Williams- Stool Flashcards
what to order to diagnose celiac disease
total celiac serology and total IgA!!!
what will be elevated in celiac disease
tT-IgA (tissue transglutaminase IgA)
This test is usedto check for IgA deficiency, a condition associated with celiac disease that can cause a false negativetTG-IgA or EMA result
total serum IgA
what is the body mainly recycling and absorbing
water and bile acids
over____L goes into our GI track and only ____ mL is excreted in the stool
over 9L; 150 mL
stool is mainly composed of what
water
composed of water, fiber, cellular debris, mucus, bacteria
stool
what makes us poop
MMC (migrating motor complex)
occurs every 90–230 minutes between meals
MMC
neurotransmitter that regulates MMC
motilin
impaired _____ can result in altered GI motility and can lead to SIBO
impaired MMC
75% of MMC originates in the _____
stomach
longest phase of MMC
phase I (resting)
active phase of MMC
phase III
questions to ask to take hx on stool
consistency
color
frequency
volume
pain
blood?
changes w/ diff foods
when are you having bowel movements
nocturnal stools red flag for what
inflammatory or secretory diarrhea
“rocks”
Bristol type 1
sausage like with cracks
bristol type 2 and 3
snake-like (normal)
Bristol type 4
bristol type 7
can you do a colonoscope here
no
normal stool color
earth colors (yellow, green, orange, brown)
how often do infants pass stool
several times a day
average for children to pass stool
every 1-2 days
average for adults to pass stool
every 1-2 days
cause of acholic stools
biliary obstruction
black stools
old blood
red in stool
fresh blood
neon color stool
from food industry (dye)
where do bile pigments come from
biliverdin
bilirubin
made from cholesterol in hepatocytes
bile acids
primary conjugation of bile acids
occurs in hepatocytes (CDxCA and cholic acid) conjugated from glycine or taurine)
____% of bile acids are recycled back to liver
90%
secondary conjugation of bile acids produces what and where do they go
deoxycholic acid or lithocholic acid; feces
comes from breakdown of old RBCs (heme)
bilirubin
gets conjugated in the liver by UGT1A1 (UDP)
bilirubin
_____% of bilirubin is excreted as feces
85%
we want to recycle ____ and excrete ____
recycle bile acids
excrete bilirubin
unconjugated bilirubin’s buddy
albumin
conjugated bilirubin’s buddy
glucoronate
2 bile pigments
biliverden (green)
bilirubin (yellow)
important to check baby’s ____ everyday
stool
average stool volume for adults
100-200g
average stool volume for infants
10g/kg/day
passage of stool should be ___ and painless
effortless
presence of pain may indicate bearing down and clenching (pooping against closed door)
dys-synergic defecation
other causes of painful bowel movement
constipation
inflammation (IBD, hemorrhoids)
is red in the stool always blood
no, can be dyes
blue for blood
fecal occult card
3 disorders to think of if patient is having diarrhea/constipation/abd pain after meals
lactose intolerance
celiac disease
IBS
nocturnal stools main indicator of _____
chronic inflammatory conditions (UC, Crohn’s)
patient can present with LLQ pain and bloody diarrhea
Ulcerative colitis
patient can present with RLQ pain and non-bloody/bloody diarrhea
Crohn’s disease
Loose watery stools more than 3 times per day
diarrhea
3 types of diarrhea
osmotic
secretory
inflammatory
increased solute load (more water to dilute the load); watery
osmotic diarrhea
stool frequency and volume will decrease with fasting
osmotic diarrhea
inflammation of intestinal mucosa; increased water and electrolyte secretion; stools mucous-filled, bloody
secretory diarrhea
stool frequency and volume NOT effected by fasting
secretory diarrhea
pH of this diarrhea is acidic
osmotic
pH of this diarrhea is neutral
secretory
low Na+ in stool
osmotic
lots of Na+ in stool
secretory
feeling of incomplete evacuation
tenesmus
trauma cases (huge blood loss); GI bleeding; significant hematochezia
ischemic injury to colon causing diarrhea
no inflammatory component seen with this syndrome
IBS
Inflammation of the intestinal mucosa, fever, elevated WBC in serum or stool, tenesmus, cramping (stool mucousy, bloody)
inflammatory diarrheal state
increased frequency of loose stools and nocturnal stools red flags for what
inflammatory diarrhea
common causes of inflammatory diarrhea
viral and bacterial infections
IBD
cancer
always look at what when patient comes in for diarrhea
