritis?

A
  • Chronic NSAID use
  • Chronic alcohol use and/or large amounts of alcohol consumption
  • Can be caused by trauma and critically ill patients
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10
Q

Treatment for gastritis?

A
  • Self limiting
  • Pt may benefit from PPI and removal of offending agent
  • Refer for endoscopy and H. Pylori testing if conservative management fails
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11
Q

How can chronic diarrheal illness be classified?

A
  • Osmotic
  • Inflammatory ( or mucosal)
  • Secretory
  • Chronic infections (parasites)
  • Malabsorption syndromes
  • Motility disorders
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12
Q

What are osmotic chronic diarrheal illness causes?

A
  • Medication

- Zollinger-Ellison syndrome

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13
Q

What are common causes of acute infectious diarrhea?

A
  • Shigella
  • Salmonella
  • Escherichia coli
  • E coli O157:H7
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14
Q

What is a common cause of acute non-inflammatory diarrhea?

A
  • Viruses (Rotavirus, Norwalk virus, Vibriones)
  • Entero-toxin E. coli
  • Agents that cause food-borne gastroenteritis
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15
Q

What are some common protozoal causes of acute non-inflammatory diarrhea?

A
  • Giardia Lamblia
  • Cryptosporidium
  • Cyclospora
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16
Q

What does the term “food-poisoning” denote?

A

Diseases caused by toxins present in consumed foods

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17
Q

What is usually a major complaint of acute gasteroenteritis?

A
  • Vomiting

- Fever is usually absent

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18
Q

In over 90% of Pt’s, within how many days will acute non-inflammatory diarrhea respond to simple rehydration therapy or antidiarrheal agents?

A

5 days

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19
Q

If diarrhea persists for more than 7 days, what must be done?

A

Send stool for:

  • Fecal leukocyte
  • Ovum and parasite evaluation
  • Bacterial culture
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20
Q

Prompt medical evaluation of diarrhea is indicated in what situations?

A
  • Signs of inflammatory diarrhea with fever (>38.5 C), bloody diarrhea, or abdominal pain
  • Passage of 6 or more unformed stools in 24 hours
  • Profuse watery diarrhea and signs or symptoms of dehydration
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21
Q

What do you want to pay special attention to on physical examination on gastroenteritis?

A
  • Pay attention to Pt’s level of hydration
  • Mental Status
  • Presence of abdominal tenderness or peritonitis
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22
Q

Symptoms for gastroenteritis (depends on causative agent)

A
  • Sudden onset
  • Nausea, vomiting, decreased appetite
  • Crampy abdominal pain
  • Loose stool
  • Malaise
  • Fatigue
  • Diffuse abdominal tenderness
  • Distension
  • Increased bowel sounds
  • Usually afebrile
  • May see + tilts (depending on fluid loss)
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23
Q

Differential diagnosis for gastroenteritis?

A
  • Food poisoning
  • IBS
  • Malabsorption
  • Medication effect
  • Laxative abuse
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24
Q

Labs for gastroenteritis?

A
  • CBC with differential
  • Fecal leukocyte
  • Fecal O/P
  • Stool culture
  • C difficle assay
  • Stool exam for Giardia Lamblia
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25
Q

Treatment of gastroenteritis?

A
  • Assess vital signs for stability
  • Treat symptomatically
  • Rehydration
  • BRAT (bananas, rice, applesauce, toast) diet, avoid irritating foods
  • Antidiarrheal agents
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26
Q

What are rehydration methods for gastroenteritis?

A
  • Oral rehydration with fluids containing glucose, NA+, K+, CL-, and bicarbonate or citrate
  • Oral electrolyte solutions
  • Lactated Ringers IV
  • Tea, “flat” carbonated beverages
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27
Q

Antidiarrheal Agents for gastroenteritis?

A
  • Loperamide

- Bismuth Subsalicylate (Pepto-bismal)

28
Q

When is empiric antibiotic therapy not indicated?

A

Acute, community acquired diarrhea

29
Q

What infectious bacterial diarrheas for which antibiotic therapy is recommended?

A
  • Shigellosis
  • Cholera
  • Salmonellosis
  • Listeriosis
  • C. difficile
30
Q

What is the parasitic infection treatment (antibiotic therapy) for diarrhea?

A
  • Amebiasis
  • Giardiasis
  • Cryptosporidiosis
31
Q

What is the treatment for chronic non-infectious diarrheal illness?

A

Treat underlying cause

32
Q

What is the pertinent anatomy associated with constipation?

A
  • Large intestine (Cecum, rectosigmoid colon)
  • Rectum
  • Anus
33
Q

What are some causes of constipation?

A
  • Diminished intake of fiber
  • Systemic diseases (hyperthyroidism, diabetes, neuro conditions)
  • Medications (CCB, Iron, antipsychotics)
  • Structural abnormalities (colonic mass, neoplasm, anal fissure)
  • IBS
  • Hirschsprung disease
34
Q

What history do you want to ask when assessing constipation?

A
  • Infrequent stool
  • Excessive straining
  • Sense of incomplete evaluation
  • Need for digital manipulation
35
Q

What are some differential diagnosis with constipation?

