Diarrhea and malabsorption syndrome

Question 1

what are the two types of diarrhea

Answer 1

acute < 14 days
chronic > 28 days

Question 2

what are the etiologies of acute diarrhea

Answer 2

infections
- viral
- bacterial
- parasitic

Question 3

which vira are involved in acute diarrhea ?

Answer 3

Rotavirus
norovirus
adenovirus
Astrovirus
coronarvirus

Question 4

which bacteria are invovled in acute diarrhea

Answer 4

• Campylobacter jejuni
• Escherichia coli
• Salmonella
• Shigella
• Clotridium difficile

Question 5

which parasites are involved in acute diarrhea ?

Answer 5

• Entamoeba histolytica
• Giardia lamblia
• Cryptosporidium

Question 6

When do symptoms of Clostridium difficile infection typically occur?

Answer 6

Usually after antibiotic treatments.

Question 7

How does antibiotic use contribute to Clostridium difficile colonization?

Answer 7

Reduction of saprophytic (beneficial) flora allows for colonization of the colon with other, non-saprophytic bacteria, including Clostridium difficile.

widespread in europe - mostly in hospitals

Question 8

What survival mechanism does Clostridium difficile possess?

Answer 8

The bacteria can form spores that survive for months, making it difficult to eradicate and contributing to recurrence.

Question 9

What is the first-line treatment for Clostridium difficile infection (CDI)?

Answer 9

Oral Vancomycin or Fidaxomicin.

10 days of treatment

Question 10

What is an alternative antibiotic that can be used for CDI if Vancomycin or Fidaxomicin are not available or appropriate?

Answer 10

Metronidazole.

Question 11

What is the most important measure to prevent Clostridium difficile infection (CDI)?

Answer 11

Careful prescription of antibiotics - only when necessary.

Question 12

Do recent AGA guidelines recommend probiotics for CDI prevention?

Answer 12

No, they do not recommend probiotics due to lack of efficiency.

Question 13

How do proton pump inhibitors (PPIs) affect the risk of CDI?

Answer 13

Administration of PPIs reduces gastric acidity, which can make it easier for Clostridium difficile bacteria to survive and colonize the gut.

Question 14

Provide an example of a situation where the benefit of antibiotics and other interventions might outweigh the risk of CDI.

Answer 14

In a patient with severe COPD (GOLD IV) and bacterial pneumonia, administration of antibiotics, corticosteroids, and PPIs may be necessary despite the increased risk of CDI due to the life-threatening nature of the pulmonary pathology.

Question 15

What type of sample is used for Clostridium difficile testing?

Answer 15

Stool sample.

Question 16

What toxins are detected in stool tests for Clostridium difficile infection (CDI)?

Answer 16

Toxins A and B.

Question 17

What is GDH, and what is its role in CDI testing?

Answer 17

GDH stands for glutamate dehydrogenase.

It is an enzyme produced by Clostridium difficile bacteria.

It is not a toxin itself but is used as a marker for the presence of the bacteria.

Question 18

Can GDH be used alone to diagnose CDI?

Answer 18

No, a positive GDH test alone is not sufficient for diagnosis. It must be correlated with clinical symptoms.

Question 19

What is the risk of recurrence after an episode of Clostridium difficile infection (CDI)?

Answer 19

The risk of recurrence is high, up to 6 months after an event.

Question 20

What is fecal matter transplant (FMT)?

Answer 20

FMT involves transplanting stool from a healthy donor into the patient’s colon to restore the normal gut microbiota.

Question 21

When is FMT typically considered for CDI?

Answer 21

It is often considered a last-resort measure for recurrent or refractory CDI.

Question 22

What are some challenges associated with FMT?

Answer 22

Legal and organizational difficulties, such as donor screening, stool processing, and ethical considerations.

Question 23

In which age group are most cases of Giardia infection seen?

Answer 23

children

50% are asymptomatic of i nfected people

Question 24

What is the main symptom of Giardia infection?

Answer 24

diarrhea

Question 25

What are some other symptoms of Giardia infection?

Answer 25

Abdominal pain, changes in stool aspect (e.g., greasy, foul-smelling stools), and potential weight loss.

Question 26

What is the main diagnostic test for Giardia infection?

Answer 26

Coproprasitological examination of stool.

Question 27

How should the stool sample be collected for Giardia testing?

Answer 27

The sample should be taken from the **altered-looking area of the stool**, as this is where the parasites are most likely to be concentrated.

Question 28

What is the primary treatment for Giardia infection?

Answer 28

Metronidazole

Question 29

Chronic diaarhea etiology

Answer 29

* Chronic infectious diarrhea – untreated Giardia, Clostridium difficile * Inflammatory bowel disease * Irritable bowel syndrome (functional) * Malabsorption * Drug induced diarrhea - laxatives or side-effects * Bile acid abnormalities * Bacterial overpopulation * Effect of other diseases – endocrine (hypothyroidism), after radiation

Question 30

What are the two main types of inflammatory bowel disease?

Answer 30

Crohn's disease and ulcerative colitis.

