UW revision factitous laxatives 12-29 (1) Flashcards
Factitious. Behavioural characteristics? 2
Intentional falsification of illness: feigninng illness, self-induced illness, exacerbation of preexisting illness
Factitious. CP? 4
Overt, dramatic symptoms
Frequent visits for medical care
Patient possibly refusing consent to release records or tampering with test samples
More common in healthcare workers (have access to drugs)
Factitious. Dx? 4
Direct obervation or discovery or medical supplies
Confirmatory testing (sulfonylurea screen, sool laxative screen)
Medical record review
prie klausimo buvo stool osmolality measure (dar yra stool electorlytes or stool osmotic gap)
Factitious. Stool osmotic gap formula?
290 - 2x(stool Na + stool K)
Factitious. Stool osmotic gap < 50?
secretory diarrhea
Factitious. Stool osmotic gap 50-125?
indeterminate
Factitious. Stool osmotic gap >125?
Osmotic diarrhea
SECRETORY DIARRHEA. Causes? 4
Toxins (eg Vibrio cholera), hormones (produced by VIPomas), congenital disorders of ion transport (eg CF), or bile acids (in postsurgical patients)
SECRETORY DIARRHEA. CP?2
Low osmotic stool gap
Diarrhea persist during periods of fasting (eg diarrhea during night)
OSMOTIC DIARRHEA. Causes?
Osmotic laxatives
Causative substances = milk in a patient with lactose intolerance
OSMOTIC DIARRHEA. CP?
Diarrhea presents only then substance is consumed, but not present when fasting.
Secretory diarrhea can occur after bowel resection or cholecystectomy - unabsorbed bile acids reach the colon and result in the direct stimulation of luminal ion chales.
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Factitious imposed on another table. definition?
intentional falsification of symptoms or induction of illness in another person (eg child, older person)
Factitious imposed on another table. Characteristics of caregiver (offender)? 2
Motivated by desire to assume caregiver role (no external gain)
Female>male (95 proc are female, often primary caretaker)
Factitious imposed on another table. CP?
frequent visits
history is incongruent with clinical findings
Unexplained illness persists despite comprehensive evaluation
Caregiver seeks multiple opinions (eg doctor shopping)
Symptoms improve when caregiver is absent
Factitious imposed on another table. Intervention?
Seek information from other observers (eg teacher, other family members)
Review previous medical records from all available sources
Create multidisciplinary team of specialists for case analysis
Involve child/adult protective services
Factitious imposed on another. Why would do that?
financial compensation, ACCESS TO CONTROLLED SUBSTANCES!!!
how long does it takes for melanosis coli to occur?
few months of anthraquinone (eg senna) use.
What metabolic in laxative use?
metabolic alkalosis (compensatory decrease in intestinal bicarbonate excretion)
What metabolic in Gi infection?
metabolic acidosis (rapid loss of intestinal bicarbonate)
what if melanosis coli is not present (gross)?
IF it is not present on gross histology can show pigment in the macrophages of the lamina propria.
metabolic disturbances in laxative? electrolytes?
Metabolic alkalosis + hypokalemia = classic finding in laxative abuse.
Potassium is lost in stools
–> impaired Cl reabsorption –> affected chloride-HCO3 exchange –> incr. serum bicarbonate.
If laxcatives contain magnesium –> hypermagnesemia
laxative. Diagnosis supported by what?
Positive stool screen for diphenolic (eg bysacodyl) or polyethylene-containing laxatives.
Further Dx suggested by melanosis coli on colonoscopy.
