Disorders of the small Bowel and Colon CIS Flashcards Preview

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Flashcards in Disorders of the small Bowel and Colon CIS Deck (65):
1

acute diarrhea- most lasts?

-most <4 days
-less than 2 wks

2

persistent diarrhea- lasts?

more than 2 weeks

3

chronic diarrhea- lasts?

> 1 month
-most likely non-infectious- IBD, IBS, chronic pancreatitis, DKA, diverticulitis

4

Campylobacter jejuni

-Guillain Barre
-bloody diarrhea!
-chicken, eggs

5

Giardia lamblia

-pear shaped trophozoite with 2 nuclei and 4 pairs of flagella
-camping

6

Cytoisospora belli

-protozoan organism that stains positive for acid fast bacilli
-in HIV pts
-watery diarrhea

7

Staph aureus

-potato salad
-rapid onset- 6 hrs
-self limited

8

Bacillus cereus

-fried rice

9

Vibrio cholera

-oysters; poor sanitation
-profuse watery (rice) stools

10

Clostridium difficile

-foul smelling
-after abx
-complications- colon perforation and toxic megacolon
-wash hands with soap and water
-PPI (omeprazole)- risk

11

Clostridium difficile- tx

-PO/IV Metronidazole
-PO vancomycin
-PO fidaxomicin

12

Antibiotic associated colitis- dx

-TCdA (enterotoxin) and TCdB (Cytotoxin)- check stool for toxin assay!!
-abx use- ampicillin, clindamycin, 3rd gen cephalosporins, fluoroquinolones

13

Salmonella typhimurium

-turtles, eggs
-bloody diarrhea

14

Salmonella typhi

-typhoid fever
-gram-neg enteric bacillus
-rose spots; relative bradycardia!!
-invades mult RES organs, Peyer's patches
-high fever
-travel, poor sanitation
-carrier site- Gallbladder! most common

15

Yersinia

-mimics appendicitis
-bloody diarrhea!
-Hemochromatosis- risk factor!!- HFE gene mutation

16

Clostridium perfringens

-ham
-watery diarrhea

17

Strongolyoides

-rhabditiform larvae in stool
-HTLV1- risk factor
-barefoot in soil

18

Cryptosporidium

-swimming pools

19

Entamoeba histolytica

-bloody diarrhea
-flask shaped ulcer
-liver abscess

20

Vibrio vulnificus

-coastal salt water
-bullous skin lesion
-cirrhotic pt

21

Listeria monocytogenes

-deli meat
-pregnancy

22

Aeromonas hydrophila

-freh water

23

Echinococcus granulosus

-dog tapeworm
-liver cysts

24

ETEC E coli

-travelers' diarrhea!- most common cause

25

Ascaris lumbricoides

-small intestine obstruction

26

Schistosoma mansoni

-liver cysts
-esophageal varices
-Africa
-snails
-bladder cancer

27

EHEC

-hemolytic uremic syndrome

28

Vibrio parahemolyticus

-bloody diarrhea
-oysters

29

most common infectious causes of BLOODY diarrhea

-salmonella
-shigella
-EHEC (0157 H7)
-campylobacter
-Yersinia enterocolitica

30

most incidental finding of appendix

-carcinoid tumor

31

MEN1

-parathyroidism- constipation
-zollinger ellison- gastrin
-pituitary adenoma
-pancreatic tumors

32

chronic diarrhea- most common causes

-medication adverse effects
-IBS
-lactose intolerance
* none of these have nocturnal diarrhea, weight loss, anemia or +FOBT

33

5-HIAA

-carcinoid

34

breath test

-glucose/lactose- small bowel overgrowth

35

IBS

-idiopathic, >6months, abd pain with altered BMs
-no structural or biochemical abnormalities

36

Rome III criteria for IBS dx

-abd discomfort for 3 days/month for past 3 months, with sx onset >6 months
-at least 2/3:
-relieved w/ defecation
-change in frequency of stool
-change in form of stool

37

low FODMAPS diet

-(Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols)- fermentable monosaccharides and short-chain carbohydrates
-ex- fructose, lactose, fructans, wheat-based products, sorbitol
-for IBS pts!!

