diarrhea - IBS Flashcards
(92 cards)
1
Q
Antibiotic associated diarrhea - etiology
A
although clindamycin may be associated with the highest incidence diarrhea and C. Diff, any antibiotc can potentially cause diarrhea
2
Q
antibiotics associated diarrhea - characteristics of the diarrhea
A
blood + white cells in the stool
3
Q
antibiotics associated diarrhea - time
A
several days or weeks after the start of antibiotivs
4
Q
antibiotics associated diarrhea - best initial test
A
stool C. diff toxin test or PCR
5
Q
antibiotics associated diarrhea - best initial therapy
A
ORAL metronidazole
6
Q
antibiotics associated diarrhea - therapy
A
best initial: oral metronidazole
if no response: switch to oral vancomycn or fidaxomicin
7
Q
repeated episode of antibiotics associated diarrhea
A
AGAIN oral metronidazole
8
Q
antibiotics associated diarrhea - IV metronidazole
A
onky if oral cannot be used (such as adynamic ileus)
9
Q
C. diff - culture
A
never –> not grow in culture
the source of the name
10
Q
C. diff - endoscopy
A
diagnose antibiotic associated diarrhea –> NOT necessary step given the availability of stool toxin assay
11
Q
antibiotics associated diarrhea - IV vancomycin
A
always wrong –> it will not pass the bowel wall
12
Q
Diarrhea after antibiotic use - management
A
C diff positive? NO: consider alternative causes YES: oral metronidazole: - if improvement --> continue - if no improvement --> switch to oral vancomycin or fidaxomicin
13
Q
Malabsorption - etiology
A
- Celiac (one of the MCC)
- Chronic pancreatitis
- tropical sprue (rare)
- Whipple disease (rare)
14
Q
all form of malabsorption present with
A
steatorrhea, deficiency of fat soluble vitamines (and their manifestation), wight loss
15
Q
steatorrhea - definition
A
oily, greasy, floating an foul smelling stools
16
Q
VIT D deficiency - manifestation
A
hypocalcemia, osteoporosis
- rickets in children
- osteomalacia in adults
17
Q
VIT K deficiency - manifestation
A
bleeding, easy brusing
18
Q
VIT B12 -deficiency
A
anemia, hypersegmented neutrophils
neuropathy
19
Q
Vitamin B12 malabsorption
A
need an intact bowel and pacreatic enzymes to be absrobed
20
Q
how t distinguish clinically tropical spure from celiac disease
A
no way
21
Q
celiac disease - is aka
A
gluten sensitive enteropathy
22
Q
celiac disease - is associated ith
A
- dermitis herpetiformis in 10% of cases
2. increased risk of malignancy (eg. T-lemphoma)
23
Q
celiac disease - affects
A
distal duodenume and/or proximal jejunum
24
Q
Whipple disease - manifestations beside malabsorption
A
- arthralgias 2. ocular findings 3. fever
- neurological abnormalities (dementia seizures)
- lymphadenpathy
25
Whipple disease - treatment
ceftriaxone followed by TMP/SMZ
26
one of the main lab distinctions between chronic pancreatitis and celiac spure is the ... (explain)
presence of iron deficiency in celiac sprue
| this is because iron needs an intact bowel wall to be absorbed, but it does not need pancreatic enzymes
27
celiac sprue - unique tests (which is first)
1. anti-tissue transglutaminase (first)
2. antiendomysial antibody
3. IgA antigliadin antibody
28
celiac spure - the most accurate test
small bowel biopsy --> flattening of the vill
29
Whipple disease - the most accurate test
small bowel biopsy --> specific organism
30
tropic sprue - the most accurate test
small bowel biopsy --> specific organism
31
celiac spure - beside diagnosis, biopsy is essential to
exclude lymphoma
32
Chronic pancreatitis - specific diagnostic tests (only names) (which is the most accurate)
1. abdominal x-ray
2. abdominal CT
3. secretin stimulation testing (the most accurate)
33
Chronic pancreatitis - abdominal x-ray - specificity and sensitivity
very specific
| 50-60% sensitive for calcification of the pancreas
34
Chronic pancreatitis - abdominal CT scan - sensitivity
80-90%
35