Question 31

What is the most common symptom of IBD?

Answer 31

Diarrhea, sometimes with rectal bleeding.

Question 32

What causes the inflammation in IBD?

Answer 32

The inflammation is caused by an **abnormal immune response**, even in the absence of an infection.

Question 33

How is IBD diagnosed?

Answer 33

Inflammatory markers (erythrocyte sedimentation rate, C-reactive protein, fecal calprotectin) Colonoscopy Histopathological examination (biopsy)

Question 34

What is the main treatment for IBD?

Answer 34

nti-inflammatory medications.

Question 35

What type of disease is Irritable Bowel Syndrome (IBS)?

Answer 35

A functional disease, meaning there's no visible damage or inflammation in the digestive tract.

Question 36

What are the Rome IV criteria for diagnosing IBS?

Answer 36

Recurrent abdominal pain on average at least 1 day/week in the last 3 months

Question 37

Rome IV Criteria (Part 2) associated with two or more of the following criteria:

Answer 37

Related to defecation Associated with a change in frequency of stool Associated with a change in form (appearance) of stool

Question 38

What type of reaction does gluten trigger in people with celiac disease?

Answer 38

An immune reaction, leading to inflammation in the small intestine.

Question 39

Celiac disease symptoms are ?

Answer 39

* Chronic watery diarrhea * Weight loss * Bloating * Dyspepsia * Herpetiform dermatitis (rare) * Edema (protein malabsorption)

Question 40

what are the malabsorption in celiac disease?

Answer 40

Iron malabsorption Calcium and vitamin D3 malabsorption Vitamin K malabsorption Protein malabsorption Iron deficiency anemia Osteoporosis Coagulation deficit Hypoalbuminemia, hypoproteinemia

Question 41

What are the two main categories of tests used to diagnose Celiac Disease?

Answer 41

**Serum tests and Genetic tests**.

Question 42

Name three types of serum tests used in Celiac Disease diagnosis.

Answer 42

Anti-tissue transglutaminase antibodies (IgA), Total IgA, and Antigliadinic antibodies.

Question 43

Why is it important to measure Total IgA in Celiac Disease diagnosis?

Answer 43

due to false negative

Question 44

What genetic markers are tested for in Celiac Disease diagnosis?

Answer 44

**HLA-DQ2 and HLA-DQ8.**

Question 45

What procedure is used to visually examine the duodenum in Celiac Disease diagnosis?

Answer 45

upper digestive endoscopy

Question 46

What is a typical visual finding in the duodenum during an endoscopy for Celiac Disease?

Answer 46

A smooth aspect of the second part of the duodenum.

Question 47

What cellular finding in a duodenal biopsy is indicative of Celiac Disease?

Answer 47

Intraepithelial lymphocytes.

Question 48

What structural change in the duodenal lining is seen in Celiac Disease?

Answer 48

**Atrophy of the villi**.

Question 49

what is the testing for carb intolorence ?

Answer 49

**hydrogen breath test**

Question 50

What is the main consequence of exocrine pancreatic failure?

Answer 50

Inability of the pancreas to secrete pancreatic enzymes.

Question 51

Name three conditions that can lead to exocrine pancreatic failure.

Answer 51

Chronic pancreatitis, Post pancreatic resection, and Cystic Fibrosis.

Question 52

What is the primary digestive issue caused by exocrine pancreatic failure?

Answer 52

Fat malabsorption.

Question 53

What is a common stool test used to diagnose exocrine pancreatic failure?

Answer 53

**Stool elastase test.**

Question 54

What is another method to detect fat malabsorption in exocrine pancreatic failure?

Answer 54

**Fat in stool test (microscopic examination).**

Question 55

Which diagnostic test for exocrine pancreatic failure is usually performed in specialized centers?

Answer 55

Secretin test.

Question 56

What are the two main approaches to treating Exocrine Pancreatic Failure?

Answer 56

Diet and Medicine.

Question 57

What dietary modification is recommended for patients with Exocrine Pancreatic Failure?

Answer 57

Reduced fat intake.

Question 58

What type of medication is used to supplement enzyme deficiency in Exocrine Pancreatic Failure?

Answer 58

Pancreatic enzymes.

Question 59

What is the typical dosage of pancreatic enzymes taken per meal for Exocrine Pancreatic Failure?

Answer 59

30,000 - 50,000 U/meal.

Question 60

Drug induced diarrhea

Answer 60

* Enteral nutrition * Proton pump inhibitors * Chemotherapy * Antibiotics * Colchicine * Metformin * NSAID * Mesalamine

Question 61

What are the two main approaches to treating Exocrine Pancreatic Failure?

Answer 61

Diet and Medicine.

Question 62

What dietary modification is recommended for patients with Exocrine Pancreatic Failure?

Answer 62

reduced fat intake

Question 63

What type of medication is used to supplement enzyme deficiency in Exocrine Pancreatic Failure?

Answer 63

Pancreatic enzymes.

Question 64

What are the two main mechanisms that can lead to bile acid induced diarrhea?

