GI

Question 1

what should you distinguish when a pt has a CC of diarrhea?

Answer 1

with or without urgency

Question 2

what time frame defines acute diarrhea?

Answer 2

less than 2 weeks

Question 3

what time frame defines chronic diarrhea?

Answer 3

more than 30 dys

Question 4

what defines a mild diarrhea?

Answer 4

less than 3BMs per day

Question 5

what defines a moderate diarrhea?

Answer 5

more than 4BMs per day with local sxs

Question 6

what defines a severe diarrhea?

Answer 6

more than 4 BMs per day with systemic sxs

Question 7

what is the MCC of acute diarrhea?

Answer 7

infectious process usu. viral and self limited

severe is usu. bacterial in nature

Question 8

what is the MCC of chronic diarrhea in underdeveloped countries??

Answer 8

chronic infection

Question 9

what is the MCC of chronic diarrhea in developed countries?

Answer 9

IBS, IBD, Malabsorption

Question 10

which viruses are a/w non inflammatory diarrhea?

Answer 10

rotavirus

norwalk virus

Question 11

which protozoa are a/w non inflammatory diarrhea?

Answer 11

giardia (streams, water)
cryptosporidium
cyclospora

Question 12

what virus is a/w inflammatory diarrhea?

Answer 12

CMV

Question 13

what protozoa is a/w inflammatory diarrhea?

Answer 13

entamoeba histolytica

Question 14

what is classic cause of bacillus cereus?

Answer 14

fried rice (causes non inflammatory diarrhea)

Question 15

which bacteria produce enterotoxins and non inflammatory diarrhea?

Answer 15

ETEC (E. coli)
vibrio cholerae (fish)

Question 16

which bacteria produce cytotoxins and inflammatory diarrhea?

Answer 16

O157:H7 (EHEC)
vibrio parahoemolyticus (fish)
c. diff

Question 17

which bacteria invade the mucosa and cause inflammatory diarrhea?

Answer 17

shigella
Campylobacter jejuni
salmonella
enteroinvasive E. coli
yersinia

Question 18

what are the pathogenic clues when assessing for diarrhea?

Answer 18

well water/farm
ill contacts
occupational exposure
recent travel
pets (reptiles)
hobbies
recent Hospitalizations and abx use
food history

Question 19

what are key food hx questions when assessing for diarrhea?

Answer 19

unpasteurized milk, apple joice

raw, undercooked meat, fish

Question 20

why is timing important for diarrhea?

Answer 20

length of time between ingestion and sxs can point to the pathogen
1-6hrs (s. aureus, b. cereus)
8-16 hrs (c. perfringens)

Question 21

when would you order O&P?

Answer 21

presistent diarrhea
foreign travel
day care exposure
community water outbreak
MSM or HIV

Question 22

when would you consider an endoscopy in a diarrhea pt?

Answer 22

suspected c. diff
suspected ischemic colitis
IBD infectious vs IBD flare
PING

Question 23

when is abx contraindicated for diarrhea?

Answer 23

suspected or proven EHEC (toxin of bacteria and abx cause renal failure)

Question 24

when might you give a pt prophylactic abx?

Answer 24

PING pts or with need for prevention while travelling

Question 25

which medications can cause chronic diarrhea?

Answer 25

``` SSRIs Cholinesterase inhibitors NSAIDS PPIs Angiotensin II receptor blockers Metformin Allopurinol Colchicine ```

Question 26

what is a cathartic screen?

Answer 26

tests for metabolites of laxatives in stool

Question 27

what is secretory diarrhea?

Answer 27

intestinal mucosa directly secretes fluid and electrolytes into the stool (pushes) causes normal or decreased osmotic gap diarrhea will not change with fasting

Question 28

what is osmotic diarrhea?

Answer 28

malabsorption of ingested substance which pulls water into lumen (substances what to be diluted) causes an increased osmotic gap will resolve during fasting

Question 29

what is the MCC of osmotic diarrhea?

Answer 29

carbohydrate malabsorption laxative use/abuse malabsorption syndromes

Question 30

what are causes of secretory diarrhea?

Answer 30

endocrine tumors | bile salt malabsorption (stimulates colonic secretion)

Question 31

what osmotic gap would indicate a secretory diarrhea?

Answer 31

50 mosm/kg

Question 32

what osmotic gap would indicate an osmotic diarrhea?

Answer 32

125 mosm/kg

Question 33

what is a normal osmotic gap?

Answer 33

50-125 mosm/kg

Question 34

what are causes of bile salt enteropathy?

Answer 34

``` drugs infection hyperthyroidism laxative abuse neuroendocrine tumor rectal villous adenoma ```

Question 35

what can cause malabsorptive d/o?

Answer 35

``` celiac sprue small bowel resection carcinoid chronic pancreatitis pancreatic carcinoma ```

Question 36

what can cause motility d/o (peristalsis is inhibited and draws more water in and causes diarrhea)?

Answer 36

postsurgical systemic d/o IBS

Question 37

what does a crampy pain usu indicate in GI?

Answer 37

obstruction

Question 38

what does a steady pain usu indicate in GI?

Answer 38

inflammatory process

Question 39

where does gall bladder pain radiate to?

Answer 39

right shoulder

Question 40

what is the test of choice for evaluating RUQ pain?

Answer 40

ultrasound

Question 41

what is the approach of a GI complaint?

Answer 41

1. complaint based | 2. disease state based

Question 42

what does odynophagia imply?

Answer 42

inflammation