Constipation/diarrhea Flashcards Preview

Step 2 CS - Minicases > Constipation/diarrhea > Flashcards

Flashcards in Constipation/diarrhea Deck (10):
1

Key history in constipation/diarrhea

Frequency, color, odor and volume of stools
Presence of mucus or flatulence
Whether stools float in bowl
Duration of change in bowel habits
Other symptoms (constitutional, abdominal pain, bloating, tenesmus, sense of incomplete evacuation, melena or hematochezia)
Thyroid disease symptoms (e.g. feeling hot, palpitations, weight loss)
Diet (especially fiber and fluid intake)
Medications (including recent antibiotics)
Sick contacts
Travel and camping history
HIV risk factors
Hx of abdominal surgeries, DM, pancreatitis
Alcohol and drug use
FHx of colon cancer

2

Key physical exam in constipation/diarrhea

Vital signs
Relevant thyroid/endocrine exam
Abdominal and rectal exams
+/- Pelvic exam

3

67 yo M with alternating diarrhea and constipation, decreased stool caliber and blood in stool for last eight months
+ unintentional weight loss
+ low fiber diet
+ FHx of colon cancer
+ last colonoscopy was 12 years ago

Colorectal cancer
IBS
Diverticulosis

Rectal exam, stool for occult blood, CBC, electrolytes, AST/ALT/bilirubin/alkaline phosphatase, colonoscopy, barium enema, CT - abdomen/pelvis

4

28 yo M with constipation for last three weeks
+ only eats junk food

Low-fiber diet
IBS
Depression
Substance use (e.g. heroin)
Hypothyroidism

Rectal exam, TSH, electrolytes, urine toxicology

5

30 yo F with alternating constipation and diarrhea
+ abdominal pain relieved by defecation
+ no N/V, weight loss, or blood in stool

IBS
IBD
Celiac disease

Rectal exam, stool for occult blood, CBC, electrolytes, colonoscopy, stool for ova and parasitology, CT - abdomen and pelvis

6

33 yo M with watery diarrhea, vomiting and diffuse abdominal pain that began yesterday
+ feels hot
+ several other coworkers feel ill, too

Infectious diarrhea (gastroenteritis)
Food poisoning

Rectal exam, stool for occult blood, stool leukocytes and culture, CBC, electrolytes, CT - abdomen/pelvis

7

40 yo F with watery diarrhea and abdominal cramps
+ recent antibiotic use

Pseudomembranous colitis
Gastroenteritis
Cryptosporidiosis
Food poisoning

Stool for C. difficile toxin, rectal exam, stool for occult blood, stool leukocytes and culture, CBC, electrolytes

8

25 yo M with watery diarrhea and abdominal cramps
+ recent travel to Mexico

Traveler's diarrhea
Giardiasis
Amebiasis
Hepatitis A

Rectal exam, stool leukocytes and culture, Giardia antigen, Entamoeba histolytica antigen, CBC, electrolytes, AST/ALT/bilirubin/alkaline phosphatase, viral hepatitis serologies

9

30 yo F with watery diarrhea, abdominal cramps and bloating
+ symptoms aggravated by milk and relieved by fasting

Lactose intolerance
Gastroenteritis
IBD

Rectal exam, stool leukocytes and culture, hydrogen breath test, TSH

10

33 yo M with watery diarrhea, diffuse abdominal pain and weight loss over last three weeks
+ not improved by antibiotics

Crohn's disease
Gastroenteritis
Ulcerative colitis
Celiac disease
Carcinoid syndrome

Rectal exam, stool for occult blood, stool leukocytes and culture, CBC, electrolytes, colonoscopy, CT - abdomen, TSH, small bowel series, 5-HIAA