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DIG: Biweekly 3 > Williams- Stool > Flashcards

Williams- Stool Flashcards

1
Q

what to order to diagnose celiac disease

A

total celiac serology and total IgA!!!

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2
Q

what will be elevated in celiac disease

A

tT-IgA (tissue transglutaminase IgA)

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3
Q

This test is usedto check for IgA deficiency, a condition associated with celiac disease that can cause a false negativetTG-IgA or EMA result

A

total serum IgA

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4
Q

what is the body mainly recycling and absorbing

A

water and bile acids

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5
Q

over____L goes into our GI track and only ____ mL is excreted in the stool

A

over 9L; 150 mL

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6
Q

stool is mainly composed of what

A

water

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7
Q

composed of water, fiber, cellular debris, mucus, bacteria

A

stool

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8
Q

what makes us poop

A

MMC (migrating motor complex)

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9
Q

occurs every 90–230 minutes between meals

A

MMC

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10
Q

neurotransmitter that regulates MMC

A

motilin

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11
Q

impaired _____ can result in altered GI motility and can lead to SIBO

A

impaired MMC

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12
Q

75% of MMC originates in the _____

A

stomach

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13
Q

longest phase of MMC

A

phase I (resting)

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14
Q

active phase of MMC

A

phase III

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15
Q

questions to ask to take hx on stool

A

consistency
color
frequency
volume
pain
blood?
changes w/ diff foods
when are you having bowel movements

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16
Q

nocturnal stools red flag for what

A

inflammatory or secretory diarrhea

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17
Q

“rocks”

A

Bristol type 1

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18
Q

sausage like with cracks

A

bristol type 2 and 3

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19
Q

snake-like (normal)

A

Bristol type 4

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20
Q
A

bristol type 7

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21
Q

can you do a colonoscope here

A

no

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22
Q

normal stool color

A

earth colors (yellow, green, orange, brown)

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23
Q

how often do infants pass stool

A

several times a day

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24
Q

average for children to pass stool

A

every 1-2 days

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25
Q

average for adults to pass stool

A

every 1-2 days

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26
Q

cause of acholic stools

A

biliary obstruction

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27
Q

black stools

A

old blood

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28
Q

red in stool

A

fresh blood

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29
Q

neon color stool

A

from food industry (dye)

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30
Q

where do bile pigments come from

A

biliverdin
bilirubin

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31
Q

made from cholesterol in hepatocytes

A

bile acids

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32
Q

primary conjugation of bile acids

A

occurs in hepatocytes (CDxCA and cholic acid) conjugated from glycine or taurine)

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33
Q

____% of bile acids are recycled back to liver

A

90%

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34
Q

secondary conjugation of bile acids produces what and where do they go

A

deoxycholic acid or lithocholic acid; feces

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35
Q

comes from breakdown of old RBCs (heme)

A

bilirubin

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36
Q

gets conjugated in the liver by UGT1A1 (UDP)

A

bilirubin

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37
Q

_____% of bilirubin is excreted as feces

A

85%

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38
Q

we want to recycle ____ and excrete ____

A

recycle bile acids
excrete bilirubin

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39
Q

unconjugated bilirubin’s buddy

A

albumin

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40
Q

conjugated bilirubin’s buddy

A

glucoronate

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41
Q

2 bile pigments

A

biliverden (green)
bilirubin (yellow)

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42
Q

important to check baby’s ____ everyday

A

stool

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43
Q

average stool volume for adults

A

100-200g

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44
Q

average stool volume for infants

A

10g/kg/day

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45
Q

passage of stool should be ___ and painless

A

effortless

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46
Q

presence of pain may indicate bearing down and clenching (pooping against closed door)

A

dys-synergic defecation

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47
Q

other causes of painful bowel movement

A

constipation
inflammation (IBD, hemorrhoids)

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48
Q

is red in the stool always blood

A

no, can be dyes

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49
Q
A

blue for blood
fecal occult card

50
Q

3 disorders to think of if patient is having diarrhea/constipation/abd pain after meals

A

lactose intolerance
celiac disease
IBS

51
Q

nocturnal stools main indicator of _____

A

chronic inflammatory conditions (UC, Crohn’s)

52
Q

patient can present with LLQ pain and bloody diarrhea

A

Ulcerative colitis

53
Q

patient can present with RLQ pain and non-bloody/bloody diarrhea

A

Crohn’s disease

54
Q

Loose watery stools more than 3 times per day

A

diarrhea

55
Q

3 types of diarrhea

A

osmotic
secretory
inflammatory

56
Q

increased solute load (more water to dilute the load); watery

A

osmotic diarrhea

57
Q

stool frequency and volume will decrease with fasting

A

osmotic diarrhea

58
Q

inflammation of intestinal mucosa; increased water and electrolyte secretion; stools mucous-filled, bloody

A

secretory diarrhea

59
Q

stool frequency and volume NOT effected by fasting

A

secretory diarrhea

60
Q

pH of this diarrhea is acidic

A

osmotic

61
Q

pH of this diarrhea is neutral

A

secretory

62
Q

low Na+ in stool

A

osmotic

63
Q

lots of Na+ in stool

A

secretory

64
Q

feeling of incomplete evacuation

A

tenesmus

65
Q

trauma cases (huge blood loss); GI bleeding; significant hematochezia

A

ischemic injury to colon causing diarrhea

66
Q

no inflammatory component seen with this syndrome

A

IBS

67
Q

Inflammation of the intestinal mucosa, fever, elevated WBC in serum or stool, tenesmus, cramping (stool mucousy, bloody)

