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5 Feb 24 Flashcards

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1
Q

RF C difficile colitis

A

🪴Recent antibiotic use or hospitalization
🪴Advanced age >65
🪴Gastric acid suppression (PPI , H2 blocker )
🪴Underlying IBD
🪴Chemotherapy

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2
Q

CF of C difficile colitis

A

🍀Profuse watery diarrhea
🍀Leukocytosis (15,000)
🍀Fulminant colitis or toxic megacolon

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3
Q

Dx of C difficile colitis

A

🪹Stool PCR for C difficile genes

🪹stool EIA for C difficile toxin and glutamate dehydrogenase antigen

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4
Q

C difficile infection control

A

🌹hand hygiene with soap and water
🌹contact isolation
🌹sporicidal disinfectants (bleach)

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5
Q

Most imp RF for C difficile

A

Antibiotic use

Others.
Recent hospitalization
IBD
(Increased susceptibility by altering gut microbiome)

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6
Q

Signs of toxic megacolon in C difficile

A

Severe systemic toxicity
Abd distention
Cesaation of diarrhea
Perforation (rebound tenderness)

Confirmation : CTscan

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7
Q

Whipple dx CF

A

Men
Age 40-60s
Weight loss
Abd pain
Diarrhea
Malabsorption with distention
Flatulence
Steatorrhea
Migratory polyarthropathy
Chronic cough
Myocardial or valvular involvement (causes CCF or valvukar regurg)

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8
Q

Workup for IBS - constipation

A

Do CBC

If normal - Treat for IBS -C

If abnormal- colonoscopy

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9
Q

Workup for IBS- diarrhea

A

CBC
Stool culture celiac dx serology
CRP or Fecal calprotectin/lactoferrin

If normal - treat for IBS-D

If abnormal- treat underlying cause
Do colonoscopy

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10
Q

Alarm symptoms of IBS

A

Age >50
Rectal bleed /melena
Fasting diarrhea (nocturnal)
Worsening abd pain
Family history of IBD/CRC

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11
Q

IBS def

A

Recurrent abd pain and changes in stool freq or form in the absence of an organic cause or red flags.

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12
Q

Ttt of IBS

A

First line :
Lifestyle modification
(Dietary changes , exercise)
Soluble fibre (psyllium)
Avoid bran
Antidiarrheals (IBS-D)

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13
Q

Secretory diarrhea CF

A

🪴Secretion of electrolyes and water into intestine
🪴Low osmolar gap <50 mOsm/kg
🪴Large volume diarrhea
🪴Persists while fasting and at night

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14
Q

Cause of secretory diarrhea

A

Toxins (vibrio cholerae)
Hormones (VIPomas)
Cystic fibrosis
Bile acids (post surgical patients)

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15
Q

Osmotic diarrhea CF

A

🪵High stool osmotic gap >125mOsm/kg
🪵Presence of non absorbed osmotically active solute (polyethylene glycol, sorbitol, lactose)

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16
Q

Normal stool osmotic gap

A

290-2 x(stool Na + stool K)

<50. Secretory diarrhea
50-125. Indeterminate
> 125. Osmotic diarrhea

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17
Q

Common cause of secretory diarrhea in post op patients

A

Bowel resection or post cholecystectomy pts
Unabsorbed bile acids reach colon and cause direct stimulation of luminal ion channels
Resection of ileocecal area reduces ability of intestines to actively absorb sodium ions against electrochemical gradient.

18
Q

Fecal incontinence in a constipated elderly mechanism

A

Overflow incontinece due to fecal impaction

Mechanism: obstruction of fecal flow in rectum can cause backup of stool proximal to impaction , passage of liquid stool around impaction leads to incontinence.

Urinary incontinence is also common due to pressure against bladder

19
Q

Fecal incontinence causes

A

Cause: Elderly
Impaired mobility
Inadequate fluid or dietary fibr
Chronic constipation
Decreased sensation of stool in rectal vault (sp cd injury, dementia)

20
Q

Ttt of fecal incontinence due to impaction

A

Manual disimpaction
Enemas
Laxatives (polyethylene glycol , lactulose)
Dietary alterations:
(Inc intake fluid and fibre)

21
Q

Proctalgia figax pathphys

A

Spastic contraction of anal sphincter

Pendundal nerve compression

22
Q

RF for proctalgia fugax

A

Female
IBS
Psychosocial stress , anxiety

23
Q

CF of proctalgia fugax

A

🌻Recurrent rectal pain unrelated to defecation
🌻Episodes last sec to minutes (<30mins)
🌻No pain between episodes.
🌻ppt by stress, intercourse or sitting but often occur with no obvious trigger

24
Q

Examination and ttt

A

PE: Normal
Normal labs

Ttt :
Reassuarance
Nitroglycerin cream +- biofeedback therapy for refractory symptoms.