Answer 64

Malabsorption of bile acids at the terminal ileum and overproduction in the liver.

Question 65

Where does bile acid malabsorption occur in bile acid induced diarrhea?

Answer 65

**The terminal ileum.**

Question 66

How does overproduction of bile acids in the liver lead to diarrhea?

Answer 66

As a result of negative feedback mechanism malfunction.

Question 67

What is the primary cause of symptoms in Bile Acid Induced Diarrhea?

Answer 67

The excessive effect of bile acids on the colon wall.

Question 68

Besides diarrhea, what other abdominal symptoms are common in Bile Acid Induced Diarrhea?

Answer 68

Abdominal pain and Bloating.

Question 69

What substance is used in the 75SeHCAT test?

Answer 69

Bile with a marked isotope (Selenium-75).

Question 70

What type of test is the C4 test?

Answer 70

Serum test.

Question 71

What is the primary dietary recommendation for treating Bile Acid Induced Diarrhea?

Answer 71

Low fat diet.

Question 72

What class of medications is used to bind and remove excess bile acids in the treatment of Bile Acid Induced Diarrhea?

Answer 72

Bile removal agents.

Question 73

Name two common bile removal agents used to treat Bile Acid Induced Diarrhea

Answer 73

Colestiramine and Colestipol

Question 74

What is a common challenge in the treatment of Bile Acid Induced Diarrhea?

Answer 74

Low treatment compliance.

Question 75

What is the defining characteristic of Bacterial Overpopulation Syndrome?

Answer 75

Excessive number of bacteria in the small intestine.

Question 76

What is the primary diagnostic test mentioned for Bacterial Overpopulation Syndrome?

Answer 76

**Glucose breath test respirator.** ## Footnote exhaled hydrogen

Question 77

What are the sensitivity values mentioned for the glucose breath test using glucose and lactulose?

Answer 77

62% (glucose) / 56% (lactulose).

Question 78

What is the preferred treatment for Bacterial Overpopulation Syndrome?

Answer 78

Antibiotics, preferably rifaximin.

Question 79

What type of disease is Microscopic Colitis?

Answer 79

Inflammatory bowel disease.

Question 80

What is a key characteristic of the symptoms of Microscopic Colitis?

Answer 80

Recurrent symptoms.

Question 81

What is a common finding during a colonoscopy in patients with Microscopic Colitis?

Answer 81

Normal colonoscopy.

Question 82

What is essential for diagnosing Microscopic Colitis?

Answer 82

Hystopathology (histopathology) - typical aspect.

Question 83

What are the two main subtypes of Microscopic Colitis?

Answer 83

**Collagenous colitis and Lymphocytic colitis**.

Question 84

risk factors microscopic colitis

Answer 84

* Smoking and previous smoking (ex-smokers = lower incidence) * More frequently in women * Chronic use of: * Proton pump inhibitors * NSAIDs * SSRIs

Question 85

What type of examination is crucial for diagnosing Microscopic Colitis?

Answer 85

Histopathological examination using Hematoxylin-eosin coloration.

Question 86

What is the defining histological characteristic of Collagenous Colitis?

Answer 86

**A sub-epithelial collagen band of over 10 µm.**

Question 87

What other histological finding is present in Collagenous Colitis?

Answer 87

**Inflammatory infiltrate in the lamina propria.**

Question 88

What is the defining histological characteristic of Lymphocytic Colitis?

Answer 88

Intraepithelial lymphocytes of over 20 per 100 cells.

Question 89

What other histological finding is present in Lymphocytic Colitis?

Answer 89

Inflammatory infiltrate in the lamina propria.

Question 90

What is the first-line medication for inducing remission in Microscopic Colitis?

Answer 90

Oral budesonide.

Question 91

What are the two phases of treatment where oral budesonide is used?

Answer 91

Induction and Remission.

Question 92

What medications are considered if budesonide treatment fails in Microscopic Colitis?

Answer 92

Thiopurine, antiTNF, and vedolizumab.

Question 93

What is one general category of mechanisms that can lead to malabsorption syndrome?

Answer 93

Deficiency of enzymes with roles in digestion.

Question 94

Give an example of a specific protein deficiency that can cause malabsorption.

Answer 94

Castle factor (leading to Vitamin B12 deficiency).

Question 95

How can a deficiency in the absorption membrane cause malabsorption?

Answer 95

Insufficient permeability.

Question 96

How can surgical resection lead to malabsorption?

Answer 96

Decrease of total absorption surface.

Question 97

What types of transport abnormalities can cause malabsorption?

Answer 97

Lymphatic or vascular obstruction.

Question 98

Malabsorption syndrome etiology

Answer 98

* Celiac disease * Protein or carbohydrate intolerance * Chronic pancreatitis * Post surgical resection of pancreas or intestines * Inflammatory or infectious bowel disease, including bacterial overpopulation syndrome * Atrophic gastritis * Bile acid abnormalities * Autoimmune diseases

Question 99

Malabsorption syndrome - Treatment

Answer 99

Depends on each individual etiology