Chronic pancreatitis - secretin stimulation testing - describe
place a nasogastric tube --> an unaffected pancreas will release a large volume of bicarbonate-rich fluid after the IV injection of secretin
36
Chronic pancreatitis - most accurate test
secretin stimulation testing
37
rice and wine in celiac sprue
safe
38
chronic pancreatitis - treatment
enzyme replacement
39
celiac sprue - treatment
avoid gluten containing foods such as wheat, oats, rye, barley
40
whipple disease - treatment
ceftriaxone followed by TMP/SMZ
41
tropical sprue
TMP/SMZ, tetracycline
42
test to distinguish chronic pancreatitis from bowel wall abnormalities
D-xylose --> normal in chronic pancreatitis
| old test
43
carcinoid syndrome - presentation
1. intermittent diarrhea
2. flushing
3. wheezing
4. cardiac abnormalities of the right side of the heart
44
carcinoid syndrome - best initial diagnostic test
5-hydroxyindoleacetic (5-HIAA) test
45
carcinoid syndrome - therapy
octreotide --> control diarrhea
46
a symptoms that occurs in almost every malabsorption syndrome, but not in lactose intolerance
weight loss --> lactose is only one of several sugars to absorb. Also lactose intolerance does not alter the absorption of any other nutrient such as fat so there is no deficiency in calories
47
lactose intolerance - calories
it does not alter the absorption of any other nutrient such as fat so there is no deficiency in calories
48
lactose intolerance - vitamins
normal
49
lactose intolerance - diarrhea due to
increased stool osmolarity
50
lactose intolerance - the usual way to make diagnosis
remove all milk containing products from the diet and wait a single day for resolution of symptoms
51
lactose intolerance - treatment
- avoid milk products except yogurt
| - oral lactose replacement is also good and is available over the counter
52
over the counter medications - definition
no prescription is needed
53
Irritable bowel syndrome - presentation (like definition)
pain syndrome that can have diarrhea, constipation or both
54
Irritable bowel syndrome - weight loss
no
| pain does not automatically mean malabsorption
55
Irritable bowel syndrome - diagnosis
there is no specific test
| diagnosis of exclusion in association with a complex of symptoms
56
Irritable bowel syndrome - characteristics of pain
1. relieved by bowel movement
2. less at night
3. relieved by a change in bowel habit such as diarrhea
57
Irritable bowel syndrome - treatment
1. fiber in the diet
2. antispasmodic agents (hyoscyamine, diclomine)
3. TCA
4. antimotility agents such as loperamide for diarrhea
5. Lubiprostone
58
Irritable bowel syndrome - antispasomodic agents such as
1. hyoscyamine
| 2. diclomine
59
Irritable bowel syndrome - Lubiprostone
Cl- channel activator that increases bowel movements frequent --> also treats the constipation that is predominant in IBS
60
inflammatory bowel disease - idiopathic disorder that presents with
1. diarrhea
2. blood in stool
3. weight loss
4. fever
61
iflammatory bowel disesase - both Crohn and ulcerative colitis have extraintestinal manifestations that can be IDENTICAL in both diseases:
1. arthralgias 2. Uveitis, iritis
3. skin manifestations
4. sclerosing cholangitis (more frequent in Ulcerative)
62
IBD - cancer
bot forms of IBD can lead to colon cancer. The risk of cancer is elated to the duration of involvement of the colon. Crohn that involves the colon has the same risk of as ulcerative colitis
63
differences between crohn and ulcerative colitis
crohn --> skp lesions, tranmural granulomas, fistulas and abscess, masses and obstruction, perianal disease
UC --> curable by surgery, entirely mucosal, no fistulas, no abscesses, no obstruction, no perianal
64
IBD - when should screening occur
afet 8-10 years of colonic involvement, with colonoscopy every 1-2 years
65
IBD - diagnostic tests - only the names of the tests (most accurate?)
