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Clin Med II - Exam 3 > Paulson - Disorders of Lower GI Tract > Flashcards

Paulson - Disorders of Lower GI Tract Flashcards

1
Q

constipation is defined as

A

< 3 stools/week

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2
Q

constipation etiologies (8)

A

inadequate fiber/water

meds

neuro conditions

prolonged immobility

metabolic dz’s

functional fecal retention

anatomic abnormalities

functional abnormalities

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3
Q

what meds are associated w. constipation

A

opioids

anticholinergic

CCBs

antacids

iron

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4
Q

what neuro conditions are associated w. constipation (4)

A

MS

Parkinsons

dementia

stroke

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5
Q

what metabolic dz’s are associated w. constipation (5)

A

DM

hypothyroidism

uremia

hypercalcemia

hypokalemia

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6
Q

what is functional fecal retention

A

chronic stool withholding

think kids

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7
Q

tx for constipation (4)

A

fiber

hyperosmolar agents → sorbitol, lactose

stimulant → glycerin suppository, dulcolax

enema → mineral or tap water

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8
Q

when should you use an opioid antagonist for constipation

A

only in terminally ill pt

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9
Q

what are 2 examples of opioid antagonists

A

relistor

naloxegol

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10
Q

what is a complication of chronic constipation

A

fecal impaction

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11
Q

fecal impaction is mc in

A

kids

elderly

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12
Q

fecal impaction is mc found in

A

rectum

distal sigmoid colon

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13
Q

what are 5 sx of fecal impaction

A

abd pain

bloating

overflow fecal incontinence

paradoxical diarrhea

increased urinary frequency

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14
Q

what might you see on pe for fecal impaction

A

impacted feces on DRE

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15
Q

what imaging is used for fecal impaction

A

xray or CT→ location of impaction and any associated obstruction

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16
Q

tx for fecal impaction (4)

A

manual disimpaction

enema

osmotic laxatives

address underlying cause

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17
Q

serious complication of fecal impaction

A

large bowel obstruction w. colonic perforation → high mortality

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18
Q

celiac disease is same same

A

gluten insensitivity

nontropical sprue

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19
Q

sx of celiac dz

A

diarrhea w bulky foul smelling bm

floating stools

steatorrhea

flatulence

wt loss

weakness

abd distension

FTT w/ infants/kids

IDA

osteopenia/porosis

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20
Q

what conditions are associated w. celiac

A

dermatitis herpetiformis

DM1

Down’s syndrome

liver dz

menstrual/reproductive issues

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21
Q

common presenting sign for celiac

A

dermatitis herpetiformis → grouped pruritic papules/vesicles

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22
Q

rf for celiac (5)

A

1st/2nd degree relative w. confirmed CD

T1DM

AI thyroiditis

down syndrome

turner syndrome

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23
Q

preferred serologic test for celiac

A

TTGIGA abs test

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24
Q

2nd line dx test for celiac

A

EMA-IgA

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25
Q

test to confirm celiac

A

small bowel bx x 4

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26
Q

what do you think when you see: atrophic appearing mucosa w. loss of folds, visible fissures, nodularity, scalloping, prominent submucosal vascularity

A

small bowel bx findings for celiac

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27
Q

dx testing for pt w. high probability of CD (classic presentation + rf)

A

blood test

PLUS

bx

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28
Q

dx testing for pt w. low probability of CD (not classic presentation, no rf)

A

serologic testing

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29
Q

does negative serology r.o celiac

A

no!

