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Gastroenterology > Other Intestinal Disorders > Flashcards

Other Intestinal Disorders Flashcards

1
Q

What is IBS?

A

Recurrent abdominal discomfort or pain, chronic for > 3 months, occurring on average at least one day per week; and has two of the three:

  1. Related to defecation
  2. Association with change in frequency of stool
  3. Association with change in consistency of stool
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2
Q

Is there an anatomical cause that can be found on labs, XRays, or biopsies in IBS?

A

No

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3
Q

What are the physiologic factors of IBS?

A
  • Altered intestinal motility
  • Increased intestinal sensitivity (visceral hyperalgesia)
  • Various genetic and environmental factors
  • Hormonal fluctuations (women)
  • Psychosocial factors
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4
Q

Rectal insensitivity can be associated with what physiologic time in women?

A

Menses

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5
Q

When is the typical onset of IBS?

A

Begins in adolescence/20’s

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6
Q

What are the common symptoms associated with IBS?

A
  • Abdominal discomfort
  • Discomfort related to defecation; often sx resolve after defecation
  • Cramping
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7
Q

Do bouts of IBS typically rouse patient from sleep?

A

No

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8
Q

What does a DRE test for?

A

Occult blood in the stool

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9
Q

What is FODMAP?

A

Diet that exclude diarrhea-producing foods

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10
Q

When treating constipation with fiber supplementation what is critically important for the patient?

A

Hydration

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11
Q

What are some diet modifications in the treatment of IBS?

A
  • Small meals, eating slowly
  • Reduce beans, cabbage, and other fermentable foods
  • Reduce sweeteners
  • Low fat diet
  • Hydration
  • Dietary fiber supplements
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12
Q

What are the three medications that can be used to treated IBS-C?

A
  • Lubiprostone
  • Linaclotide
  • Plecanatide
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13
Q

What are the medications that can be used to treat IBS-D?

A
  • Diphenoxylate or Loperamide
  • Rifaximin
  • Alosetron
  • Elexadoline (need special license to prescribe)
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14
Q

What is the drug name for Miralax?

A

Polyethylene glycol laxative

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15
Q

What symptom of IBS can probiotics be helpful in alleviating?

A

Bloating

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16
Q

What are the symptoms associated with lactose intolerance?

A

Diarrhea
Abdominal distention
Flatulence

17
Q

What is the most common type of lactose intolerance?

A

Acquired lactose deficiency

18
Q

What is the clinical presentation of lactose intolerance in children?

A

Diarrhea after ingesting a significant amount of milk; not gaining weight

19
Q

What is the clinical presentation of lactose intolerance in adult?

A

Watery diarrhea, bloating, excessive flatus, nausea, borborygmi, abdominal cramps after ingesting lactose

20
Q

What is the preferred test for diagnosing lactose intolerance?

A

Hydrogen breath test (but doesn’t have to be completed if high clinical suspicion)

21
Q

What is the treatment for lactose intolerance?

A

Avoid dietary sugars
Enzyme supplements

22
Q

What supplement should patients with lactose intolerance take?

A

Calcium

23
Q

What is non-ulcer dyspepsia?

A

Dyspeptic symptoms with no abnormalities on PE and EGD and/or other evaluation

24
Q

Alternating constipation and diarrhea with dyspepsia suggests what two possible etiologies?

A

IBS or Excessive use of OTC

25
Q

What are ulcer-like symptoms?

A

Pain localized in epigastrium, occurs before meals, partially relieved by food, antacids, or H2 blockers

26
Q

What bacteria causes non-ulcerative dyspepsia and can increase risk of cancer?

A

H. pylori

27
Q

What is the treatment for non-ulcer dyspepsia?

A

Treat specific symptoms

*symptoms can be treated with PPI’s, H2 blockers, or cytoprotective agent

28
Q

What is the role of treatment with TCA’s in non-ulcer dyspepsia?

A

Alter sensory perception

29
Q

Is acute constipation more suggestive of an organic or functional cause?

A

Organic

30
Q

Excessive straining may contribute to anorectal pathology which may include

A

Hemorrhoids
Anal fissure
Rectal prolapse
Syncope

31
Q

What is the normal transit time of food to pass through the entire GI system?

A

35 hours

32
Q

What is the treatment for constipation?

A

Trial of fiber and/or over the counter laxatives

33
Q

If trial of treatment fails in constipation what is the next step?

A

Measure colonic transit times with radiopaque markers (Sitz markers)

34
Q

What patient cohorts is laxative abuse more likely?

A
  • Eating disorders
  • Elderly who continue treatment after constipation ceased
35
Q

When prescribing opioids what should be co-prescribed to be started at the same time?

A

Laxatives

36
Q

What is the etiology of opioid induced constipation?

A

Opioids inhibit gastric emptying and peristalsis in GI tract, delays absorption of meds and increased absorption of fluid

37
Q

What are the prescribed pharmacologic treatments for OIC?

A
  • Methylnaltrexone bromide (Relistor)
  • Lubiprostone (Amitiza)

Gastroenterology (12 decks)

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