A

inflammatory diarrheal state

68
Q

increased frequency of loose stools and nocturnal stools red flags for what

A

inflammatory diarrhea

69
Q

common causes of inflammatory diarrhea

A

viral and bacterial infections
IBD
cancer

70
Q

always look at what when patient comes in for diarrhea

A

medications they are taking

71
Q

SSRI’s, NSAIDs, PPI’s, Metformin, Allopurinol can have SE of what

A

diarrhea

72
Q

“I am having diarrhea, haven’t had solid stool in a year” (stool felt all over abdomen)—–patient is having_______

A

overflow constipation (NOT diarrhea)

73
Q

malabsorption diseases causing diarrhea

A

celiac disease
SIBO

74
Q

osmotic diarrhea examples

A

toddler’s diarrhea
laxative overuse
disaccharidase deficiency

75
Q

secretory diarrhea examples

A

carcinoid syndrome
bile salt malabsorption
hyperthyroidism

76
Q

Difficult, incomplete, or infrequent evacuation of dry hardened feces

A

constipation

77
Q

Loose stools are not always diarrhea, they are sometimes _____ due to excessive stool burden

A

overflow of liquid (constipation w/ overflow)

78
Q

primary reason for most cases of constipation in the US

A

inadequate fluid and fiber intake
IBS

79
Q

continence controlled by what

A

internal anal sphincter

80
Q

can lose function of nervous input to external, but can still maintain continence if what is still functioning

A

internal anal sphincter

81
Q

Absence of an ________ can lead to small bowel bacterial overgrowth (SIBO)

A

ileocecal valve

82
Q

7 sphincters of GI tract

A

UES
LES
pyloric
sphincter of Oddi
Ileocecal
internal anal
external anal

83
Q

what is wrong

A

B shows compromised sphincter function

84
Q

preferred method for checking for bacteria

A

collecting stools

85
Q

____ are used for detecting N. gonorrhoeae and Chlamydia

A

swabs

86
Q

Decreased in iron, vitamin B12, and folate malabsorption or with blood loss

A

hematocrit, hemoglobin

87
Q

Decreased in iron malabsorption; increased in folate and vitamin B12malabsorption

A

mean corpuscular volume

88
Q

Decreased in vitamin B12and folate malabsorption; low lymphocyte count in lymphangiectasia

A

WBC’s (CBC w/ diff)

89
Q

Decreased in severe fat malabsorption

A

TG’s

90
Q

Decreased in bile acid malabsorption or severe fat malabsorption

A

cholesterol

91
Q

Decreased in severe malnutrition, lymphangiectasia, protein-losing enteropathy/ liver disease

A

albumin

92
Q

Increased in calcium and vitamin D malabsorption (severe steatorrhea)

A

Alk Phos

93
Q

decreased in vitamin D deficiency

A

Ca2+, phosphorus, magnesium

94
Q

Decreased in extensive small intestinal mucosal disease or intestinal resection

A

zinc, Ca2+, phosphorus, magnesium

95
Q

Decreased in celiac disease, in other extensive small intestinal mucosal diseases, and with chronic blood loss

A

iron, ferritin

96
Q

Prolonged in vitamin K malabsorption

A

prothrombin time (PT)

97
Q

Decreased in fat malabsorption from hepatobiliary or intestinal diseases

A

beta-carotene

98
Q

Decreased in lymphangiectasia, diffuse lymphoma

A

immunoglobulins

99
Q

Decreased in extensive small intestinal mucosal diseases, with anticonvulsant use, in pregnancy; may be increased in SIBO

A

folic acid

100
Q

Decreased after gastrectomy, in pernicious anemia, terminal ileal disease, SIBO, and infection withDiphyllobothrium latum

A

vitamin B12

101
Q

Markedly elevated in vitamin B12deficiency

A

methylmalonic acid

102
Q

Markedly elevated in vitamin B12or folate deficiency

A

homocysteine

103
Q

May be decreased in destructive small intestinal mucosal disease or intestinal resection

A

citrulline

104
Q

qualitative increase in fat malabsorption seen in what test

A

stool fat test

105
Q

Decreased concentrations and output in exocrine pancreatic insufficiency/chronic pancreatitis

A

fecal elastase or chymotrypsin

106
Q

Less than 5.5 in carbohydrate malabsorption

A

stool pH

107
Q

NAAT and PCR can be used for

A

N. gonorrhoeae and Chlamydia

108
Q

Sudan III staining (for fecal fat) more than ____ globules = + result

A

6

109
Q

floating stool concerning for

A

steatorrhea or fat malabsorption

110
Q

Elevated in various situations of protein losing enteropathy

A

fecal alpha 1 anti-trypsin level

111
Q

protein losing enteropathies

A

FPIAP (milk protein allergy)
medications
IBD

112
Q

Elevated in the setting of carbohydrate malabsorption

A

stool reducing substances

113
Q

Low in the setting of carbohydrate malabsorption

A

stool pH

114
Q

stool sodium for

A

congenital Na+ losing diarrhea

115
Q

stool chloride for

A

congenital chloride losing diarrhea

116
Q

stool potassium for

A

stool osmolality

117
Q

Assay to screen for PMN’s in the stool (normal is <50); used to differentiate inflammatory from non-inflammatory

A

fecal calprotectin

118
Q

Will be high in the setting of infectious gastroenteritis, inflammatory bowel disease, and other inflammatory processes of the colon

A

fecal calprotectin

119
Q

vitamin B12 (cobalamin) being malabsorbed

A

SIBO helminthic infections

120
Q

vitamin B12 being malabsorbed due to decreased gastric acid or intrinsic factor secretion

A

pernicious anemia
atrophic gastritis

DIG: Biweekly 3 (12 decks)

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