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30
Q

tx for celiac

A

gluten free diet

RD referral

replete nutritional deficiencies

DXA

pneumococcal vaccination

screen family members

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31
Q

education regarding dermatitis for celiac pt

A

improvement of rash more delayed than intestinal manifestations

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32
Q

mc cause of anal fissures

A

local trauma

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33
Q

other causes of anal fissures

A

constipation

anal sex

diarrhea

vaginal delivery

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34
Q

causes of secondary anal fissures (3)

A

IBD

malignancy

STI

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35
Q

mc location for anal fissures

2nd mc location for anal fissures

A

posterior midline

anterior midline

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36
Q

acute anal fissures will appear

A

fresh

superficial

like a papercut

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37
Q

chronic anal fissures will appear

A

raised edges

fibrotic appearance

often w. skin tag (sentinel pile)

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38
Q

sx of anal fissures

A

anal pain → intensifies w. bm

ripping/tearing feeling → can last for hours

+/- anal bleeding

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39
Q

dx for anal fissures (2)

A

direct visualization

reproduce pain w. digital palpation of posterior anal verge

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40
Q

tx for anal fissures

A

fiber + water

+/- stool softeners

sitz bath

topical analgesics

topical vasodilators

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41
Q

2 ex of topical vasodilators

A

nifedepine gel

topical nitroglycerin

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42
Q

IBD includes

A

crohn’s

uc

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43
Q

rf for IBD (4)

A

15-40 yo

jewish

1st degree relative w. hx

western diet

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44
Q

highest risk for IBD

A

western diet

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45
Q

smoking is protective for __

and rf for __

A

UC

crohn’s

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46
Q

UC always starts __ at the rectum

and progresses __

in a __ manner

A

distally

proximally

continuous circumferential

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47
Q

UC is characterized by no __ progression

A

skips

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48
Q

UC is characterized by inflammation in the mucosa of the

A

colon

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49
Q

onset of UC is

A

gradual/progressive

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50
Q

PE for UC is usually __,

but might include (6)

A

ttp

fever

hypotn

tachycardia

pallor

blood on rectal exam

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51
Q

2 common sx of UC

A

bloody diarrhea

frequent BMs that are smaller in volume

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52
Q

if UC is mainly distal, symptoms may include (4)

A

constipation + frequent blood/mucus d.c

incontinence

colicky abd pain

systemic systems

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53
Q

systemic sx in UC include (3)

A

fever

weight loss

fatigue

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54
Q

extraintestinal sx affect what systems

A

joints

eyes

skin

bv

gallbladder

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55
Q

what joint sx are associated w. UC (2)

A

nondestructive peripheral arthritis of large joints

ankylosing spondylitis

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56
Q

what eye sx are associated w. UC

A

episcleritis

uveitis

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57
Q

what is this condition

A

episcleritis

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58
Q

what is this condition

A

uveitis

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59
Q

what skin sx are associated w. UC

A

erythema nodosum

pyoderma gangrenosum

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60
Q

what is this condition

A

pyoderma nodosum

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61
Q

what is this condition

A

erythema nodosum

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62
Q

what bv conditions are associated w. UC (3)

A

VTE

arterial thromboembolism

AI hemolytic anemia

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63
Q

what other GI condition has a strong association w. UC

A

primary sclerosing cholangitis

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64
Q

labs abnormalities associated w. UC (4)

A

anemia

elevated ESR/CRP

electrolyte abnormalities

fecal calprotectin

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65
Q

elevated fecal calprotectin is a marker of

A

active inflammation in the GI tract

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66
Q

is imaging required for dx of UC

A

no!

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67
Q

what imaging might you use in UC (4)

A

xray

double contrast barium enema

CT/MRI

bx

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68
Q

xray findings associated w. UC (3)

A

proximal constipation

mucosal thickening or “thumbprinting”

colonic dilation → if severe

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69
Q

what do you think of when you see, microulcerations, collar button ulcers, loss of haustra, pseudopolyps

A

UC findings on barium enema

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70
Q

what are pseudopolyps

A

mass of scar tissue from granulation

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71
Q

you should avoid barium enemas in __

bc it can cause __

A

severely ill

megacolon

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72
Q

what type of imaging is this and what is it showing

A

barium enema

loss of haustra → smooth featureless colon

UC

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73
Q

what are haustra

A

folds in sigmoid colon

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74
Q

what imaging is this and what is it showing

A

barium enema

microulcerations (white spots)

