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Gastrointestinal II Exam #1 > Diarrhea DSA > Flashcards

Diarrhea DSA Flashcards

1
Q

Clinical Dx of diarrhea

How long is acute diarrhea? Chronic?

A

3 or more loose/watery stools a day
OR
Decrease in consistency and increased frequency of BMs

<2 wks for acute
>4 wks for chronic

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2
Q

All inflammatory diarrheas (blood, pus, fever, etc.) require:

A

Stool bacterial cultures

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3
Q

Most common non-infectious cause of diarrhea

A

Meds - Abx, NSAIDs, anti-depressants, chemo, etc.

Sweeteners - Sorbitol

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4
Q

What features of diarrhea will warrant further workup?

A

Nocturnal diarrhea
Wt loss
Anemia
+ fecal occult blood test

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5
Q

Normal stool osmolality =

A

<50 mOsm/kg

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6
Q

Osmotic diarrhea

What happens to stool volume when fasting?

What is the stool osmotic gap?

Symptoms include:

Most common causes (4)

A

Stool volume decreases w/ fasting

Stool Osm gap: > 50-75 mOsm/kg

Abdominal distention, bloating, flatulence

Meds
Lactose intolerance
Laxative abuse
Malabsorptive syndromes

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7
Q

Secretory diarrhea

What happens to stool volume when fasting?

What is the stool osmotic gap?

Symptoms include:

Most common causes (4)

A

Stool volume does not improve w/ fasting

Normal Osm gap

High-volume watery diarrhea, dehydration (hyponatremia, NAGMA)

Endocrine tumors
Bile salt malabsorption
Factitious diarrhea (laxative abuse)
Villous adenoma

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8
Q

Which 2 parasites should be detected by fecal antigen?

A

Giardia

E. histolytica

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9
Q

Which 2 parasites should be detected by modified acid-fast staining?

A

Cryptosporidium

Cyclospora

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10
Q

Which patients should have an endoscopic exam and mucosal Bx?

A

Pts. w/ chronic persistent diarrhea

-IBD, microscopic colitis, clonic neoplasia, etc.

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11
Q

What signs/findings are consistent with pancreatic insufficiency vs. chronic pancreatitis?

A

Pancreatic insufficiency: fecal elastase < 100 mcg/g

Chronic pancreatitis: calcification on abdominal XR

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12
Q

How is small bowel bacterial overgrowth diagnosed? (2)

A

Non-invasive breath test (glucose or lactulose)

dConfirmed by obtaining an aspirate of SI contents for aerobic/anaerobic cultures

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13
Q

What does a H+ breath test help diagnose?

A

Lactase deficiency

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14
Q

Reported abnormalities in IBS (3)

A

Altered colonic motility at rest and response to stress, drugs, CCK
Altered SI motility
Enhanced visceral sensation - lower pain threshold

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15
Q

Patients with what unique symptomology may present with IBS?

A

Psychological disturbances

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16
Q

3 types of clinical presentation of IBS

A
  1. Spastic colon: chronic abdominal pain and constipation
  2. Alternating constipation and diarrhea
  3. Chronic, painless diarrhea
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17
Q

Pencil thin stools are common in:

A

IBS

18
Q

At what point should IBS be in the differential?

In patients with diarrhea, bloating and flatulence, what should be excluded?

A

At least 3 mo. IBS usually diagnosed at 6 mo.

Lactose intolerance

19
Q

What is used to diagnose IBS?

A

ROME IV clinical diagnostic criteria

20
Q

What diet is used to treat/manage IBS?

A

Low FODMAPS diet

Fermentable oligosaccharides
Oligosaccharides
Disaccharides
Monosaccharides
Polyols
21
Q

3 protists associated with chronic diarrhea

A

Giardia
E. histolytica
Cyclospora

22
Q

What intestinal nematode is associated with chronic diarrhea?

A

Strongyloides

23
Q

What bacteria is associated with chronic diarrhea?

A

C Diff

24
Q

Diagnostics for C Diff (3)

A 
Stool assay (toxins A and B)
WBC > 15K
Pseudomembranous colitis on sigmoidoscopy w/ volcano eruptions (not needed in most pts.)
25
Q

Diarrheal type in C Diff

A

Mild to moderate geenish, foul-smelling watery diarrhea 5-15x a day

26
Q

2 major complications with a C Diff infection

A

Toxic megacolon and hemodynamic instability

27
Q

Microscopic colitis include which 2 variants?

Which patients are at the greatest risk?

What med is most often implicated?

Tx?

A

Lymphocytic and collagenous colitis

F>M; >50 y/o; idiopathic

NSAIDs

Tx anti-diarrheal w/ loperamide and stop offending agent

28
Q

Symptoms of malabsorption syndromes (4)

A

Weight loss
Osmotic diarrhea
Steatorrhea
Nutritional deficiency

29
Q

What damage occurs in Celiac disease?

What alleles are associated w/ Celiac?

Abs involved:

A

Diffuse damage to the proximal SI mucosa w/ malabsorption

HLA-DQ2 and HLA-DQ8

tTG abtibodies

30
Q

3 atypical symptoms of Celiac disease

A

Dermatitis herpetiformis
Iron deficiency anemia
Osteoporosis

31
Q

Major histological change in Celiacs

A

Complete loss of intestinal villi

32
Q

What test is done to screen for osteoporosis in patients with sprues?

A

DEXA

33
Q

Where are bile salts reabsorbed?

What causes destruction or loss of bile salts?

Steatorrhea? Weight loss?

Absorption of what is impaired?

What kind of diarrhea?

A

Terminal ileum

Bacterial overgrowth, acid hypersecretion, meds that bind bile salts

Mild steatorrhea, with minimal wt loss

Impaired absorption of fat-soluble vitamins (ADEK)

Watery diarrhea

34
Q

Symptoms of Whipple disease

What is used to diagnose?

If untreated, it is…

A

Wt. loss, malabsorption, chronic diarrhea

Endoscopy w/ duodenal Bx with PAS stain (+ for Mo w/ characteristic bacillus)

Fatal

35
Q

Pseudo-diarrhea =

Accompanies which pathologies?

A

Frequent passage of small volumes of stool

IBS and prostitis

36
Q

Fecal incontinence =

What causes it?

A

Involuntary discharge of rectal contents

NM disorders pr structural problems

37
Q

Overflow diarrhea =

Where is it seen?

What is readily found by rectal exam?

A

Severe constipation, only contents that get by is liquid

Elderly/nursing homes

Fecal impaction

38
Q

What is melanosis coli? What causes it?

A

A benign hyperpigmentation of the colon caused by chronic laxative use

39
Q

What is paradoxical diarrhea?

A

Diarrhea from stool leaking around impacted feces - “overflow incontinence”

40
Q

In what case should you not do a DRE?

A

If pt. has leukopenia

41
Q

What kind of diarrhea accompanies bile salt malabsorption?

A

Osmotic diarrhea

Gastrointestinal II Exam #1 (19 decks)

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