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GI Flashcards

(57 cards)

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1
Q

Constipation definition

A

Less than 3 BM per week
Hard stools
Excessive straining
Incomplete evacuation

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2
Q

Basis for diagnosis of constipation

A

BM frequency and completeness

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3
Q

Pediatric constipation definition

A

2 or more of the following w/in 8 weeks:
Fewer than 3 BMs in 1 week
Greater than 1 episode of fecal incontinence a week
Large stool in rectum or palpable on ab exam
Painful defecation
Passing stool large enough to obstruct the toilet
Retentive posturing and withholding behavior

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4
Q

“Functional” constipation definition

A

2 or more of the following w/in 2 months if older than 4 years or 2 or more of the following within 1 month if younger than 4 years:
2 or less defectations per week
At least 1 episode of fecal incontinence a week
H/o large diameter stools obstructing the toilet
H/o painful or hard BMs
H/o retentive posturing or excessive volitional stool retention
Presence of large fecal mass in rectum

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5
Q

What does withholding cause

A

Decreased ability to pass stool
Decreased sensitivity to pass stool
Increased stool time in rectum (stool becomes harder/larger)

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6
Q

Constipation differential diagnosis

A

Anatomic
Dietary
Medication related

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7
Q

Constipation differential diagnosis: anatomic

A

CF
Metabolic and endocrine (DM, hypercalcemia, hypothyroidism)
Neurologic (Cerebral palsy, Hirschsprung disease, Spina Bifida)
SLE

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8
Q

Constipation differential diagnosis: Dietary

A

Dehydration
High in fat
Low in fiber

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9
Q

Constipation differential diagnosis: medication related

A 
Antacids - Ca containing
Antidepressants
Antihistamines
Cathartics (abuse/overuse)
Iron supplements
Opioids
Pseudoephedrine
Vincristine
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10
Q

Constipation s/sx

A

Ab distention
Ab pain
Bloating
Nausea

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11
Q

Functional constipation s/sx

A 
Becoming fidgety 
Decreased appetite
Decreased food intake
Rocking back and forth
Standing on tiptoes
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12
Q

Constipation non-pharmacologic treatment

A

Behavior modification
Diet
Digital disimpaction

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13
Q

Constipation pharmacologic treatment

A

Lubricants (soften stool, prevent reabsorption of water)
Osmotic laxatives
Osmotic enemas
Stimulant laxatives

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14
Q

Constipation pharmacologic plan to avoid recurrences

A

Lubricants
Osmotic laxatives
Stool softener

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15
Q

Stool softener

A

Docusate
Reduces surface tension on the water/oil interface in stool
Increases water absorption in stool

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16
Q

Diarrhea definition

A

> /= 3 water, loose stools per day

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17
Q

Acute diarrhea

A

Increased number and stool consistency change for less than 7 days

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18
Q

Chronic diarrhea

A

Diarrhea lasting more than 14 consecutive days

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19
Q

Diarrhea pathophysiology

A

Normal GI tract fx is impaired (Impaired fluid and electrolyte balance)
Fluid volume in GI lumen

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20
Q

How is fluid volume in the GI lumen affected in diarrhea?

A

Dietary fluid intake
Intestinal secretions
Colonic reabsorption

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21
Q

Electrolyte contents in fecal stool

A

Na - 40
K - 90
Cl - 15
Na bicarb - 30

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22
Q

Types of diarrhea

A

Secretory
Osmotic
Exudative
Changed motility

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23
Q

Secretory diarrhea

Study These Flashcards
A

Stimulant
Increases secretion of water into lumen
Decreases absorption of water and electrolytes from lumen (inhibits Na/K ATP ase)

24
Q

Secretory diarrhea causes

Study These Flashcards
A 
Bacterial toxins
Hormones (secretin)
Increased bile acids
Laxatives
Unabsorbed dietary fat
25
Osmotic diarrhea
Created of osmotic gradient in lumen d/t poorly absorbed substances in GI tract
26
Osmotic diarrhea causes
Lactose intolerance Malabsorption Medications (lactulose, Mg containing products)
27
Exudative diarrhea
Injury to mucosal lining in lumen | Inflamed intestine prevents proper water and electrolyte transfer
28
Exudative diarrhea causes
IBD (CD/UC)
29
Changed motility diarrhea
Decreased time for normal absorption
30
Changed motility diarrhea causes
Bacterial over growth Early colonic emptying Reduction in small intestine transit time
31
Viral diarrhea differential diagnosis
Adenovirus CMV Norovirus Rotavirus
32
Bacterial diarrhea differential diagnosis
``` C diff E coli Salmonella Shigella Yersinia ```
33
Parasitic diarrhea differential diagnosis
Cryptosporidium Entameba histolytica Giardia
34
Toxin diarrhea causes
C diff toxin | Enterotoxins
35
Exposure diarrhea causes
``` Chemo Laxative abuse/overuse Medications Radiation Tumor secretions ```
36
Malabsorption diarrhea causes
``` Allergic enteropathy Celiac disease Chronic liver disease Glucose/galactose transport defect Pancreatic insufficiancy ```
37
IBD diarrhea causes
Allergic colitis CD Eosinophilic gastroenteritis UC
38
Intake diarrhea causes
High carb load
39
Non-pharmacologic treatment of diarrhea
``` Restore fluid and electrolyte balance Adjust diet (continue feedings during acute diarrhea phases) ```
40
Oral replacement therapy
Pedialyte Enfalyte Rehydralyte Cerelyte
41
Pharmacologic treatment of diarrhea
``` Bismuth subsalicylate Cholestyramine Probiotics Psyllium Opioids Vitamin A Zinc ```
42
Bismuth subsalicylate
Facilitated extra water absorption from the lumen Inhibits PGs decreasing GI tract inflammation Caution with viral infections
43
Cholestyramine
Used in increased bile acid related diarrhea Duration of therapy in patients under 2 years of age = 2 days Interactions with medication absorption
44
Opioid examples
Diphenoxylate Loperamide (do not use under 3 yo) Morphine
45
GERD definition
Passage of stomach contents into the esophagus
46
GERD mechanism
``` LES relaxation (w/out swallowing) Stomach contents reflux into stomach ```
47
GERD in pediatric non-pharmacologic treatment
Feeding changes Change volumes Modify frequency Thicken feeds
48
GERD sx
Ab pain Food refusal Heartburn Regurgitation
49
GERD complications
Barrett's esophagus Hemorrhage Reflux esophagus Stricture
50
GERD RF
Chronic lung disease Esophageal atresia Neurologic impaired (cerebral palsy) Prematurity
51
H2RA disadvantages
ADR: HA, irritability, somnolence | Tolerance development
52
GERD pharmacologic treatments
``` Antacids H2RAs Prokinetic agents PPI Surface-protectant agents ```
53
Prokinetic agent advantages
Facilitates gastric emptying | Improves sx
54
Prokinetic agent disadvantages
ADR: EPS, GI upset, hepatotoxicity Limited evidence Not efficacious
55
Prokinetic agent examples
Bethanecol Erythromycin Metoclopramide
56
PPI ADRs
Constipation Diarrhea HA Nausea
57
Surface-protectant agent advantages
Aids mucosal healing | Low risk of ADR

Pediatrics (9 decks)

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