UC

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75
Q

what type of imaging is this and what is it showing

A

barium enema

pseudopolyps w. stricture

UC

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76
Q

what type of imaging is lower sensitivity for UC and is not used for dx

A

CT/MRI

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77
Q

what do you think when you see, loss of vascular markings from swelling of mucosa; petechiae; exudates, edema; erosions that are friable to touch; and spontaneous bleeding

A

endoscopic findings of UC

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78
Q

what imaging is this and what is it showing

A

endoscopy

petechiae

bleeding

UC

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79
Q

what is this endoscopy showing

A

pseudopolyps

UC

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80
Q

what do you think of when you see, crypt abscesses; shortenings and disarray; crypt atrophy; epithelial cell abnormalities; mucin depletion; paneth cell metaplasia; inflammatory features

A

bx findings of UC

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81
Q

4 dx factors for UC

A
  1. chronic diarrhea x at least 4 weeks
  2. e.o active inflammation on endoscopy
  3. chronic changes on bx
  4. exclusion of other causes
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82
Q

what do you think when you see, lamina propria cellularity, basal plasmacytosis, basal lymphoid aggregates, lamina propria eosinophios

A

inflammatory findings of bx for UC

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83
Q

in UC progression, there are no __ areas of mucosa

A

normal

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84
Q

mild UC parameters (3)

A

4 or less stool/day without blood

normal ESR

no systemic sx → severe abd pain, fever, wt loss, profuse bleeding

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85
Q

moderate UC parameters (5)

A

more than 4 bloody stools/day

mild anemia → does not require transfusion

moderate abd pain

minimal signs of systemic toxicity

no wt loss

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86
Q

severe UC parameters (4)

A

6 or more frequent, loos bloody stools/day

severe abd pain

systemic sx

+/- rapid wt loss

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87
Q

4 systemic sx considerations in US severity grading

A

fever

tachycardia

anemia

elevated ESR

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88
Q

first step in tx of UC

A

classify severity of dz

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89
Q

what is the most distal manifestation of UC

A

ulcerative proctitis or proctosigmoiditis

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90
Q

first line tx for ulcerative proctitis or proctosigmoiditis

A

topical 5-aminosalyclic acid (5-ASA)

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91
Q

5-ASA offers __

and __ for UC

A

symptomatic relief

AND

decreased bleeding

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92
Q

5-ASA acts quickly and can cause complete healing in

A

4-6 weeks

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93
Q

if a pt has complete healing of UC following 5-ASA tx, how should you d.c med

A

continue 8 weeks longer → then taper

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94
Q

how should you administer 5-ASA for UC

A

suppository and/or enema

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95
Q

which suppository is used if UC is confined distally, and how is it administered

A

Mesalamine

suppository

96
Q

how should mesalamine be administered if UC extends past the distal part of rectum

A

enema

PLUS

suppository

97
Q

mesalamine is what class of drug

A

5-ASA

98
Q

mesalamine should offer symptomatic relief in

A

a few days

99
Q

maintenance therapy for UC is NOT recommended for

A

1st episode of proctitis

100
Q

for UC, maintenance therapy is recommended for

A

proctosigmoiditis

1 or more relapses per year

101
Q

alternative meds for UC (besides mesalamine) (2)

A

topica steroids

oral 5-ASA

102
Q

tx for left-side colitis, extensive colitis, pancolitis

A

combo therapy:

oral 5-ASA, steroid suppositories

PLUS

5-ASA or steroid enemas

103
Q

all pt w. left-sided colitis, extensive colitis, and pancolitis should receive

A

maintenance therapy

104
Q

tx for refractory UC

A

refer for further oral immunosuppressants

105
Q

2 complications of chronic UC

A

strictures

colorectal ca

106
Q

strictures are mc in __ UC

and are __ until proven otherwise

via __

A

rectosigmoid colon

malignant

bx

107
Q

what GI d.o involves transmural inflammation of GI tract anywhere from mouth to perianal area

