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Flashcards in GI Deck (42):
1

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

with or without urgency

2

what time frame defines acute diarrhea?

less than 2 weeks

3

what time frame defines chronic diarrhea?

more than 30 dys

4

what defines a mild diarrhea?

less than 3BMs per day

5

what defines a moderate diarrhea?

more than 4BMs per day with local sxs

6

what defines a severe diarrhea?

more than 4 BMs per day with systemic sxs

7

what is the MCC of acute diarrhea?

infectious process usu. viral and self limited
severe is usu. bacterial in nature

8

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

chronic infection

9

what is the MCC of chronic diarrhea in developed countries?

IBS, IBD, Malabsorption

10

which viruses are a/w non inflammatory diarrhea?

rotavirus
norwalk virus

11

which protozoa are a/w non inflammatory diarrhea?

giardia (streams, water)
cryptosporidium
cyclospora

12

what virus is a/w inflammatory diarrhea?

CMV

13

what protozoa is a/w inflammatory diarrhea?

entamoeba histolytica

14

what is classic cause of bacillus cereus?

fried rice (causes non inflammatory diarrhea)

15

which bacteria produce enterotoxins and non inflammatory diarrhea?

ETEC (E. coli)
vibrio cholerae (fish)

16

which bacteria produce cytotoxins and inflammatory diarrhea?

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

17

which bacteria invade the mucosa and cause inflammatory diarrhea?

shigella
Campylobacter jejuni
salmonella
enteroinvasive E. coli
yersinia

18

what are the pathogenic clues when assessing for diarrhea?

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

19

what are key food hx questions when assessing for diarrhea?

unpasteurized milk, apple joice
raw, undercooked meat, fish

20

why is timing important for diarrhea?

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

21

when would you order O&P?

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

22

when would you consider an endoscopy in a diarrhea pt?

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

23

when is abx contraindicated for diarrhea?

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

24

when might you give a pt prophylactic abx?

PING pts or with need for prevention while travelling

25

which medications can cause chronic diarrhea?

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

26

what is a cathartic screen?

tests for metabolites of laxatives in stool

27

what is secretory diarrhea?

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

28

what is osmotic diarrhea?

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

29

what is the MCC of osmotic diarrhea?

carbohydrate malabsorption
laxative use/abuse
malabsorption syndromes

30

what are causes of secretory diarrhea?

endocrine tumors
bile salt malabsorption (stimulates colonic secretion)

31

what osmotic gap would indicate a secretory diarrhea?

50 mosm/kg

32

what osmotic gap would indicate an osmotic diarrhea?

125 mosm/kg

33

what is a normal osmotic gap?

50-125 mosm/kg

34

what are causes of bile salt enteropathy?

drugs
infection
hyperthyroidism
laxative abuse
neuroendocrine tumor
rectal villous adenoma

35

what can cause malabsorptive d/o?

celiac sprue
small bowel resection
carcinoid
chronic pancreatitis
pancreatic carcinoma

36

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

postsurgical
systemic d/o
IBS

37

what does a crampy pain usu indicate in GI?

obstruction

38

what does a steady pain usu indicate in GI?

inflammatory process

39

where does gall bladder pain radiate to?

right shoulder

40

what is the test of choice for evaluating RUQ pain?

ultrasound

41

what is the approach of a GI complaint?

1. complaint based
2. disease state based

42

what does odynophagia imply?

inflammation

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