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GI Week 2 & 3 > Diarrhea DSA > Flashcards

Diarrhea DSA Flashcards

1
Q

What electrolytes are usually lost due to diarrhea?

A

Bicarbonate and potassium

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2
Q

Which type of acute diarrhea usually does not need any work up because it is self-limited?

A

Non-inflammatory

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3
Q

With inflammatory acute diarrhea would should be performed for all patients?

A

Routine stool bacterial cultures including E. coli 0157:H7

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4
Q

What is the most common cause of non-infectious diarrhea that occurs greater than 14 days?

A

Medications such as antibiotics and NSAIDs

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5
Q

What food sweetener is a common cause of non-infectious diarrhea?

A

Sorbitol (found in chewing gum)

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6
Q

What is acute diarrhea defined as?

What is chronic diarrhea defined as?

A

1) Less than two weeks duration

2) Greater than four weeks duration

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7
Q

What are some clues that lean towards osmotic diarrhea?

A

1) Stool volume decreases with fasting

2) Increased stool osmotic gap

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8
Q

What should patients be asked about if they present with osmotic diarrhea?

A

Their intake of dairy products (lactose), fruits and artificial sweeteners (fructose and sorbitol), and alcohol

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9
Q

What is a major dietary cause of osmotic diarrhea?

How is it diagnosed?

A

1) Lactose intolerance

2) Hydrogen breath test

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10
Q

What are some clues that lean towards secretory diarrhea?

A

1) Stool volume doesn’t change with fasting
2) Normal stool osmotic gap
3) High volume watery diarrhea

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11
Q

What does secretory diarrhea lead to?

A

1) Dehydration
2) Hyponatremia
3) Non-anion gap metabolic acidosis

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12
Q

What types of tumors are common causes of secretory diarrhea?

A

Endocrine tumors like ZE syndrome

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13
Q

What are the three most common causes of chronic diarrhea?

What symptoms are inconsistent with these common causes and warrant further evaluation?

A

1) Meds, IBS, Lactose intolerance

2) Nocturnal diarrhea, weight loss, anemia, or positive FOBT

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14
Q

Fecal leukocytes, fecal calprotectin, and fecal lactoferrin may suggest?

A

IBD

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15
Q

What is a more sensitive and specific method than wet mount when testing for Giardia and E. histolytica?

A

Fecal antigen test

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16
Q

What do most patients with chronic persistent diarrhea undergo in order to exclude IBD, microscopic colitis, and colonic neoplasia?

A

Colonoscopy with mucosal biopsy

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17
Q

What is performed when a small intestinal malabsorptive disorder is suspected?

A

EGD with small bowel biopsy

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18
Q

If malabsorption is suspected what is used to determine if the cause is pancreatic insufficiency?

What is used to determine if the cause is due to chronic pancreatitis?

A

1) Fecal elastase less than 100 mcg/g

2) Calcification on a plain abdominal radiograph

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19
Q

Presence of what symptoms should make you lean away from diagnosis of IBS and warrant investigation for an underlying disease?

A

1) Acute onset
2) Nocturnal diarrhea
3) Severe constipation or diarrhea
4) Hematochezia
5) Weight loss
6) Fever

20
Q

What is IBS characterized by?

A

1) Altered bowel habits
2) Abdominal pain
3) Absence of detectable organic pathology

21
Q

What is the diagnostic criteria used for IBS?

A

ROME IV Clinical Diagnostic Criteria

22
Q

Hydrogen breath test is used to diagnose?

A

Lactase deficiency

23
Q

What is the most common cause of antibiotic associated colitis?

A

C. diff

24
Q

Is C. diff aerobic or anaerobic?

Is it gram + or - ?

Sporulating or non?

Shape?

A

1) Anaerobic
2) Gram positive
3) Spore forming
4) Bacillus

25
Q

What C. diff toxins cause mucosal damage?

A

Toxins A and B

26
Q

What are the most common antibiotics that cause C. Diff infection?

A

1) Ampicillin
2) Clindamycin
3) Third-generation cephalosporins
4) Fluoroquinolones

27
Q

What would be in the CBC that pointed towards C. diff?

A

Leukocytosis: white blood count > 15,000/mcL

28
Q

What is found on flexible sigmoidoscopy for C. diff patients?

Biopsies reveal epithelial ulceration with a classic?

A

1) Yellow pseudomembranous colitis

2) Volcano exudate of fibrin and neutrophils

29
Q

When should alcohol sanitizer be used in order to minimize the transmission of C. diff?

A

Never, always wash hands with soap and water

30
Q

What complications can C. diff cause?

A

Toxic megacolon and hemodynamic instability

31
Q

What are the characteristics of malabsorption syndromes?

A

1) Weight loss

2) Steatorrhea

32
Q

Celiac disease is an immunologic response to what storage protein?

It causes diffuse damage to?

A

1) Gluten

2) Proximal small intestinal mucosa

33
Q

Celiac disease is only present in people with?

It causes antibodies to?

A

1) HLA-DQ2 or HLA-DQ8

2) Gluten and IgA tissue transglutaminase (tTG)

34
Q

What atypical symptom of celiac causes pruritic papulovesicles over the extensor surfaces of the extremities and over the trunk, scalp, and neck?

A

Dermatitis herpetiformis

35
Q

Celiac disease leads to what histologic finding?

What is seen on endoscopy?

A

1) Complete loss of intestinal villi

2) Atrophy or scalloping of the duodenal folds

36
Q

Where are bile salts reabsorbed?

Problems with this process can be seen in what conditoin?

A

1) Terminal ileum

2) Crohn’s disease

37
Q

Bile salt malabsorption causes impaired absorption of what, leading to bleeding tendencies, osteoporosis, and hypocalcemia?

What type of diarrhea is seen?

A

1) Fat-soluble vitamins (A, D, E, K)

2) Watery secretary

38
Q

What rare multisystem disease presents with weight loss, malabsorption, chronic diarrhea and is due to infection with a gram positive bacillus that is not acid fast?

What is the name of that bacteria?

A

1) Whipple disease

2) Tropheryma whipplei

39
Q

What is diagnostic of whipple disease with endoscopy with duodenal biopsy?

A

Periodic acid Schiff positive for macrophages with characteristics bacillus

40
Q

What conditions does pseudo-diarrhea accompany?

A

IBS or proctitis

41
Q

What is severe constipation where the only contents that gets by is liquid?

A

Overflow diarrhea

42
Q

What population is overflow diarrhea most common in?

A

Elderly

43
Q

What medication is a common cause of constipation?

A

Opioids

44
Q

What are three reasons not to do a digital rectal exam?

A

1) You don’t have a finger
2) The patient doesn’t have a rectum
3) The patient has leukopenia

45
Q

Chronic use of laxatives can lead to?

A

Melanosis coli (a benign hyperpigmentation of the colon)

GI Week 2 & 3 (9 decks)

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