A

Crohn’s Dz

108
Q

2 mc locations in Crohn’s

A

ileum

right colon

109
Q

__ areas are classic in Crohn’s

A

skip

110
Q

peak incidence of Crohn’s occurs btw __ yo

A

15-35

younger than UC

111
Q

5 common sx of crohn’s (7)

A

crampy abd pain

strictures

diarrhea

fistulas

malabsorption

abscess formation

aphtous ulcers

112
Q

what do you think when you see strictures with repeated obstruction

A

Crohn’s

113
Q

diarrhea in crohn’s __ over time

and __ is less common then in UC

A

fluctuates

bleeding

114
Q

4 common fistula sites Crohn’s

A

enterovesical

enterocutaneous

enteroenteric

enterovaginal

115
Q

enterovesical is bleeding to the

A

bladder

116
Q

2 mc extraintestinal manifestations of crohn’s

A

fatigue

arthritis of large joints

wt loss

117
Q

eye sx related to crohn’s

A

uveitis

iritis

episcleritis

118
Q

skin manifestations associated w. crohn’s

A

erythema nodosum

pyoderma gangrenosum

119
Q

what other bowel condition is associated w. crohn’s

A

primary sclerosing cholangitis

120
Q

bv manifestations of crohn’s

A

VTE

arterial thromboembolism

121
Q

renal manifestation of crohn’s related to steatorrhea and diarrhea

A

nephrolithiasis

122
Q

what vitamin deficiency is related to crohn’s

A

B12

123
Q

does crohn’s affect the lungs

A

yes!

124
Q

what is secondary amyloidosis and what GI condition is it associated w.

A

build up of abnormal proteins in tissues and organs

crohn’s

125
Q

pe for crohn’s is often __

and can include (5)

A

perianal skin tags

sinus tracts

abd tenderness

wt loss

pallor

126
Q

what labs might be helpful in crohn’s

A

CBC

CMP

ESR/CRP

serum iron

vit D/B12

fecal calprotectin

abs test

127
Q

CRP is higher in __

than in __

A

CD

UC

128
Q

what test can help differentiate crohn’s from IBS

A

fecal calprotectin

129
Q

what abs tests can help dx IBD and distinguish CD from UC

A

pANCA

ASCA

130
Q

what is used to establish dx in crohn dz

A

colonoscopy

131
Q

what do you think when you see, focal ulcerations adjacent to areas of normal appearing mucosa; and polypoid mucosal changes that give a cobblestone appearance

A

colonoscopy findings of crohn’s

132
Q

in crohn’s dz, __ areas

and __ sparing is common

A

skip

rectal

133
Q

what do you think when you see, cobblestone appearance

A

crohn’s dz

134
Q

what do you think when you see, crypt abscesses, crypt branching, crypt atrophy, and paneth cell metaplasia

A

UC

135
Q

what do you think when you see, thumbprinting

A

UC

136
Q

besides colonoscopy, what is another way to visualize small bowel that does not involve radiation exposure

A

wireless capsule endoscopy

137
Q

in what pt population should you avoid wireless capsule endoscopy

A

pt’s with suspected stricture

138
Q

what imaging is helpful in crohn’s dz (3)

A

xray → upper GI series w.small bowel follow through

CT

MRI

139
Q

what do you think when you see, narrowing of lumen w. nodularity and ulceration, string sign, cobblestone appearance, fistulas/abscess formation, bowel wall thickening, and stricturing

A

crohn’s dz

140
Q

what is this showing

A

nodular filling defects

xray finding of crohn’s

141
Q

what is this showing

A

cobblestoning

xray findings of crohn’s

142
Q

what is this showing

A

string sign

xray finding of crohn’s

143
Q

best imaging for crohn if abscess is suspected

A

CT

144
Q

what do you think when you see, mural thickening, high mural signal intensity (edema), and layered pattern of enhancement

