Williams- Stool Flashcards
1
Q
what to order to diagnose celiac disease
A
total celiac serology and total IgA!!!
2
Q
what will be elevated in celiac disease
A
tT-IgA (tissue transglutaminase IgA)
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
4
Q
what is the body mainly recycling and absorbing
A
water and bile acids
5
Q
over____L goes into our GI track and only ____ mL is excreted in the stool
A
over 9L; 150 mL
6
Q
stool is mainly composed of what
A
water
7
Q
composed of water, fiber, cellular debris, mucus, bacteria
A
stool
8
Q
what makes us poop
A
MMC (migrating motor complex)
9
Q
occurs every 90–230 minutes between meals
A
MMC
10
Q
neurotransmitter that regulates MMC
A
motilin
11
Q
impaired _____ can result in altered GI motility and can lead to SIBO
A
impaired MMC
12
Q
75% of MMC originates in the _____
A
stomach
13
Q
longest phase of MMC
A
phase I (resting)
14
Q
active phase of MMC
A
phase III
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
16
Q
nocturnal stools red flag for what
A
inflammatory or secretory diarrhea
17
Q
“rocks”
A
Bristol type 1
18
Q
sausage like with cracks
A
bristol type 2 and 3
19
Q
snake-like (normal)
A
Bristol type 4
20
Q
A
bristol type 7
21
Q
can you do a colonoscope here
A
no
22
Q
normal stool color
A
earth colors (yellow, green, orange, brown)
23
Q
how often do infants pass stool
A
several times a day
24
Q
average for children to pass stool
A
every 1-2 days
25
average for adults to pass stool
every 1-2 days
26
cause of acholic stools
biliary obstruction
27
black stools
old blood
28
red in stool
fresh blood
29
neon color stool
from food industry (dye)
30
where do bile pigments come from
biliverdin
bilirubin
31
made from cholesterol in hepatocytes
bile acids
32
primary conjugation of bile acids
occurs in hepatocytes (CDxCA and cholic acid) conjugated from glycine or taurine)
33
____% of bile acids are recycled back to liver
90%
34
secondary conjugation of bile acids produces what and where do they go
deoxycholic acid or lithocholic acid; feces
35
comes from breakdown of old RBCs (heme)
bilirubin
36
gets conjugated in the liver by UGT1A1 (UDP)
bilirubin
37
_____% of bilirubin is excreted as feces
85%
38
we want to recycle ____ and excrete ____
recycle bile acids
excrete bilirubin
39
unconjugated bilirubin's buddy
albumin
40
conjugated bilirubin's buddy
glucoronate
41
2 bile pigments
biliverden (green)
bilirubin (yellow)
42
important to check baby's ____ everyday
stool
43
average stool volume for adults
100-200g
44
average stool volume for infants
10g/kg/day
45
passage of stool should be ___ and painless
effortless
46
presence of pain may indicate bearing down and clenching (pooping against closed door)
dys-synergic defecation
47
other causes of painful bowel movement
constipation
inflammation (IBD, hemorrhoids)
48
is red in the stool always blood
no, can be dyes
49
blue for blood
fecal occult card
50
3 disorders to think of if patient is having diarrhea/constipation/abd pain after meals
lactose intolerance
celiac disease
IBS
51
nocturnal stools main indicator of _____
chronic inflammatory conditions (UC, Crohn's)
52
patient can present with LLQ pain and bloody diarrhea
Ulcerative colitis
53
patient can present with RLQ pain and non-bloody/bloody diarrhea
Crohn's disease
54
Loose watery stools more than 3 times per day
diarrhea
55
3 types of diarrhea
osmotic
secretory
inflammatory
56
increased solute load (more water to dilute the load); watery
osmotic diarrhea
57
stool frequency and volume will decrease with fasting
osmotic diarrhea
58
inflammation of intestinal mucosa; increased water and electrolyte secretion; stools mucous-filled, bloody
secretory diarrhea
59
stool frequency and volume NOT effected by fasting
secretory diarrhea
60
pH of this diarrhea is acidic
osmotic
61
pH of this diarrhea is neutral
secretory
62
low Na+ in stool
osmotic
63
lots of Na+ in stool
secretory
64
feeling of incomplete evacuation
tenesmus
65
trauma cases (huge blood loss); GI bleeding; significant hematochezia
ischemic injury to colon causing diarrhea
66
no inflammatory component seen with this syndrome
IBS
67
Inflammation of the intestinal mucosa, fever, elevated WBC in serum or stool, tenesmus, cramping (stool mucousy, bloody)
inflammatory diarrheal state
68
increased frequency of loose stools and nocturnal stools red flags for what
inflammatory diarrhea
69
common causes of inflammatory diarrhea
viral and bacterial infections
IBD
cancer
70
always look at what when patient comes in for diarrhea
medications they are taking
