DSA 6: Diarrhea DSA

Question 1

What electrolytes are usually lost due to diarrhea?

Answer 1

Bicarbonate and potassium

Question 2

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

Answer 2

Non-inflammatory

Question 3

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

Answer 3

Routine stool bacterial cultures including E. coli 0157:H7

Question 4

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

Answer 4

Medications such as antibiotics and NSAIDs

Question 5

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

Answer 5

Sorbitol (found in chewing gum)

Question 6

What is acute diarrhea defined as?

What is chronic diarrhea defined as?

Answer 6

1) Less than two weeks duration

2) Greater than four weeks duration

Question 7

What are some clues that lean towards osmotic diarrhea?

Answer 7

1) Stool volume decreases with fasting

2) Increased stool osmotic gap

Question 8

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

Answer 8

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

Question 9

What is a major dietary cause of osmotic diarrhea?

How is it diagnosed?

Answer 9

1) Lactose intolerance

2) Hydrogen breath test

Question 10

What are some clues that lean towards secretory diarrhea?

Answer 10

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

Question 11

What does secretory diarrhea lead to?

Answer 11

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

Question 12

What types of tumors are common causes of secretory diarrhea?

Answer 12

Endocrine tumors like ZE syndrome

Question 13

What are the three most common causes of chronic diarrhea?

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

Answer 13

1) Meds, IBS, Lactose intolerance

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

Question 14

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

Answer 14

IBD

Question 15

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

Answer 15

Fecal antigen test

Question 16

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

Answer 16

Colonoscopy with mucosal biopsy

Question 17

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

Answer 17

EGD with small bowel biopsy

Question 18

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?

Answer 18

1) Fecal elastase less than 100 mcg/g

2) Calcification on a plain abdominal radiograph

Question 19

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

Answer 19

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

Question 20

What is IBS characterized by?

Answer 20

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

Question 21

What is the diagnostic criteria used for IBS?

Answer 21

ROME IV Clinical Diagnostic Criteria

Question 22

Hydrogen breath test is used to diagnose?

Answer 22

Lactase deficiency

Question 23

What is the most common cause of antibiotic associated colitis?

Answer 23

C. diff

Question 24

Is C. diff aerobic or anaerobic?

Is it gram + or - ?

Sporulating or non?

Shape?

Answer 24

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

Question 25

C. diff toxins A and B cause?

Answer 25

Mucosal damage

Question 26

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

Answer 26

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

Question 27

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

Answer 27

Leukocytosis: white blood count > 15,000/mcL

Question 28

What is found on flexible sigmoidoscopy for C. diff patients? What do biopsies reveal epithelial ulceration with a classic?

Answer 28

1) Yellow pseudomembranous colitis | 2) Volcano exudate of fibrin and neutrophils

Question 29

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

Answer 29

Never, always wash hands with soap and water

Question 30

What complications can C. diff cause?

Answer 30

Toxic megacolon and hemodynamic instability

Question 31

What are the characteristics of malabsorption syndromes?

Answer 31

1) Weight loss | 2) Steatorrhea

Question 32

Celiac disease is an immunologic response to what storage protein? It causes diffuse damage to?

Answer 32

1) Gluten | 2) Proximal small intestinal mucosa

Question 33

Celiac disease is only present in people with? It causes antibodies to?

Answer 33

1) HLA-DQ2 or HLA-DQ8 2) Gluten and IgA tissue transglutaminase (tTG)

Question 34

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

Answer 34

Dermatitis herpetiformis

Question 35

Celiac disease leads to what histologic finding? What is seen on endoscopy?

Answer 35

1) Complete loss of intestinal villi | 2) Atrophy or scalloping of the duodenal folds

Question 36

Where are bile salts reabsorbed? Problems with this process can be seen in what conditoin?

Answer 36

1) Terminal ileum | 2) Crohn's disease

Question 37

Bile salt malabsorption causes impaired absorption of what, leading to bleeding tendencies, osteoporosis, and hypocalcemia? What type of diarrhea is seen?

Answer 37

1) Fat-soluble vitamins (A, D, E, K) | 2) Watery secretary

Question 38

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?

Answer 38

1) Whipple disease | 2) Tropheryma whipplei

Question 39

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

Answer 39

Periodic acid Schiff positive for macrophages with characteristics bacillus

Question 40

What conditions does pseudo-diarrhea accompany?

Answer 40

IBS or proctitis

Question 41

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

Answer 41

Overflow diarrhea

Question 42

What population is overflow diarrhea most common in?

Answer 42

Elderly

Question 43

What medication is a common cause of constipation?

Answer 43

Opioids

Question 44

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

Answer 44

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

Question 45

Chronic use of laxatives can lead to?

Answer 45

Melanosis coli (a benign hyperpigmentation of the colon)