Diarrhea

Question 1

Antibiotic-Associated Diarrhea Dx

Answer 1

best initial test: stool C. diff toxin test or PCR.***
=”nucleic amplification assay”
Blood and white blood cells may be present in the
stool

Question 2

Antibiotic-Associated Diarrhea tx

Answer 2

1° Oral vancomycin** OR oral metro +barato
not working? tapered dose of vanco OR fidaxomicin.
not PO possible? EV metronidazol

Question 3

After multiple recurrences of Antibiotic-Associated Diarrhea, tx

Answer 3

fecal transplantation.

Question 4

What is fulminant C. diff?

Answer 4

High WBC
Metabolic acidosis
High lactate
High creatinine

onlinemed:”fever+leukocytosis+megacolon+renal fail”

Question 5

fulminant C. diff Tx

Answer 5

use both vancomycin po and

metronidazole IV

Question 6

fat Malabsorption Rare causes

Answer 6

tropical sprue and Whipple disease.

Question 7

Vitamin D Deficiency Manifestation

Answer 7

Hypocalcemia, osteoporosis

Question 8

Vitamin K Deficiency Manifestation

Answer 8

Bleeding, easy bruising

Question 9

Vitamin B12 Deficiency Manifestation

Answer 9

Anemia, hypersegmented neutrophils, neuropathy

Question 10

Celiac disease comes along with this disease _____in 10% of cases.

Answer 10

dermatitis

herpetiformis

Question 11

Whipple Disease CXFx

Answer 11

also presents with:
Cardiac symptoms*
Arthralgias*
Ocular findings
Neurologic abnormalities (dementia, seizures)*
Fever
Lymphadenopathy
Diarrhea* trots
"CANT"

Question 12

Whipple Disease Tx

Answer 12

ceftriaxone followed by TMP/SMX

Question 13

Malabsorption Diagnostic Tests

Answer 13

iron deficiency: suggest celiac. kinda r/o chronic pancreatitis

Question 14

Celiac disease: first test

Answer 14

Anti-tissue transglutaminase (TTG). This is the best!!!!!!!.
Then u can use
Antiendomysial antibody
IgA antigliadin antibody

Question 15

most accurate diagnostic test for celiac disease

Answer 15

small bowel biopsy: flattening of the villi

also important to exclude lymphoma

Question 16

Whipple disease and tropical sprue dx

Answer 16

most accurately diagnosed with a bowel wall biopsy showing the specific
organism.
Klebsiella, E coli and Enterobacter.
T. whippelii

Question 17

Chronic Pancreatitis most accurate diagnostic test.

Answer 17

Secretin stimulation testing: pancreas will release a large volume of bicarbonate-rich fluids after the intravenous injection of secretin

Question 18

Chronic Pancreatitis Dx also

Answer 18

Abdominal x-ray:
Abdominal CT scan:
calcification of the pancreas

D-xylose testing: normal results

Question 19

Chronic

pancreatitis tx

Answer 19

Enzyme replacement

Question 20

Celiac disease tx

Answer 20

Avoid gluten-containing foods such as wheat, oats, rye, or barley

Question 21

Whipple disease tx

Answer 21

Ceftriaxone, trimethoprim/sulfamethoxazole

Question 22

Tropical sprue tx

Answer 22

Trimethoprim/sulfamethoxazole, tetracycline

Question 23

Carcinoid Syndrome CxFx

Answer 23

Diarrhea
Flushing
Wheezing
Cardiac abnormalities of the right side of the heart

Question 24

Carcinoid Syndrome best initial diagnostic test

Answer 24

urinary 5-hydroxyindoleacetic acid (5 HIAA) test

Question 25

Carcinoid Syndrome tx

Answer 25

octreotide (a synth. somatostatin)

Question 26

Lactose Intolerance cx fx

Answer 26

No weight loss no deficiency in calories not vits >f in asians

Question 27

Lactose Intolerance dx

Answer 27

stool osmolality is increased, but the usual way to make the diagnosis is simply to remove all milk-containing products from the diet and wait a single day for resolution of symptoms.