A

MRI findings of acute small bowel inflammation

crohn’s dz

145
Q

what are the 2 dz activity and rating scales for crohn’s

A

crohn’s disease activity index (CDAI)

harvey-bradshaw index (HBI)

146
Q

what factors are included in the CDAI (7)

A

stool patterns

abd pain rating

general wellbeing

complications

abd mass

anemia

wt change

147
Q

what factors are included in the HBI

A

general well being

abd pain

of liquid stools

abd mass

complications

148
Q

according to the CDAI, clinical remission parameters

A

asymptomatic

no sequelae

achieved spontaneously or after medical or surgical intervention

149
Q

according to CDAI, mild crohn’s parameters (5)

A

ambulatory

tolerating oral diet

<10% wt loss

no systemic sx

no s/s of obstruction

150
Q

according to CDAI, mod-severe Crohn’s parameters

A

have failed tx for mild-mod dz

have prominent sx: fever, wt loss, abd pain/tenderness, intermittent n/v, anemia

151
Q

according to CDAI, severe-fulminant crohn’s

A

persistent s/s despite steroids or biologic agents

high fever, persistent vomiting

intestinal obstruction, peritoneal signs

cachexia

e.o abscess

152
Q

what are the 2 tx approaches to crohn’s

A

step up therapy

top down therapy

153
Q

step up therapy is used for

A

mild crohn’s

154
Q

top down therapy is used for

A

severe crohn’s

155
Q

in step up therapy, meds are __ potent,

but have fewer __

A

less

side effects

156
Q

in top-down therapy, the goal is to use more potent therapies early on before the patient becomes

A

glucocorticoid dependent

157
Q

the goal for crohn’s tx is to achieve remission, which includes __ (3)

evidence of of complete mucosal healing

A

endoscopic

histologic

clinical

158
Q

tx for mild-mod crohn’s w. ileum or proximal colon involvement

A

budesonide x 4-8 weeks → for induction → then taper for 8-12 weeks

can continue at lower dose for no more than 3-6 mo

prednisone is alternative

159
Q

tx for mild-mod crohn’s w. diffuse colitis or left colonic involvement

A

oral prednisone x 1 week → then taper

then clinically observe

sulfasalazine is alternative

160
Q

tx for oral lesions in crohn’s

A

topical meds → triamcinolone acetonide

161
Q

what class of drug is budesonide (enterocort)

A

corticosteroid

162
Q

s.e of budesonide

A

HA

acne

adrenal suppression

osteoporosis

immunosuppression

psychiatric disturbance

exacerbation of CV

hyperglycemia

163
Q

__ should be used to clinically observe pt’s w. crohn’s after induction therapy has been d.c

A

ileocolonoscopy q 6-12 mo

164
Q

how do you tx relapse of mod-sev crohn’s

A

2nd course of glucocorticoid

165
Q

tx for severe crohn’s

A

refer!

biologic + immunomodulatory for induction

+/- addition of glucocorticoid for acute relief

maintenance therapy w. biologic agent

166
Q

what immunomodulatory drugs are used for severe crohn’s

A

azathioprine

6-mercaptopurine

methotrexate

167
Q

surgical indications for crohn’s

A

perforation

abscess

fistula

hemorrhage

stricture

neoplasm

persistent sx despite medical management

168
Q

2nd mc cause of cancer deaths in US (after lung ca)

A

colorectal ca

169
Q

colorectal ca is often __

and is dx __

A

asymptomatic

incidentally w. routine colonoscopy

170
Q

colorectal ca can be asymptomatic or present w.