1. endoscopy (most accurate when can be reached)
2. radiologic studies (barium)
3. serologic testing
66
IBD - endoscopy
the most accurate when the disease can be reached by a scope
67
IBD - radiologic studies
For crohn that is mainly in the small bowel, radiologic tests such as BARIUM will detect the lesions
68
IBD serologic testing
if unclear. All IBD is associated with anemia. also:
- ANCA: UC
- ASCA: Crohn
69
IBD - ANCA?
antineutrophil cytoplasmic antibody --> ulcerative colitis (not in corhn)
70
IBD - ASCA?
antisaccharomyces cerevesiae antibody --> Crohn (not in ulcerative)
71
IBD - treatment of acute exacerbations
steroids in both IBD and UC
| prednisone or budesonide
72
IBD - chronic maintenance or remission
5-ASA derivatives:
UC --> asacol, rowasa (if limited to the rectum)
CD --> pentasa
73
IBD - how to wean patients off of steroids
1. azathiprine
2. 6-mercaptopurine
when the disease is so severe that severe recurrence develop as the steroids are stop
74
every IBD needs ... (additional treatment)
calcium and vit D
75
perianal CD is tread with
1. ciprofloxacin + metronidazole
76
IBD - TNF agents
FISTULAE and severe disease unresponsive to other agents is treated with TNF agents such as infiximab
77
IBD - fistulae treatment?
TNF agents such as infiximab
| If no response --> surgery
78
IBD - surgery?
neither form is routinely treated with surgery. UC can be cured, however, with colectomy. In CD, surgery is used exclusively for bowel obstruction. CD will tend to recur at the site of surgery
79
Budesonide - IBD
budesonide is a steroid sepcific for IBD. First pass effect is good
80
Divrticulosis - epidemiology
outpocketing of the colon are so common on a standard meat-filled diet as to be routinely expected in those above 65-70. Vegeterians rarely develop diverticulosis
81
diverticulosis - presentation
- asymptomatic most of the time
- left lower quadrant abdominal pain
- constipation
- bleeding
- sometimes infection (diverticulitis
82
diverticulosis - most accurate test
colonoscopy
83
diverticulosis - Barium
acceptable, but not as accurate
84
diverticulosis - treatment
Bran (πίτουρο), psyllium, methylcelluose (μεθυλοκυτταρίνη) and increased dietary fiber are used to decrease the rate of progression and complications
85
diverticulitis - presentation
1. LLQ pain and TENDERNESS
2. fever
3. Leukocytosis
4. palpable mass (sometimes)
5. nausea, constipation, bleeding (nonspecific)
86
Diverticulitis - best initial test
diverticulitis
87
Colonoscopy and barium - diverticulitis
both are DANGEROUS in acute diverticulitis because of increased risk of perforation
infection weakens the colonic wall
88
Treatment of diverticulitis is with antibiotics that cover ...
E. coli and anaerobes of the bowel
89
Treatment of diverticulitis - antibiotics
1. ciprofloxacin + metronidazole OR
2. beta lactam + lactamase (amoxicillin/clavulanate)
3. ticarcillin / clavulanate
4. ertapenem (carbapenems)
90
diverticulitis - surgery indications
1. no response to medical therapy
2 frequent recurences of infection
3. perforation, fistula formation, absecess, strictures or obstruction (complications)
91
surgery of devirticulitis - who is more likely to get recommendation of surgery - young or old
younger should have the colon resected more often because of the greater total number of recurrent episodes that will occur. Diverticular disease does not disappear despite treating episodes of diverticulitis or the use of fiber on the diet
92
diverticulitis - food
patients with acute diverticulitis should not be fed