Question 28

Lactose Intolerance tx

Answer 28

Avoiding milk products except yogurt | oral lactase replacement

Question 29

acute and chronic diarrhea diff

Answer 29

<2 w Ac here is subacute. >4wk chro

Question 30

Dx test if it's not C diff. Wath in the workup labs can guide you to find out whether it is invasive or enterotoxic, and how would you interpret that?

Answer 30

stool WBC, Reds,}both + in invasive | and Lactoferrin:+ for invasive. - for enterotoxic

Question 31

if invasive diarrhea suspected, what to do?

Answer 31

culture + colonoscopy

Question 32

Hemolytic-uremic Sx (HUS) Pathogen + CxFx + source of infection

Answer 32

on the spectrum of thromocytopenic thrombotic purpura. PATH: EHEC O157:H7 Blody diarrhea after eating uncooked meat+ anemia + renal failure

Question 33

Hemolytic-uremic Sx HUS patho

Answer 33

microangiopatic hemolitic anemia

Question 34

HUS Dx

Answer 34

blood smear: schistocytes | shiga like toxine assay

Question 35

HUS Tx

Answer 35

supportive plasma exchange Avoid antibiotics and antimotility agents Dialysis if AKI

Question 36

Secretory Diarrhea labs

Answer 36

labs are normal! particularly they just have positive nocturnal symp. "even when slept its secreting!"

Question 37

inflammatory chronic diarrhea labs findings

Answer 37

+RBC +WBC + mucose | Co

Question 38

what to do if secretory diarrhea is suspected?

Answer 38

get a Endoscopy, C Diff testing, and hormones?

Question 39

what to do if chronic inflammatory diarrhea is suspected?

Answer 39

colonoscopy + bx

Question 40

VIPoma Dx

Answer 40

VIP level

Question 41

VIPoma Tx

Answer 41

Resection

Question 42

Carcinoid patho

Answer 42

5ht secretor tumor of the intestines. Usually that 5ht in metabolized by the liver and all ok. tho sometimes it can metastize to hepatic vein, right side of the heart. TOTALLY dif, to the carcinoma of the lung who goes to left heart. both fibrose and make valve disease.

Question 43

Carcinoid Cx Fx

Answer 43

Right sided cardiac fibrosis diarrhea flush

Question 44

Carcinoid Dx

Answer 44

5HIAA urine test

Question 45

Carcinoid Tx

Answer 45

resection if resectable, if not: somatostatin

Question 46

Duodenum malabsorption problems lead to missing what nutrients, and diseases

Answer 46

Folate: macrocytic Iron: mycrocitic Calcium: osteoporosis carbohidrates: bolating, flatos.

Question 47

terminal ileum malabsorption problems lead to missing what nutrients, and diseases

Answer 47

``` b12 A D E K ```

Question 48

Vitamin E Deficiency Manifestation

Answer 48

nystagmus

Question 49

some important test you could do at first when suspecting malabsorption

Answer 49

-100g fat load 72 hours -d xylose absorption. Usually no one does this duh

Question 50

Tropical sprue dx

Answer 50

endoscopy + bx

Question 51

Tropical sprue epidem

Answer 51

caribean farmer

Question 52

biopsy of whipple tropical sprue celiac dissease

Answer 52

biopsy of whipple= electron mycrocsope, tons of dots for macrophages. tropical sprue= Villous atrophy, elongated crypts, presence of inflammatory cells celiac dissease=+-loss villi

Question 53

S3 sound

Answer 53

s3, cierre de aortica y pulmonar because of the movement of the blood: increased blood in heart : ICC, hypertyroidism, Insuf Aortica, anemia, pregnancy, ., niños benigno

Question 54

s4

Answer 54

justo antes de s1, hipertrofia ventricular.