A

acute event → obstruction, peritonitis, non acute GI bleed

171
Q

mc non acute event sx associated w. colorectal ca

A

change in bowel habits

also unexplained IDA, rectal mass, abd mass, abd pain

172
Q

procedure that is diagnostic and therapeutic for colorectal ca

A

colonoscopy

173
Q

what do you think when you see, endoluminal masses; friable, nectrotic, ulcerated lesions; +/- bleeding

A

colonoscopy findings of colorectal ca

174
Q

what is this showing

A

apple core → circumferential involvement of colorectal ca

175
Q

alternative to colonoscopy for colorectal ca

A

CT colonography (aka virtual colonoscopy/CT cologaphy)

176
Q

__ is still required for CT colonography;

if results are abnormal, __ is required

A

bowel prep

real colonoscopy

177
Q

CT colonography is not

A

therapeutic

178
Q

tumor marker associated w. colorectal ca

A

CEA

179
Q

CEA has __ diagnostic ability,

and is used for __ in colorectal ca

A

low

f/u

180
Q

CEA is __,

but level > __

os associated w. worse prognosis for colorectal ca

A

nonspecific

5

181
Q

if CEA is still elevated post surgery, consider

A

refractory/recurrent colorectal ca

182
Q

rf for colorectal ca that are NOT associated w. early screening recommendations

A

obesity

DM

red and processed red meat/high cooking temps

smoking

etoh

183
Q

emergency admission for colorectal ca (3)

A

intestinal obstruction

peritonitis

acute GI bleed

184
Q

tx for colorectal ca if carcinoma in a polyp (contained) → clear margins

A

endoscopic removal alone

185
Q

tx for larger colorectal tumors

A

surgical resection → adjuvant chemo

186
Q

xrt for colorectal ca is mc used for __

and is not routinely used for __

A

rectal ca

resected colon ca

187
Q

rf associated w. increased risk/early screening (5)

A

personal OR fam hx CRC or adenomatous polyp

personal or fam hx of genetic syndromes that cause CRC

IBD

prior hx abd xrt for childhood malignancy

cystic fibrosis

188
Q

what genetic syndromes are associated w. increased risk for CRC (5)

A

familial adenomatous polyposis

lynch syndrome

juvenile polyposis syndrome

peutz-jeaghers syndrome

MUYTH-associated dz

189
Q

what 2 factors MAY influence screening guidelines for CRC (4)

A

HIV (+) men

AA

acromegaly

renal transplant + long-term immunosuppression

190
Q

age to initiate screening in average risk pt

A

50 yo

+/- 45 yo for AA

191
Q

when to d.c screening for average risk

A

screen through 75 yo if expected to live at least 10 more years

192
Q

screening tests for CRC

A

colonoscopy

FIT (fecal immunochemical testing)

CT colonography

sigmoidoscopy + FIT

sigmoidoscopy alone

guaiac-based FOBT

stool DNA

193
Q

choice of screening in pt’s w. FH CRC or advanced polyp

A

colonoscopy every 10 years

FIT annually if pt refuses colonoscopy

194
Q

when to start screening if pt has fam hx CRC

A

40 yo or 10 years before youngest FDRs dx

195
Q

high risk syndrome pt’s start screening for CRC (lynch, FAP, peutz-jeghers)

A

8-20 yo

196
Q

swollen veins on rectum/anus can can lead to prolapse/bleeding

A

hemorrhoids

197
Q

rf for hemorrhoids

A

anything that puts strain on abd area:

age

chronic constipation

pregnancy

pelvic tumors

diarrhea

anal sex

prolonged sitting

anticoags

198
Q

3 classifications of hemorrhoids

A

external

internal

mixed

199
Q

what landmark differentiates hemorrhoid classification

A

dentate line

200
Q

pe findings of hemorrhoid

A

acute perianal pain w. palpable lump

protuberant purple nodules covered by mucosa

201
Q

which type of hemorrhoid is painful

A

external

202
Q

__% of hemorrhoids are asymptomatic

A

40

203
Q

sx associated w. hemorrhoids (6)

