UW revision factitous laxatives

Question 1

Factitious. Behavioural characteristics? 2

Answer 1

Intentional falsification of illness: feigninng illness, self-induced illness, exacerbation of preexisting illness

Question 2

Factitious. CP? 4

Answer 2

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)

Question 3

Factitious. Dx? 4

Answer 3

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)

Question 4

Factitious. Stool osmotic gap formula?

Answer 4

290 - 2x(stool Na + stool K)

Question 5

Factitious. Stool osmotic gap < 50?

Answer 5

secretory diarrhea

Question 6

Factitious. Stool osmotic gap 50-125?

Answer 6

indeterminate

Question 7

Factitious. Stool osmotic gap >125?

Answer 7

Osmotic diarrhea

Question 8

SECRETORY DIARRHEA. Causes? 4

Answer 8

Toxins (eg Vibrio cholera), hormones (produced by VIPomas), congenital disorders of ion transport (eg CF), or bile acids (in postsurgical patients)

Question 9

SECRETORY DIARRHEA. CP?2

Answer 9

Low osmotic stool gap
Diarrhea persist during periods of fasting (eg diarrhea during night)

Question 10

OSMOTIC DIARRHEA. Causes?

Answer 10

Osmotic laxatives
Causative substances = milk in a patient with lactose intolerance

Question 11

OSMOTIC DIARRHEA. CP?

Answer 11

Diarrhea presents only then substance is consumed, but not present when fasting.

Question 12

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.

Answer 12

.

Question 13

Factitious imposed on another table. definition?

Answer 13

intentional falsification of symptoms or induction of illness in another person (eg child, older person)

Question 14

Factitious imposed on another table. Characteristics of caregiver (offender)? 2

Answer 14

Motivated by desire to assume caregiver role (no external gain)

Female>male (95 proc are female, often primary caretaker)

Question 15

Factitious imposed on another table. CP?

Answer 15

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

Question 16

Factitious imposed on another table. Intervention?

Answer 16

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

Question 17

Factitious imposed on another. Why would do that?

Answer 17

financial compensation, ACCESS TO CONTROLLED SUBSTANCES!!!

Question 18

how long does it takes for melanosis coli to occur?

Answer 18

few months of anthraquinone (eg senna) use.

Question 19

What metabolic in laxative use?

Answer 19

metabolic alkalosis (compensatory decrease in intestinal bicarbonate excretion)

Question 20

What metabolic in Gi infection?

Answer 20

metabolic acidosis (rapid loss of intestinal bicarbonate)

Question 21

what if melanosis coli is not present (gross)?

Answer 21

IF it is not present on gross  histology can show pigment in the macrophages of the lamina propria.

Question 22

metabolic disturbances in laxative? electrolytes?

Answer 22

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

Question 23

laxative. Diagnosis supported by what?

Answer 23

Positive stool screen for diphenolic (eg bysacodyl) or polyethylene-containing laxatives.

Further Dx suggested by melanosis coli on colonoscopy.