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Clinical medicine > Small bowel > Flashcards

Small bowel Flashcards

1
Q

Diarrhea important things to consider

A

Quality of stool, freq, duration, pt hx, diet, recent antibiotic use

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2
Q

Difference between acute, chronic and persistent

A

acute 14 days, chronic>30 days

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3
Q

Common causes of acute diarrhea

A

Viruses (norovirus, rotavirus, adenoviruses, astrovirus), Bacteria (salmonella, shigella, campylobacter, enterotoxigenic E coli, c. diff), Protozoan (Cryptosporium, giardia, cyclospora, entamoeba)

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4
Q

Assessment of acute diarrhea

A

Hx (travel, food, occupation), signs of dehydration, temperature, abdominal exam

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5
Q

Indications for further evaluation of acute diarrhea

A

watery diarrhea, hypovolemia, blood, fever, >6/24 hour, abd pain, elderly, recent antibiotic use, pregnant

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6
Q

Diagnostic test of acute diarrhea

A

fecal leukocyte in stool and occult blood, stool culture w/ gram stain, if bloody have plated on Macconkey-sorbitol agar to test for Ecoli

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7
Q

Indications for Ova or parasite testing in acute diarrhea

A

persistent, travellling, exposure to infants, MSM or AIDS pt, bloody w/ no fecal leukocytes

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8
Q

High risk pop that requires testing sooner of acute diarrhea

A

immunocompromised, comorbidities, severe inflammatory, IBS, pregnant women

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9
Q

Treatment of acute diarrhea

A

Hydration, rest bowel (BRAT diet), antibiotics (not in most cases), antidiarrheal agents

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10
Q

Antidiarrheal agents

A

Loperamide (Imodium), Diphenoxylate (Lomotil), bismuth subsalicylate (pepto bismol), avoid anticholinergics

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11
Q

Chronic diarrhea affects how many

A

5% of pop

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12
Q

Chronic diarrhea causes

A

medications, infections, functional disorder, malabsorption, IBS

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13
Q

Meds that can cause diarrhea

A

BB, ACEI, statins, furosemide, CNS meds: alprazolam, lithium, levodopa, fluoceine, Meformin, ibuprofen, naproxen, GI: PPI, Lactulose, magnesium, H2 receptor blockers

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14
Q

Whipple disease

A

rare, slow progression, tropheryma whippeli (bacillus), white men 40-60 yo

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15
Q

Symptoms of whipple disease

A

joint pain, Later: abd pain, diarrhea, fever, weight loss, lymphadenopathy, heart murmur

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16
Q

Diagnosis of whipple disease

A

EGD: duodenal biopsy, Acid schiff positive macrophages w/ bacillus

17
Q

Treatment of whipple disease

A

Antibiotic: ceftriazone IV, bactrim bid for 1 year, dietary supplements, if untreated it’s fatal

18
Q

Lactase deficiency

A

lactase hydrolyzes the disaccharide lactose into glucose and galactose, not usually produced past 12 yo

19
Q

Symptoms of lactase deficiency

A

Chronic diarrhea, bloating, flatulence, abd pain after milk products

20
Q

Confirming lactase deficiency

A

hydrogen breath test, bacteria produces hydrogen in presence of undigested foods

21
Q

Antibiotic associated diarrhea

A

acute or chronic, most cases not C. diff

22
Q

C. diff

A

mild to moderate green, foul-smelling watery diarrhea 5-15 times per day, lower abd cramping, mild LLQ, stools contain mucus, occasionally blood

23
Q

C. diff treatment

A

D/c antibiotic, treat with metronidazole (flagyl), or vancomycin, in severe cases WBC > 15 or creatinine>1.5 times baseline

24
Q

Irritable bowel disease

A

Unknown pathology, maybe linked to pscyh, more common in females, late teens to 20 yo, most common cause of chronic diarrhea in US

25
Q

Symptoms of IBS

A

abd pain, pain worsened w/ food and relieved w/ defecation, bowel distention, postprandial urgency, changes in stool frequency, dyspepsia, urinary frequency

26
Q

Symptoms not associated with IBS

A

large volume diarrhea, blood, nocturnal diarrhea, greasy stool

27
Q

Types of IBS

A

constipation, diarrhea, mixed or unsubtyped

28
Q

Physical exam of IBS

A

tender, palpable sigmoid, hyperresonance on percussion over abdomen

29
Q

Alarm symptoms of diarrhea

A

rectal bleeding, weight loss, nocturnal or progressive abd pain, anemia, electrolyte disturbances, elevated inflammatory markers

30
Q

Non-pharm treatment of IBS

A

strong pt provider relationship, avoid triggers, dietary modification (Fodmap), increase physical activity

31
Q

Pharm treatment of IBS

A

osmotic laxatives (PEG), Lubiprostone, linaclotide, for diarrhea: antidiarrheals, bile acid sequestrants, alosetron if severe, abd pain: antispasmodics, peppermint oil, antidepressants

Clinical medicine (19 decks)

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