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