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Gastro > S/Sx 2 - Constipation and Diarrhea > Flashcards

S/Sx 2 - Constipation and Diarrhea Flashcards

1
Q

How may a patient define constipation?

A
  1. Infrequent stools **less than 3x week
  2. Hard stools
  3. Excessive straining
  4. Incomplete evacuation
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2
Q

What are some things that can cause constipation?

A
  • *Inadequate fiber
  • *Poor hydration
    • Opiods

Other

Poor bowel habits, systemic disease, meds, *IBS - C

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3
Q

Compare primary vs secondary constipation

A

Primary - Common, “functional”, Poss Hx psychosocial

Secondary - systemic, meds, lesions… **Sudden

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4
Q

What do we do during PE of constipation patient? What may we find?

A

DRE and ABD percussion

DRE - R/O structural abnormal or impaction

Percuss - dullness to Left Quadrants

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5
Q

When do we need to do a further diagnostic test for constipation (ie Colonoscopy)

A
  1. Pt older 50 **
  2. Severe ?
  3. Signs of Organic disorder
  4. Alarm signs **
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6
Q

What are the alarm signs with constipation?

A

Hematochezia
Weight loss
Pos FOBT
Family hx of colon cancer or IBD

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7
Q

When doing further workup for constipation, what are our options in terms of Labs, Rads, and endoscopy?

A

Labs = CBC, CMP, Thyroid

Rads = ABD (will show non-specific bowel gas)

Endoscopy = Colonoscopy and flex sig

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8
Q

How do we treat constipation?

A

Diet and lifestye (excercise, fiber etc)
Change offending meds
Pharmacotherapy - Osmotic, stimulant, stool surfactant, enema

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9
Q

Describe the types of Osmotic laxatives, Stimulant laxatives, Stool surfactants, Enemas

A 
1. Osmotic
Mag Hydroxide
Polyethelyne glycol 3350 
" w/o 3350
Mag citrate
  1. Stim
    Bisacodyl
    Senna
  2. Stool Surfactants
    Ducosate
  3. Enema
    Tap water
    saline
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10
Q

What are 2 complications of constipation

A

Fecal Impaction = paradoxical diarrhea –> manual disimpaction

Hemmorrhoids

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11
Q

When do we refer constipatio patients?

A 
Symptoms refractory to tx
Structural abnormality
Obstruction
Over 50 (scope) **
Alarm symptoms (scope) **
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12
Q

Differentiate acute vs chronic diarrhea

A 
Acute = <2 weeks
Chronic = >4 weeks
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13
Q

Differentiate inflamm vs non-inflamm diarrhea

A

Bloody vs. non - bloody

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14
Q

What are the diagnostic pearls of acute non-inflamm diarrhea? Is diagnostic evaluation needed?

A
  1. acute length
  2. water/non bloody
  3. mild and self limiting
  4. virus or non-invasive bacteria

Workup not needed unless *severe or persistant beyond **7 DAYS

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15
Q

What are 3 common etiologies for Acute non inf diarrhea?

A

Norovirus
Rotavirus
Giardia lamblia (water)

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16
Q

What are the diagnostic pearls for Acute Inflammatory Diarrhea? Do we need diagnostic eval?

A
  1. acute length
  2. blood or pus
  3. invasive or toxin prod. bacteria

Yes, Stool bacteria culture (O157:H7 E coli) is routinge. PRN = C Diff toxin, O and P

17
Q

What are some common etiologies for Acute inflammatory diarrhea?

A

E coli
Shigella
Salmonella
C Diff (think ABX)

18
Q

Symptoms of acute inflammatory diarrhea typically include what findings?

A 
Diarrhea
Fever
LLQ cramping
Urgency
Tenesmus
19
Q

Prompt evaluation for acute diarrhea is required when?

A
  1. Inflamm diarrhea - FEVER, 15000+ WBC, Bloody, Severe abd pain
  2. Profuse non inflamm
  3. frail old people
  4. Immune compromise
  5. ABX
  6. Nosocomial (3 days of hospitalization)
  7. Systemic illness
20
Q

How do we typically treat acute diarrhea? Without meds

A

BRAT diet, avoid bad food

Rehydrate PO, ORS prn.

21
Q

What are examples of antidiarrheals? Should we always give them? Why or why not?

A

Loperamide and bismuth subsalicylate. Diarrhea is the method of flushing the system. Dont give unless pt needs to continue important things.

22
Q

What are the ABX’s of choice for acute diarrhea? In what cases would you consider emperic therapy? **Not traveler’s

A

Empiric -

Flouroquinolones - Cipro, Ofloxacin, Levofloxacin

Other - Septra (trimethoprim sulfamethoxazole) and Doxy

23
Q

What is traveler’s diarrhea? How do you treat?

A

Diarrhea that develops during travel or w/in 10 days of return.

Flouroquinolones - Cipro, Oflox, Levo **Not for asia

Azithromycin
Rifaximin

24
Q

What organisms require specific tx w/ antibiotics in acute diarrhea

A 
Shigellosis
Cholera
Extraintestinal salmonellosis
Listeriosis
T-diarrhea
Giradiasis
Amebiases
25
Q

When should acute diarrhea patients get admitted?

A
  1. Severe dehydration requiring IV fluids
  2. Bloody diarrhea that is *sever or *worsening
  3. Severe ABD pain **toxic colitis, IBD, Ischemia, Surgical abdomen
  4. Severe infection 39.5 C +, leuks, rash
  5. Sever or worsening if **over 70
  6. Hemolytic-uremic syndrome (kidney, platelets, hemolytic anemia
26
Q

How do we work up Chronic Diarrhea?

A
  1. Exclude most common causes - offending meds, IBS, Lactose intolerance
  2. Base eval on history and S/Sx
  3. Labs - CBC, CMP, LFT, Thyroid, ESR, CRP, Stool - culture, leuks, lactoferrin, FOBT, O and P
  4. Colonoscopy w/ biopsy to r/o IBD and neoplasm
  5. Other = 24 hour stool for weight and fat
27
Q

Chronic diarrhea warrants _________ to _______ in most cases

A

Referral to gastroenterologist

Gastro (9 decks)

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