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GI Board EU Preparation (FR/EN) > Chapter 9 - Diarrhea And Constipation > Flashcards

Chapter 9 - Diarrhea And Constipation Flashcards

1
Q

Osmotic diarrhea osmotic gap

A

> 50 mOsm/kg suggestive
100mOsm/kg specific

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2
Q

Secretory diarrhea osmotic gap

A

<50 mOsm/kg

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3
Q

Enterotoxigene E.coli mechanism

A

Adhere to specific glycoprotein receptors on the intact microvillous membrane by means of pili which permits colonization

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4
Q

Enteropathogenic E.coli mechanism

A

Obliterate microvilli, producing pedestals to which they adhere

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5
Q

Shigella mechanism

A

Internalized by endocytosis and spreads laterally from cell to cell

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6
Q

Salmonella mechanism

A

Penetrates the brush border and tight junction to gain access not only to the mucosa, but also to the bloodstream

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7
Q

Cholera toxin mechanisms

A
  • binds to apical membrane, internalized, cAMP activation and production. Blocks sodium absorption and stimulates chloride secretion by the entorocytes
  • interacts with enteroendocrine cells and enteric nervous system altering electrolyte transport and motility.
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8
Q

E.coli STa toxin mechanism

A

Ligand to brush-border receptor guanylin and uroguanylin, endogenous regulatory peptides produced by enterocytes and distributed intraluminally. Guanylate Cyclase and cGMP production causing Cl secretion.

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9
Q

Campylobacter Jejuni mechanism

A

Often tissue invasion and severe colitis mimicking UC

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10
Q

E.coli O157:H7: clinical manifestation and source

A

Hemorrhagic segmental colitis
Hemolytic uremic syndrome

Undercooked hamburger or other foods

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11
Q

C.difficile mechanism

A

Cytotoxin production that kills enterocytes and produces pseudomembrane colitis

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12
Q

Rome IV criteria IBS

A

Abdominal pain with 2/3:
- related to defecation
- associated with change of stool frequency
- associated with change of stool consistency/form

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13
Q

Bile acid malabsorption diagnostic strategy

A
  • SeCHAT retention
  • C4 or FGF-19 assay
  • trial of bile acid sequestrant
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14
Q

SIBO diagnostic strategy

A

Quantitative culture of small intestinal aspirate
Breath hydrogen testing
Trial antibiotic therapy

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15
Q

What does pH of stoo < 6 indicate?

A

Excess carbohydrate fermentation in the colon

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16
Q

How much fat to ingest per day for accurate fat output testing?

A

70-120g

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17
Q

Possible bacteria for chronic diarrhea

A

Aeromonas and pleisiomonas

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18
Q

Protozoal pathogens in stool requiring modified acid-fast or safranin staining

A

Cryptosporidium, cyclospora and cystoisospora

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19
Q

Type 1 bile acid diarrhea

A

Après resection iléale ou dysfonctionnement iléale

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20
Q

Type 2 bile acid diarrhea

A

Idiopathic
30% patients with IBS-D or functional diarrhea
Due to defective FGF-19 feedback
Serum FGF19 bas et C4 élevé

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21
Q

Type 3 bile acid diarrhea

A

Associated to other diseases in which bile acid malabsorption might play a role.
- Post-Cholecystectomy
- postvagotomy
- SIBO
- post-radiation diarrhea

22
Q

Magnesium associated osmotic diarrhea diagnosis

A

Excretion > 15 mmol (30mEq)
Concentration in stool water > 45 mmol/l (90mEq/l)

23
Q

Malabsorption hydrocarbures diagnostic

A

Gap osmotic fecal >50mOsm/kg
PH selles <6
Anamnese alimentaire

24
Q

Chronic inflammatory diarrhea: pathogens

A

C.difficile
CMV
Entamoeba histolytica
Tuberculose

25
Steatorrhea definition
Excessive loss of fat in the stool >7g ou 9% de la prise en 24h (pas valable si diarrhée)
26
Major causes of steatorrhea
Mucosal disease Pancreatic exocrine insufficiency Lack of bile
27
Eluxadoline
Delta-opiate receptor agonist Do not give if pancreatitis, alcohol abuse or st.p. Cholecystectomy
28
Crofelemer: mechanism and indication
Inhibits electrolyte secretion in the intestine (chloride channel blocker) Approved for HIV therapy induced diarrhea
29
Différence entre IBS-C et constipation chronique idiopathique
La douleur
30
Temps de transit dans le colon
24-30 du caecum au rectum
31
Qu’arrive-t-il au fibre pendant le transit dans le colon
Fermenté en gaz et en acides gras à chaîne courte par la flore bactérienne
32
Quantité de selles normales par 24h
80-120 g/ 24h
33
Temps de transit colon: technique et résultat normal
Capsule qui contient 24 radiomarqueurs, Rx abdomen 5 jours après. Rétention de > 5 marqueurs après 5 jours est anormal.
34
Test d’expulsion: quand est-ce que c’est anormal
Si échec d’expulsion d’un ballon contenant 50 ml d’eau dans les 60 à 120 secondes
35
Cible de fibre par jour
20-30g/j
36
Lubiprostone: mechanism
Ouvre les canaux chloriques ClC-2 ce qui augmente la sécrétion luminale, change la perméabilité épithéliale ou aussi effet sur la fonction nrégulatoire de l’intestin.
37
Lubiprostone dose
Constipation: 24 mcg 2x/j IBS-C: 8 mcg 2x/j
38
Linaclotide: nom commercial
Constella
39
Linaclotide: mécanisme
Augmente la sécrétion de chlore en ouvre les canaux CFTR via cGMP Possible effet inhibiteur sur les nerfs nociceptifs du systeme nerveux entérique
40
Linaclotide: dose
Constipation: 72 mcg ou 145 mcg par jour IBS-C: 290 mcg/j
41
Plecanatide: mécanisme
Analogue d’uroguanylin, effet similaire à Linaclotide avec ouverture des CFTR. PH dépendant, agit seulement au niveau du grele donc fait possiblement moins de diarrhées
42
Plecanatide: nom commercial
Trulance
43
Plecanatide: dosage
3mg/j (Constipation et IBS-C)
44
Tenapanor
Inhibiteur de NHE3 (échangeur de sodium de la muqueuse intestinale). Diminue absorption de sodium ce qui peut améliorer les symptomes d’IBS-C
45
Tenapanor: dose
Constipation: 10mg/j IBS-C: 50 mg 2x/j
46
Liste de sécrétagogue:
Lubiprostone Linaclotide Plecanatide Tenapanor
47
Liste de traitements systémiques de la constipation
Bethanechol Misoprostol Colchicine Prucalopride
48
Prucalopride: nom commercial
Resolor
49
Prucalopride: mécanisme
- agoniste complet des récepteurs 5-HT4 - augmente le péristaltisme et diminue la douleur viscérale sans agir sur les récepteur cardiaques
50
Prucalopride: dose
2mg/j
51
Antagonistes mu périphériques
Méthylnaltrexone Naloxegol Nalmétidine
52
Methylnaltrexone: nom commercial
Relistor

GI Board EU Preparation (FR/EN) (6 decks)

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