Colitis, Toxic Megacolon, & IBS

Question 1

what are 5 risk factors for infectious colitis?

Answer 1

immune deficiency
recent abx usage - C. diff
ingestion of undercooked foods
endemic area travel
receptive rectal intercourse

Question 2

a patient with a history of Herpes presents with abdominal pain, tenderness, +/- fever, and diarrhea +/- gross blood. Dx?

Answer 2

infectious colitis

Question 3

what is the management for infectious colitis? (4)

Answer 3

antibiotics or antivirals
address underlying deficiency
D/C problematic meds
STI precautions

Question 4

potentially life-threating complication of IBD or infectious colitis that results in an ileus, dilation, and sepsis

Answer 4

toxic megacolon

Question 5

what are 4 etiologies of toxic megacolon?

Answer 5

hypokalemia
meds: antimotility, anticholinergics, opiates, antidepressants
barium enemas
colonoscopy

Question 6

a patient presents with worsening abdominal pain, worsening diarrhea + bloody or obstipation, with abdominal tenderness, +/- peritonitis, and +/- sepsis. Dx?

Answer 6

toxic megacolon

Question 7

what diagnostic can we do to diagnose toxic megacolon? (2)

Answer 7

CT scan OR abdominal xray

Question 8

what will we see in a CT scan or abdominal xray of a patient with toxic megacolon? (2)

Answer 8

colon dilation
free air in RUQ if perforation

Question 9

what should we avoid doing in a patient with toxic megacolon? (2) why?

Answer 9

colonoscopy
sigmoidoscopy

avoid perforation

Question 10

what will be seen in labs of toxic megacolon? (4)

Answer 10

leukocytosis
anemia
electrolyte abnormalities
+ FOBT

Question 11

what are the diagnostic criteria for toxic megacolon? (3)

Answer 11

radiographic colon distention
+
at least 3: fever > 100.4, HR > 120, neutrophil > 10,500, anemia
+
at least 1: clinical dehydration, AMS, electrolyte disturbance, hypotension

Question 12

what is the management for toxic megacolon? (5)

Answer 12

NPO
IV hydration
NG tube decompression OR log roll
D/C problematic meds
antibiotics

Question 13

when is surgery indicated for toxic megacolon? (4)

Answer 13

uncontrolled bleeding
perforation
worsening toxicity
dilation

Question 14

idiopathic, functional GI disorder that is characterized by chronic or recurrent symptoms with no evidence of structural or biochemical abnormalities

Answer 14

irritable bowel syndrome

Question 15

what are the diagnostic criteria for IBS?

Answer 15

at least 3 months of abdominal pain
at least 1x per week
+
at least 2:
relief with bowel movement
change in stool frequency
change in stool form

Question 16

a patient presents with abdominal cramps (esp. in lower abdomen), change in stool frequency or consistency, diarrhea/constipation, and does not interfere with sleep. Dx?

Answer 16

irritable bowel syndrome

Question 17

how is irritable bowel syndrome diagnosed?

Answer 17

clinically

Question 18

in which patients should IBS be suspected? (2)

Answer 18

abdominal pain
altered bowel habits

Question 19

when should labs and colonoscopy be performed in a patient with suspected IBS?

Answer 19

if patient has red flags:
nocturnal diarrhea
hematochezia
weight loss
reported fever
FHx of cancer, IBD, or celiac disease
onset > 40 yo

Question 20

what is the management for IBS? (4)

Answer 20

reassurance
education
support
diet

Question 21

what is the 1st line treatment for IBS? (2)

Answer 21

exercise
increased soluble fiber in diet

Question 22

what is the 2nd line treatment for IBS? (2)

Answer 22

TCAs
SSRIs

Question 23

what is the recommended diet that should be avoided in IBS?

Answer 23

Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
Polyols

Question 24

what med can be used for diarrhea in IBS?

Answer 24

rifaximin

Question 25

what med can be used for constipation in IBS? (2)

Answer 25

lubiprostone
OR
linaclotide