A

painless hemorrhoidal bleeding associated w. BM

bright red blood that coats stool

pruritis/irritation of perineal

mild fecal incontinence

mucus d.c

wet sensation

204
Q

dx of hemorrhoids (2)

A

classic symptoms

PLUS

visualization

205
Q

how do you visualize internal hemorrhoids

A

anoscopy

206
Q

grade 1 hemorrhoid

A

no prolapse

207
Q

grade 2 hemorrhoid

A

prolapse w. defecation → spontaneously reduces

208
Q

grade 3 hemorrhoid

A

prolapse w. defecation or other times → needs manual reduction

209
Q

grade 4 hemorrhoid

A

permanently prolapses → irreducible

visible externally

+/- strangulation

210
Q

tx for hemorrhoids (5)

A

increase fiber/water

topical steroids → hydrocortisone or suppository

topical analgesics → lidocaine gel

sitz bath

nitroglycerin ointment

211
Q

what drug reduces inflammation/edema for hemorrhoids

A

warm sitz bath

212
Q

what med reduces sphincter spasm for hemorrhoids

A

antispasmotic → nitroglycerin

213
Q

when to refer for hemorrhoids (3)

A

symptomatic low grade fever I or II that are refractory

symptomatic high grade III or IV

thrombosed hemorrhoids

214
Q

office based procedures for hemorrhoids (3)

A

rubber band ligation

sclerotherapy

infrared coagulation

215
Q

rubber band ligation should only be used for

A

internal hemorrhoids!

216
Q

what in office therapy is good for pt at increased bleeding risk

A

sclerotherapy

217
Q

surgery indications for external hemorrhoidectomy

A

large

refractory

mixed internal/external

218
Q

surgery indications for internal hemorrhoidectomy

A

prolapsed

incarcerated

refractory

mixed internal/external

219
Q

diverticulosis includes (5)

A

diverticular dz

diverticulitis

diverticular colitis

symptomatic

uncomplicated diverticular dz

220
Q

sac-like protrusion of colonic wall at points of weakness

A

diverticulosis

221
Q

rf for diverticulosis

A

increasing age

low fiber/high fat/red meat

lack of PA

BMI >25

NSAIDs/steroids/opiates

222
Q

clinically significant and symptomatic diverticulosis

A

diverticular dz

223
Q

mc cause of brisk/painless hematochezia

A

diverticular dz

224
Q

inflammation of diverticulum

A

diverticulitis

4-15% of pt’s

225
Q

inflammation of interdiverticular mucosa w.o involvement of diverticular orifices

A

diverticular colitis

226
Q

persistent abd pain of interdiverticular mucosa w.o involvement of diverticular orifices

A

symptomatic uncomplicated divertiular dz aka smoldering diverticulitis

227
Q

functional dz of GIT w. chronic pain, altered bowel habits

A

IBS

228
Q

3 conditions associated w. IBS

A

fibromyalgia

chronic fatigue syndrome

dpn

anxiety

229
Q

bowel symptoms of ibs are

A

highly variable → constipation, diarrhea, both etc

230
Q

w. ibs, __ worsens pain

and __ improves pain

A

stress

bm

231
Q

rome criteria

A

recurrent abd pain at least 1 week x 3 months

PLUS 2 of the following:

related to defecation

associated w. change in stool frequency

associated w. change in stool appearance

232
Q

indications for GI referral for IBS

A

more than minimal rectal bleeding

wt loss

unexplained IDA

nocturnal sx

FH of CRC, celiac, IBD

233
Q

tx for IBS

A

ex + reassurance

FODMAP

if constipation: more fiber, Miralax, Lubriprostone

diarrhea predominant: immodium, cholestramine

antispasmotics for postprandial pain: dicyclomine (Bentyl)

234
Q

lubiprostone is a

A

promotility med

235
Q

cholestramine is a

A

antidiarrheal

236
Q

dicyclomine (Bentyl) is a

A

antispasmotic

Clin Med II - Exam 3 (14 decks)

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