Week 3 Flashcards
what are the 4 IBS subtypes
IBS-d (with diarrhea)
IBS-c (with constipation)
IBS-m (mixed with const. and diarrhea)
IBS-u (unsubtyped IBS)
Rome Criteria IV
Bristol stool scale
Brain-Gut Pathway
Gut-Brain Axis
Some things that happen with IBS
Alarm features for IBS
- Age ≥50 years old
- Blood in stools
- Nocturnal symptoms
- Unintentional weight loss
- Change in symptoms
- Recent antibiotic use
- Family history of organic GI
disease
Peruse some ways of screening some things
Why is colonoscopy not necessary without alarm features?
Because low occurrence of abnormal visual structures
Diagnostic flow for IBS
safety of some foods
What the fuck is FODMAP. You want low FODMAP with IBS, typical diets are considered high FODMAP
High FODMAP Foods
Low FODMAP BAMMM!!
Does just going GF help all people with IBS?
nah brah, you gotta test other foods dudes
Use peppermint oil, duh
Antidepressants help
ok
Treat predominant symptoms. Ab Pain
Treat predominant symptoms. Constipation
Treat predominant symptoms. Diarrhea
Treat predominant symptoms. Bloating
Two types of IBD
Crohn’s
Ulcerative colitis
3 legs of IBS stool of treatment
-motility agents (laxatives, anti-diarrheal)
-Neuromodulators, antidepressants
-Dietary changes
Sx of Crohn’s
-Skip lesions, skip areas (from mouth to rectum, typically starts at terminal ileum, affects any part of digestive tract.
-cobblestoning
-creeping fat and fistula
-diarrhea
-x-ray-String Sign (bowel wall thickening)
-Histopathology ~ non-reseating granuloma, Th 1 mediated inflammation, transmural inflammation
Sx of Ulcerative colitis
-Inflammation limited to colon
-continuous information, always involves rectum
-Deep ulcerations and pseudo polyps
-Bleeding diarrhea
-X-ray lead-pipe sign (loss of haustra)
-histopathology -> crypt abcess, th2 mediated inflammation, involves mucosa, submucosa
Good to explore what’s going on in intestines
The ravages of IBD
Compare risk factors of IBD types (Crohn’s and Ulcerative)
Review CDAI scoring for Crohn’s
Mayo clinic scoring
Therapeutic goals in IBD
Is IBD increased risk for colon cancer?
Yes, 10% at 20 years…
Recommended surveillance?
Red flags in GI: Mid-epigastric pain and vomit blood
condition assumed present until proven otherwise
-upper GI hemorrhage from inner lining of ST/esophagus
-possible consequences of misdiagnosis is massive bleeding from upper GI leading to death
Signs of Mid-epigastric pain with vomit blood
Refer to ER
Red flags in GI: Daily heartburn for many years
Refer to Doc
Red flags in GI: Mid-ab pain followed by vomiting then pain moving to RLQ
ACUTE APPENDICITIS, Refer to ER
Signs of appendicitis
- Only 50% of case has the above symptoms
- Absence of appetite
- Vomit follows onset of pain
- RLQ tenderness
- Rebound tenderness, pain on percussion, rigidity, guarding
- Invariably absence of bowel sounds
- Low grade fever -> Rupture of appendix
what can mimic appendicitis symptoms?
ectopic pregnancy
Tests for appendicitis?
Red flags in GI: mid to lower Ab colicky pain, vomit, constipation, ab distension
Condition assumed present until proven otherwise: BOWEL OBSTRUCTION
Possible consequences of Bowel Obstruction?
Death.
Refer to Emergency Department
four types of bowel obstruction?
bowel obstruction key feature?
persistent vomit
acute small intestine obstruction Sx
- Pain appears first and followed by vomit, distension, constipation
large intestine bowel obstruction Sx
- Constipation is followed by distension, pain, vomit
sign always present with any bowel obstruction?
distended abdomen
GI red flags: Acute bloody diarrhea (6-8 stools/day) and fever of over 101.5 F
Serious
Enteritis (Gastroenteritis if persistent vomit in addition to diarrhe)
possible consequences of serious enteritis?
serious disability and/or death from dehydration and electrolyte imbalance
2 types of serious enteritis?
acute infectious (viruses, bacteria, parasites)
inflammatory autoimmune bowel disease (UC, Crohn’s, etc)
What to ask and look for in serious enteritis?
Inquire:
* Number of stools daily
* Presence of blood in stool
* Presence of fever
Objective Findings:
* Visible blood
* Temp > 101.5 F
* Hyperactive bowel sound (borborygmi)
* Generalized abdominal tenderness to palpation, esp. if on LLQ
Risk factors for infectious enteritis:
- Age < 5 y.o.
- Exposure to unclean water / food
- Lack of hand washing
risk factors for IBD
- Cigarette smoking
- Family history
Red flags in GI: new onset constipation + unexplained weight loss in person over 40 years old
Carcinoma of colon (and rectum)
Possible consequences of missing carcinoma
metastasis, death
what do to if you see new onset constipation + unexplained weight loss in person over 40 years old
Refer to doctor