medications they are taking
SSRI’s, NSAIDs, PPI’s, Metformin, Allopurinol can have SE of what
diarrhea
“I am having diarrhea, haven’t had solid stool in a year” (stool felt all over abdomen)—–patient is having_______
overflow constipation (NOT diarrhea)
malabsorption diseases causing diarrhea
celiac disease
SIBO
osmotic diarrhea examples
toddler’s diarrhea
laxative overuse
disaccharidase deficiency
secretory diarrhea examples
carcinoid syndrome
bile salt malabsorption
hyperthyroidism
Difficult, incomplete, or infrequent evacuation of dry hardened feces
constipation
Loose stools are not always diarrhea, they are sometimes _____ due to excessive stool burden
overflow of liquid (constipation w/ overflow)
primary reason for most cases of constipation in the US
inadequate fluid and fiber intake
IBS
continence controlled by what
internal anal sphincter
can lose function of nervous input to external, but can still maintain continence if what is still functioning
internal anal sphincter
Absence of an ________ can lead to small bowel bacterial overgrowth (SIBO)
ileocecal valve
7 sphincters of GI tract
UES
LES
pyloric
sphincter of Oddi
Ileocecal
internal anal
external anal
what is wrong
B shows compromised sphincter function
preferred method for checking for bacteria
collecting stools
____ are used for detecting N. gonorrhoeae and Chlamydia
swabs
Decreased in iron, vitamin B12, and folate malabsorption or with blood loss
hematocrit, hemoglobin
Decreased in iron malabsorption; increased in folate and vitamin B12malabsorption
mean corpuscular volume
Decreased in vitamin B12and folate malabsorption; low lymphocyte count in lymphangiectasia
WBC’s (CBC w/ diff)
Decreased in severe fat malabsorption
TG’s
Decreased in bile acid malabsorption or severe fat malabsorption
cholesterol
Decreased in severe malnutrition, lymphangiectasia, protein-losing enteropathy/ liver disease
albumin
Increased in calcium and vitamin D malabsorption (severe steatorrhea)
Alk Phos
decreased in vitamin D deficiency
Ca2+, phosphorus, magnesium
Decreased in extensive small intestinal mucosal disease or intestinal resection
zinc, Ca2+, phosphorus, magnesium
Decreased in celiac disease, in other extensive small intestinal mucosal diseases, and with chronic blood loss
iron, ferritin
Prolonged in vitamin K malabsorption
prothrombin time (PT)
Decreased in fat malabsorption from hepatobiliary or intestinal diseases
beta-carotene
Decreased in lymphangiectasia, diffuse lymphoma
immunoglobulins
Decreased in extensive small intestinal mucosal diseases, with anticonvulsant use, in pregnancy; may be increased in SIBO
folic acid
Decreased after gastrectomy, in pernicious anemia, terminal ileal disease, SIBO, and infection withDiphyllobothrium latum
vitamin B12
Markedly elevated in vitamin B12deficiency
methylmalonic acid
Markedly elevated in vitamin B12or folate deficiency
homocysteine
May be decreased in destructive small intestinal mucosal disease or intestinal resection
citrulline
qualitative increase in fat malabsorption seen in what test
stool fat test
Decreased concentrations and output in exocrine pancreatic insufficiency/chronic pancreatitis
fecal elastase or chymotrypsin
Less than 5.5 in carbohydrate malabsorption
stool pH
NAAT and PCR can be used for
N. gonorrhoeae and Chlamydia
Sudan III staining (for fecal fat) more than ____ globules = + result
6
floating stool concerning for
steatorrhea or fat malabsorption
Elevated in various situations of protein losing enteropathy
fecal alpha 1 anti-trypsin level
protein losing enteropathies
FPIAP (milk protein allergy)
medications
IBD
Elevated in the setting of carbohydrate malabsorption
stool reducing substances
Low in the setting of carbohydrate malabsorption
stool pH
stool sodium for
congenital Na+ losing diarrhea
stool chloride for
congenital chloride losing diarrhea
stool potassium for
stool osmolality
Assay to screen for PMN’s in the stool (normal is <50); used to differentiate inflammatory from non-inflammatory
fecal calprotectin
Will be high in the setting of infectious gastroenteritis, inflammatory bowel disease, and other inflammatory processes of the colon
fecal calprotectin
vitamin B12 (cobalamin) being malabsorbed
SIBO helminthic infections
vitamin B12 being malabsorbed due to decreased gastric acid or intrinsic factor secretion
pernicious anemia
atrophic gastritis