71
SSRI's, NSAIDs, PPI's, Metformin, Allopurinol can have SE of what
diarrhea
72
“I am having diarrhea, haven’t had solid stool in a year” (stool felt all over abdomen)-----patient is having_______
overflow constipation (NOT diarrhea)
73
malabsorption diseases causing diarrhea
celiac disease
SIBO
74
osmotic diarrhea examples
toddler's diarrhea
laxative overuse
disaccharidase deficiency
75
secretory diarrhea examples
carcinoid syndrome
bile salt malabsorption
hyperthyroidism
76
Difficult, incomplete, or infrequent evacuation of dry hardened feces
constipation
77
Loose stools are not always diarrhea, they are sometimes _____ due to excessive stool burden
overflow of liquid (constipation w/ overflow)
78
primary reason for most cases of constipation in the US
inadequate fluid and fiber intake
IBS
79
continence controlled by what
internal anal sphincter
80
can lose function of nervous input to external, but can still maintain continence if what is still functioning
internal anal sphincter
81
Absence of an ________ can lead to small bowel bacterial overgrowth (SIBO)
ileocecal valve
82
7 sphincters of GI tract
UES
LES
pyloric
sphincter of Oddi
Ileocecal
internal anal
external anal
83
what is wrong
B shows compromised sphincter function
84
preferred method for checking for bacteria
collecting stools
85
____ are used for detecting N. gonorrhoeae and Chlamydia
swabs
86
Decreased in iron, vitamin B12, and folate malabsorption or with blood loss
hematocrit, hemoglobin
87
Decreased in iron malabsorption; increased in folate and vitamin B12 malabsorption
mean corpuscular volume
88
Decreased in vitamin B12 and folate malabsorption; low lymphocyte count in lymphangiectasia
WBC's (CBC w/ diff)
89
Decreased in severe fat malabsorption
TG's
90
Decreased in bile acid malabsorption or severe fat malabsorption
cholesterol
91
Decreased in severe malnutrition, lymphangiectasia, protein-losing enteropathy/ liver disease
albumin
92
Increased in calcium and vitamin D malabsorption (severe steatorrhea)
Alk Phos
93
decreased in vitamin D deficiency
Ca2+, phosphorus, magnesium
94
Decreased in extensive small intestinal mucosal disease or intestinal resection
zinc, Ca2+, phosphorus, magnesium
95
Decreased in celiac disease, in other extensive small intestinal mucosal diseases, and with chronic blood loss
iron, ferritin
96
Prolonged in vitamin K malabsorption
prothrombin time (PT)
97
Decreased in fat malabsorption from hepatobiliary or intestinal diseases
beta-carotene
98
Decreased in lymphangiectasia, diffuse lymphoma
immunoglobulins
99
Decreased in extensive small intestinal mucosal diseases, with anticonvulsant use, in pregnancy; may be increased in SIBO
folic acid
100
Decreased after gastrectomy, in pernicious anemia, terminal ileal disease, SIBO, and infection with Diphyllobothrium latum
vitamin B12
101
Markedly elevated in vitamin B12 deficiency
methylmalonic acid
102
Markedly elevated in vitamin B12 or folate deficiency
homocysteine
103
May be decreased in destructive small intestinal mucosal disease or intestinal resection
citrulline
104
qualitative increase in fat malabsorption seen in what test
stool fat test
105
Decreased concentrations and output in exocrine pancreatic insufficiency/chronic pancreatitis
fecal elastase or chymotrypsin
106
Less than 5.5 in carbohydrate malabsorption
stool pH
107
NAAT and PCR can be used for
N. gonorrhoeae and Chlamydia
108
Sudan III staining (for fecal fat) more than ____ globules = + result
6
109
floating stool concerning for
steatorrhea or fat malabsorption
110
Elevated in various situations of protein losing enteropathy
fecal alpha 1 anti-trypsin level
111
protein losing enteropathies
FPIAP (milk protein allergy)
medications
IBD
112
Elevated in the setting of carbohydrate malabsorption
stool reducing substances
113
Low in the setting of carbohydrate malabsorption
stool pH
114
stool sodium for
congenital Na+ losing diarrhea
115
stool chloride for
congenital chloride losing diarrhea
116
stool potassium for
stool osmolality
117
Assay to screen for PMN’s in the stool (normal is <50); used to differentiate inflammatory from non-inflammatory
fecal calprotectin
118
Will be high in the setting of infectious gastroenteritis, inflammatory bowel disease, and other inflammatory processes of the colon
fecal calprotectin
119
vitamin B12 (cobalamin) being malabsorbed
SIBO helminthic infections
120
vitamin B12 being malabsorbed due to decreased gastric acid or intrinsic factor secretion
pernicious anemia
atrophic gastritis
