5.15 GI 7 & 8 game Flashcards
(31 cards)
How do you Tx toxic megacolon?
1) Admit to ICU
2) ABCs
3) Bowel rest (NPO)
4) Stop any antimotility agents
5) Treat underlying cause
6) Surgery
Name some etiologies of toxic megacolon
1) IBD (most common UC) or infectious colitis
2) Antidiarrheals
3) Antimotility agents (loperamide), opiates, anticholinergics, antidepressants
What are the 2 major components of toxic megacolon?
Sepsis
Mega colon
What are other causes of large bowel obstructions? What abt small bowel?
Malignancy, hernias, strictures
Small bowel: adhesions
What is the most common cause of large bowel obstructions?
Volvulus
. Name the 3 arteries involved in mesenteric ischemic (that supply the GI tract). Which is most common?
1) SMA, IMA, Celiac arteries
2) SMA most common
Name 4 things that can cause mesenteric ischemia
Thrombus, vasospasm, hypercoagulable state, low flow
Mesenteric ischemia typically involves what part of the intestine?
Small bowel
Name 4 DDxs for IBS
IBD, Celiac, Microcolitis, SBO
Name & describe 4 parts of the initial IBS work up
1) History: IBS features, BSFS, organic disease, med exposures, recent gastroenteritis, FHx (CRC, IBD, Celiac)
2) Physical examination: usually normal, possible tender abdomen; include DRE for constipation
3) Labs to exclude alternative diagnosis:
All IBS: CBC + CMP
IBS-D: fecal calprotectin or lactoferrin, stool test for giardia, Celiac serologies, CRP (if calprotectin or lactoferrin not available)
Cultures + occult blood
4) Colonoscopy: age-appropriate CRC screening in all pts
What number on the Bristol Stool scale is considered normal? Constipation? Diarrhea?
1-2 = constipation
4 = normal
6-7 = diarrhea
List the 4 Rome IV criteria
1) Related to defecation
2) Associated with a change in stool frequency
3) Associated with a change in stool form (appearance)
4) Recurrent abdominal pain, on average, at least one day per week in the last three months
Name the alarm features of IBS
Age of onset > 50
Rectal bleeding/melena
Nocturnal diarrhea
Progressive abdominal pain
Unexplained weight loss
Lab abnormalities (IDA, elevated CRP or fecal calprotectin/lactoferrin)
Family history of IBD or CRC
Name 4 symptoms of IBS
Crampy pain relieved with defecation, diarrhea, constipation, & urgency
How do you wash your hands w C. Diff?
With soap and water [for at least 15 seconds]
GBS is noted most commonly after which pathogen?
Campylobacter
Name 3 post diarrhea complication
1) Post-Infectious Reactive Arthritis (ReA)
2) Post-Infectious Guillain-Barre Syndrome (GBS)
3) Post-Infectious Irritable Bowel Syndrome (IBS)
Which infectious diarrhea do you NOT give ATBs for and why?
Shiga toxigenic E. coli (STEC); can increase risk of HUS.
What are 2 DOCs for infectious diarrhea?
1) Cipro 500 mg x 1-3 days
2) Metronidazole 500 mg PO Q6-8 hrs x 7-14 days
Should you give empiric ATBs to your pts with acute diarrhea?
No; usually not indicated
What anti-diarrheal is contraindicated in acute diarrhea?
Diphenoxylate/atropine (Lomotil)
When should you use and not use antidiarrheals in acute diarrhea?
1) Contraindicated for [infectious] bloody diarrhea, high fever, systemic toxicity
2) Can use for non-infectious diarrhea that’s mild or moderate
What diet should you recommend for acute diarrhea?
BRAT diet, avoid caffeine, alcohol, fat, dairy
Name at least 5 s/Sx in a pt with acute diarrhea that would indicate further eval is needed
1) Signs of inflammatory diarrhea (fever >101°F), >WBC 15,000/mL, bloody diarrhea, or severe abdominal pain)
2) Profuse watery diarrhea & dehydration
3) Worsening Sx
4) Sepsis
5) Populations: Frail, older, immunocompromised