A
  • Fecal impaction
  • Intestinal-pseudo obstruction (Ogilvie Syndrome)
  • Intestinal obstruction (refer to surgery)
36
Q

Labs for constipation?

A
  • CBC for anemia
  • Thyroid function tests
  • Electrolyte abnormalities
37
Q

Rads for constipation?

A
  • Upright chest film
  • Abdominal flat and erect films
  • Abdominal films
38
Q

What is the first line treatment for constipation?

A
  • Strict dietary changes
  • Exercise regime
  • Increased water intake
  • Fiber supplementation
39
Q

What is the second line treatment for constipation?

A
  • Stool softening or laxative use
  • Emollients (colace)
  • Stimulants (Bisacodyl (dulcolax))
  • Saline laxative (magnesium hydroxide aka milk of magnesium)
40
Q

What is the third line treatment for constipation?

A
  • Suppositories or enemas
  • Suppositories: glycerin suppository
  • Enemas: fleet enemas
41
Q

MEDEVAC for constipation?

A
  • Uncomplicated: retain on board

- Complicated/chronic case: refer to gastroenterologist

42
Q

Initial care of constipation?

A
  • Treat empirically in acute phase
  • Start less invasive
  • Lifestyle change could prove pivotal
  • Monitor for improvement or absence before progressing to next level of treatment
43
Q

Where are internal hemorrhoids located?

A
  • Located above dentate line
  • Subepithelial cushions of anorectum
  • submucosa and muscularis
  • No nervous innervation
44
Q

Where are external hemorrhoids located?

A
  • Arise from inferior hemorrhoidal veins
  • Below dentate line
  • Covered with squamous epithelium
  • Possess nervous innervation (painful when thrombosed)
45
Q

What do internal hemorrhoids (subepithelial vascular cushions) consist of?

A
  • Connective tissue
  • Smooth muscle fibers
  • Arteriovenous communications between terminal branches of superior rectal artery and rectal veins
46
Q

What are the 3 primary locations of internal hemorrhoids?

A
  • Right anterior
  • Right posterior
  • Left lateral
47
Q

Hemorrhoids can become symptomatic as a result of what?

A

Activities that increase venous pressure, resulting in distension and engorgement

48
Q

What can contribute to hemorrhoids?

A
  • Straining at stool
  • Constipation
  • Prolonged sitting
  • Pregnancy
  • Obesity
  • Low fiber diets
49
Q

Thrombosis of an external hemorrhoid plexus results in?

A

Perianal hematoma

50
Q

How can a perianal hematoma occur?

A

Commonly occurs in otherwise healthy adults and may be precipitated by:

  • coughing
  • heavy lifting
  • straining at stool
51
Q

What are the principle problems attributable to internal hemorrhoids?

A
  • Painless bleeding (bright red blood)
  • Prolapse
  • Mucoid discharge
52
Q

What are the stages of internal hemorrhoids?

A

Stage I - IV

53
Q

What is internal hemorrhoids Stage I?

A

Internal hemorrhoids are confined to the anal canal

54
Q

What is internal hemorrhoids Stage II?

A

Internal hemorrhoids gradually enlarge and protrude from the anal opening
- At first, mucosal prolapse occurs during straining and reduces spontaneously

55
Q

What is internal hemorrhoids Stage III?

A

Prolapsed hemorrhoids may require manual reduction after bowel movements

56
Q

What is internal hemorrhoids Stage IV?

A

May remain chronically protruding and unresponsive to manual reduction

57
Q

What can chronically prolapsed hemorrhoids result in?

A

Sense of fullness or discomfort and mucoid perianal discharge resulting in irritation and soiling of undergarments

58
Q

Are hemorrhoids palpable on physical examination?

A
  • Internal: neither palpable or painful

- External: Visible, extremely tender on palpation

59
Q

Prolapsed hemorrhoids are visible as what?

A

Protuberant purple nodules covered by mucosa

60
Q

What is a differential diagnosis for hemorrhoids?

A
  • Anal Fissure/fistula
  • Neoplasm of distal colon or rectum
  • Ulcerative colitis or Chron colitis
  • Rectal ulcers
61
Q

Radiology studies with hemorrhoids?

A

Colonoscopy for Pt’s with hematochezia

62
Q

Treatment of thrombosed external hemorrhoids?

A
  • Warm sitz baths
  • Analgesics and ointment
  • Removal of clot if seen within 24-48 hours
  • High fiber diet
  • Increase water intake
63
Q

Gentle, manual reduction of edematous, prolapsed hemorrhoids may be supplemented by what?

A
  • Suppositories
  • Topical pads containing witch hazel
  • Warm sitz bath
64
Q

Surgical excision (hemorrhoidectomy) is reserved for what percentage and stage of patients?

A
  • 5-10% of Pt’s with chronic bleeding due to Stage III or IV
65
Q

What is the initial care of hemorroids?

A
  • Acute onset, stay with treatment protocol

- Pt’s presenting with problematic stage III or Stage IV require further assessment for surgical correction

Gastrointestinal (6 decks)

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