25
Q

DX of carcinoid syndrome

A

🌵Elevated 24hr urinary 5-HIAA
🌵CT / MRI of abd and pelvis to localise tumor
🌵Octreoscan to detect mets
🌵Echo (if symptoms of carcinoid heart dx are present)

26
Q

Ttt of Carcinoid S

A

🪴Octreotide for symptomatic pts
And prior to surgery / Anasthesia

🪴Surgery for Liver mets.

27
Q

Carcinoid etiology

A

🌸Well differentiated neuroendocrine tumors
🌸Location : distal intestine , prox small colon , lung , mets to liver.

🌸Secrete histamine , serotonin , VIP
In pts with liver mets the hormones are directly released into systemic circulation causing carcinoid

28
Q

CF of carcinoid syndrome

A

🍁Episodic flushing (85%)
🍁Hypotension and tachycardia
🍁Secretory diarrhea (with abd cramping)
🍁Cutaneous telangiectasia
🍁Bronchospasm
🍁TR :
Plaque like deposits of fibrous tissue on endocardium on Rt side of heart.

29
Q

Crohn dx CF

A

GIT :

   Abd pain 
   Non bloody diarrhea 
   Oral ulcers 
   Malabsorption 
   Weight loss 
   Fistula /abscess formation 
   Perianal dx

Extraintestinal :

   Musculoskeletal :       arthritis 
   Ophthalmic :            uveitis , scleritis , episcleritis 
   Skin :            Erythema nodosum, Pyoderma gangrenosum
30
Q

Dxof crohn

A

🌞Labs :

         Inc TLC
         Fe def 
         Inc Inflammatory markers

🌞B12 def (if terminal ileum involved)

🌞Endoscopy:

       Focal ulceration next to normal mucosa (cobblestoning) 
       Skip lesions, rectal sparing

🌞Radiography:

     Strictures , bowel wall thickening 
     And luminal narrowing (terminal ileum on CT)
31
Q

Ttt of crohn

A

Corticosteroids
Azthioprine
Anti TNF (infliximab)

32
Q

What is infectious colitis

A

Mimics crohns
Presents with ileitis
Acute process
Doesnt involve oral mucosa
Causative : Yersinia , parasites , amoebae

33
Q

Factitious diarrhea labs

A

Stool osmolality:

   Hypoosmolar: added water 
   Hyoerosmolar :   Urine added

Stool electrolytes :

    Mg and PO4 laxatives

Stool osmolar gap:

   High SOG:  lactulose , polyethylene glycol 
   Low SOG :  senna , bisacodyl
34
Q

Factitious disorder (imposed on self )
Features

A

Self induced illness
Exacerbation on self induced illness
Motivated by internal factors(making ppl take care of them -sick role)
And not external gains(finacial compensation)

35
Q

Factitious Dx imposed on self

A

DX :
Discovery of medical supplies
Sulfonylurea screen, stool laxative screen
Medical record review

36
Q

Gonococcal proctitis transmission

A

Receptive anal intercourse
Direct spread from vagina

37
Q

CF of gonococcal proctitis and ttt

A

🌎 mucopurulent anal discharge , occasional rectal bleed
🌎 tenesmus(straining with minimal stool , constipation
🌎 pruritis , rectal pain , rectal fullness

Dx : NAAT of rectal swab

Ttt: Ceftriaxone + doxycycline (to cover chlamydia)

38
Q

DD crohn dx vs gonococcal proctitis

A

CD has rectal sparing so it doesnt cause tenesmus.
CD has anal fistula and perirectal abscess (visible on exam)

39
Q

Clostridium septicum bacteremia association?

A

Colon cancer

Do colonoscopy as screening

Also ass with group D strept(bovis)

40
Q

Why is C septicum risk inc in cancer

A

Tumor cells undergo anaerobic glycolysis creating adequte env for germination of C septicum spores , tumor damages the colonic mucosa which allows sporulated bacteria to go to bloodstream.

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