38

Neuroendocrine

-VIP-oma
-medullary thyroid carcinoma (calcitonin)
-zollinger-ellison syndrome (gastrin)
-carcinoid syndrome (5-HIAA)

39

causes constipation

-inadequate fiber and fluid intake
-hypothyroidism
-Ca channel blocker use
-Ca supplementation

40

Lesar-Trelat sign

-many pigmented lesions
-colon cancer assoc

41

constipation/fecal impaction- dx, tx

-dx- digital rectal exam
-tx- enemas, digital disruption

42

microscopic colitis- causes

-idiopathic- medications can cause it
-W>M; 5-6 decade
-watery diarrhea
-lymphocytic- lymphocytes and plasma cells
-collagenous- thickened band of subepit colagen

43

diverticulitis- sx, tx

risk for perforation so dont do scope!!!
-ttp in LLQ,fever, FOBT positive, elevated WBC count
-tx- start antibiotics; NPO/clear liquid diet
-after sx resolution- diagnostic imaging to rule out colonic neoplasms

44

diverticulosis bleed

painless bloody poops

45

diverticular dz of the colon- risk factors, sx, dx, complications

-inc age, CT dz, low fiber diet or chronic constipation (Debated)
-sx- asymptomatic
-dx- colonoscopy or barium enema
-complications- GI bleed, diverticulitis

46

types of polyps

-adenomatous (70%)
-serrated- sessile serrated, serrated adenoma
-nonneoplastic- juvenile, hamartomas, infl

47

colorectal cancer screening

-FH
-if 1st degree relative dx at 60 yo- begin screening at 40!!
-begin screening at age 40 or 10 yrs younger than diagnosis of affected relative

48

95% of colon adenocarcinoma- come from?

-adenomas and serrated polyps!
-advanced- higher risk of progressing to malignancy- if > 1 cm, high-grade dysplasia
-asymptomatic- FOBT positive, iron def anemia

49

ways to detect polyps

-barium enema- poor diagnostic accuracy
-CT colonosgraphy- less sensitive at catching < 10 mm
-colonoscopy- gold standard!!!

50

Cowden disease

-PTEN mult hamartoma syndrome
-hamartomatous polyps and lipomas thruout GI tract!
-hair follicle tumors (around lips)- Trichilemmomas
-cerebellar lesions
-inc rate of malignancy

51

lynch syndrome

-endometrial cancer- transvaginal US

52

FAP- caused by, tx

-100-1000s of adenomatous polyps and adenocarcinoma
-APC gene or MUTYH gene mutation
-tx- prophylactic colectomy

53

Peutz-Jeghers Syndrome

-Hamartomatous polyposis syndrome- AD
-mucocutaneous pigmented macules around lips
-GI malignancy- 40%

54

Familial juvenile polyposis

-hamartomatous polyposis syndrome- AD
->10 hamartomatous polyps- in colon
-inc risk of adenocarcinoma!!

55

Lynch syndrome (HNPCC)

-AD
-MMR gene mutation- MLH1, MSH2!
-inc risk of CRC, endometrial cancer!!!
-rapid polyp transformation to malignant- 1-2 yrs

56

Gardner's syndrome

-adenomatous colon polyps
-95% develop colorectal polyps
-osteomas of mandible, skull, long bones
-supernumerary teeth, thyroid and adrenal tumors, desmoid tumors
-AD

57

Turcot's syndrome

-adenomatous colon polyps
-brain tumors
-colorectal cancer- 100% at 40 yo
-AD

58

Celiac dz- ab's

-IgA tTG
-if IgA def- anti-DGP
(HLA-DQ2/8)

59

celiac dx- sx

-wgt loss, chronic diarrhea
-dermatitis herpetiformis, iron def anemia, osteoporosis

60

celiac dz- at risk for?

malabsorption!
-type 1 DM
-osteoporosis- DEXA scan

61

celiac dz- biopsy

-complete loss of intestinal villi
-intraepit lymphocytes
-plasma cells with hypertrophy of intestinal crypts

62

Whipple disease- dx, sx, tx

-biopsy- PAS + macrophages with gram + bacilli (Tropheryma whipplei)
-lose ADEK
-fever, LAD, arthralgias, malabsorption
-tx- antibiotics

63

Short bowel syndrome- if <200 cm left of jejunum and no colon

-total parental nutrition!!!

64

bacterial overgrowth- sx, caused by? dx?

-malabs of fat soluble vitamins; steatorrhea
-PPI, gastric surgery of small bowel, small intestine motility disorders, gastrocolic or coloenteric fistula
-dx H breath test
-tx- antibiotics

65

TI resection

-bile salts and vit B12 malabs
-give calcium supplementation- inc risk of oxalate kidney stones