GI 8 highlights Flashcards
(27 cards)
Define IBS
Functional disorder of the gastrointestinal tract characterized by chronic abdominal pain & altered bowel habits
What is a key feature of IBS?
(important)
Chronic abd pain relieved with defecation
What 4 things are NOT part of IBS (alarm features)?
Bleeding, fever, weight loss, nocturnal awakening with diarrhea
List the Rome IV criteria for IBS diagnosis
(know this)
Recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following criteria:
1) Related to defecation
2) Associated with a change in stool frequency
3) Associated with a change in stool form (appearance)
Who may present with a fear of serious disease?
IBS
List the 4 subtypes of IBS
1) IBS with predominant constipation (IBS-C)
2) IBS with predominant diarrhea (IBS-D)
3) IBS with mixed bowel habits (IBS-M)
4) IBS unclassified (IBS-U)
Describe the workup for alarm features with IBS
1) Age of onset > 50
2) Rectal bleeding/melena
3) Nocturnal diarrhea
4) Progressive abdominal pain
5) Unexplained weight loss
6) Lab abnormalities (IDA, elevated CRP or fecal calprotectin/lactoferrin)
7) Family history of IBD or CRC
What is a key part of IBS management?
Direct therapy to the initial predominant symptom
1) Name the first line Tx for IBS-C
2) What abt IBS-D?
3) What should you give if they’re mainly complaining of cramping?
1) Linzess
2) Biberci
3) Diacylamine
Mesenteric ischemia:
List 3 parts of the intestinal vascular supply
1) Celiac artery
2) Superior mesenteric artery (SMA)
3) Inferior mesenteric artery (IMA)(
Vasculitis (systemic lupus erythematosus, polyarteritis nodosa) may cause what?
SMA thrombosis (15-20%)
List 3 clinical features of acute mesenteric ischemia
1) Sharp or colicky; pain is out of proportion with PE
2) Duration of 2-3 hours (arterial) or 5-30+ days (venous)
3) Mesenteric occlusion on angiography
- Use contrast-enhanced CT to Dx mesenteric venous thrombosis
List one clinical feature of chronic mesenteric ischemia
Worse after meals, resolving over hours
List some clinical features of colonic mesenteric ischemia
1) Nausea, vomiting, diarrhea, passage of maroon stools
2) Hypotension, new hypotensive agent, long distance runners
Acute mesenteric ischemia has up to 90% survivability if what?
No peritonitis
What is the most common cause of large bowel obstruction?
Sigmoid volvulus
_____________ due to prior colorectal resection is a risk factor for colorectal obstruction
Stricture
70% of colorectal polyps removed during colonoscopy are ______________________
adenomatous (precancerous)
Toxic megacolon: Total or segmental non-obstructive colonic dilatation occurring in context of ___________ toxicity
systemic
Toxic megacolon is a potentially lethal complication of _____________________ or infectious colitis
IBD (most common UC)
What is the most common presenting symptom of toxic megacolon?
Severe bloody diarrhea
Limited endoscopy should be done for for selected patients with what?
Toxic megacolon
List 2 main findings of toxic megacolon on an exam
1) Toxic-appearing patient with altered sensorium
2) Distention
Toxic megacolon Dx is based on clinical signs of systemic toxicity with radiographic evidence of ___________________________ (use diagnostic criteria)
colonic dilatation (> 6 cm)
