Diarrhea (Quiz 2)

Question 1

acute diarrhea is defined as lasting how long

Answer 1

• less than 2 weeks

Question 2

common etiology of acute diarrhea

Answer 2

• infectious

Question 3

chronic diarrhea is defined as lasting how long

Answer 3

• more than 4 weeks

Question 4

etiology of chronic diarrhea

Answer 4

• multiple etiologies

- often non-infectious

Question 5

pathophysiology of osmotic/malabsorption diarrhea

Answer 5

• increased osmotic load in intestine

- retains fluid in lumen of bowel

Question 6

treatment of osmotic diarrhea

Answer 6

• resolves or decreases with fasting

Question 7

pathophysiology of secretory diarrhea

Answer 7

• excess secretion of electrolytes and water into intestinal lumen

Question 8

secretory diarrhea characterized by

Answer 8

• elevated stool volumes

- hypokalemia

Question 9

result of fasting with secretory diarrhea

Answer 9

• continues despite fasting

Question 10

how to calculate stool osmotic gap

Answer 10

290 - (2 x (Stool Na + Stool K)

Question 11

stool osmotic gap > 100 suggests

osmotic gap < 50 suggests

Answer 11

• osmotic diarrhea

- secretory diarrhea

Question 12

pathophysiology of inflammatory diarrhea

Answer 12

• mucosal destruction leads to increased permeability

- inflammatory mediators stimulate secretion and inhibit reabsorption

Question 13

clinical features of inflammatory diarrhea

Answer 13

• WBC and blood in stool
• fever
• tenesmus

Question 14

what is tenesmus

Answer 14

• urgency to have a bowel movement

Question 15

two divisions of microscopic colitis

Answer 15

• lymphocytic colitis

- collagenous collitis

Question 16

which microscopic colitis affects women more

which one affects both equally

Answer 16

• collagenous - women

- lymphocytic - men and women affected equally

Question 17

what does the colon look like with endoscopy and radiographically in microscopic colitis

Answer 17

• normal appearing colon

Question 18

how to diagnose microscopic colitis

Answer 18

• colonic mucosal biopsies

Question 19

biopsy of lymphocytic colitis shows

Answer 19

• infiltration of colonic epithelium with lymphocytes

Question 20

biopsy of collagenous colitis shows

Answer 20

• thickening of sub epithelial collagen band

- some increase in intraepithelial lymphocytes

Question 21

treatment of microscopic colitis

Answer 21

• Budesonide

Question 22

genetics of celiac disease

importance of this test

Answer 22

• lack of HLADQ2/8 forms autoantibodies (TTG, EMA)

- patient’s don’t necessarily have celiac if they are negative for these HLAs but they could have it

Question 23

presentations of celiac disease

Answer 23

• ADEK deficiencies
• iron deficiency anemia
• dermatitis herpetiformis

Question 24

histologic findings for celiac disease

Answer 24

• blunting of villi (crypt:villus ratio 3:1 instead of 1:3)
• increased lymphocytes and plasma cells in lamina propria of epithelium
• fusion of microvilli

Question 25

pancreatic exocrine insufficiency - malabsorption does not occur until exocrine secretions are decreased by

Answer 25

- 90%

Question 26

pancreatic exocrine insufficiency what you see in clinical studies

Answer 26

- fat in stool | - decrease in ADEK vitamins

Question 27

pathophysiology of bacterial overgrowth

Answer 27

- decreased transit resulting in overgrowth of bacteria in the small bowel

Question 28

how to diagnose bacterial overgrowth

Answer 28

- small bowel X-rays - hydrogen breath test - empiric antibiotic trial

Question 29

exogenous agents that can cause osmotic diarrhea

Answer 29

- sorbitol - lactose in those deficiency in lactase - fructose in those deficient in GLUT5

Question 30

pathophysiology of motility diarrhea

Answer 30

- rapid transit through colon

Question 31

what is IBS

Answer 31

- functional bowel disorder | - abdominal pain associated with defecation or change in bowel habit

Question 32

4 IBS subtypes

Answer 32

- IBS constipation - IBS diarrhea - IBS mixed - IBS unspecified

Question 33

pathophys of IBS

Answer 33

- heightened visceral hypersensitivity - altered gut-brain axis - abnormal CNS processing of visceral stimuli - due to infection

Question 34

red flags for IBS

Answer 34

- onset after age 50 - worsening symptoms - weight loss - nocturnal diarrhea - family history of colon cancer, celiac, IBD - rectal bleeding or melena - iron deficiency anemia

Question 35

treatment of motility diarrhea

Answer 35

- improves with fasting

Question 36

what are the criteria for IBS

Answer 36

- Rome IV criteria