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Clinical Medicine III > GI: IBS, Diarrhea, Constipation > Flashcards

GI: IBS, Diarrhea, Constipation Flashcards

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1
Q

This is a functional bowel d/o w. recurrent abdominal pain and altered bowel habits…

A

IBS

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2
Q

The below should indicate what in an IBS patient?

i. Onset after 50 yo
ii. Severe/worsening
iii. Nocturnal
iv. Fever/vomiting
v. Wt. loss
vi. Melena. Hematochezia, (+) hemoccult
vii. Hx of Colon CA, IBD, Celiac
viii. Unexplained IDA

A

emergent eval

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3
Q

A patient presents with dyspepsia, atypical CP, vomiting, altered bowel habits and recurrent abd. pain. What should you suspect?

A

IBS

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4
Q

The below conditions commonly accompany what condition?

FM
interstitial cystitis
dyspareunia
dyspepsia

A

IBS

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5
Q

Is physical exam in IBS typically normal or abnormal?

A

normal +/- abd. TTP

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6
Q

Rome IV criteria suggests IBS if…

recurrent abd. pain q once weekly x 3 mo and 2 of what 3 additional sxs?

A

related to defecation
change in BM frequency
Change in BM appearance

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7
Q

What Bristol Scale Type?

separate, hard lumps

A

type I

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8
Q

What Bristol Scale Type?

lumpy but sausage shaped

A

type 2

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9
Q

What Bristol Scale Type?

cracked, sausage shaped

A

type 3

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10
Q

What Bristol Scale Type?

sausage shaped, smooth, soft

A

Type 4

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11
Q

What Bristol Scale Type?

soft blobs w/ clear edges

A

type 5

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12
Q

What Bristol Scale Type?

fluffy w. ragged edges, mushy stool

A

Type 6

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13
Q

What Bristol Scale Type?

entirely liquid

A

type 7

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14
Q

Which IBS subclass has bristol type 1 and type 2?

A

IBS-C

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15
Q

Which IBS subclass has bristol type 6 and type 7?

A

diarrhea

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16
Q

Which IBS subclass has bristol type 1 and type 6?

A

Mixed

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17
Q

Unclassified IBS has what bristol type?

A

none

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18
Q

If typical IBS hx and no alarm features, how is IBS diagnosed?

A

clinical +/- labs, h. pylori tests, stool studies

No imaging

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19
Q

What labs can be included in IBS diagnosis?

A 
CBC 
CMP
TSH
ESR/CRP
Celiac Serology
H. pylori
Stool studies
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20
Q

Atypical IBS sxs + alarm features or refractory cases require what workup? (labs + imaging?)

A 
CBC 
CMP
TSH
ESR/CRP
Celiac Serology
H. pylori
Stool studies

Cross sectional/small bowel imaging

Endoscopy/colonoscopy w. Bx

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21
Q

What is first line to treat IBS?

A

reconcile offending meds, lifestyle changes, Low FODMAP

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22
Q

Low FODMAP occurs by eliminating foods over what time frame?

A

4-8 weeks

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23
Q

What IBS drugs are available for abd. pain?

A

antispasmotics (amines, peppermint oil)

antidepressants (TCA, SSRI)

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24
Q

The below drugs are available for which IBS type?

prosecretory agents (lubiprostone, linaclotide, plecanatide)

5-HT4 Agonist (tegaserod)

A

constipation

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25
The below drugs help treat... lubiprostone, linaclotide, plecanatide 5-HT4 Agonist (tegaserod)
constipation
26
The below drugs help treat what IBS related condition? 1. OTC: loperamide 2. Bile acid sequestrants (off-label) 3. Rifaximin 4. Eluxadoline 5. 5-HT3 Antagonist: alosetrone
Diarrhea
27
What type of constipation? Constipation, no pain ii.
Functional Chronic idiopathic constipation
28
What type of constipation? constipation + pain
Functional Constipation IBS-C
29
The below drugs are common causes of... ``` anticholinergics, antipsychotics Iron antacids (Ca, Al) CCBs TCAs ```
med induced constipation
30
The below are what cause of constipation? ``` Pelvic floor dysfunction rectal prolapse rectocele colon CA polyps stricture impaction ```
Defecation/Obstructive constipation
31
The below are what cause of constipation? ``` hyperCa hyperPTH hyperthyroid DM pregnancy Hirschsprung MS Parkinson spinal cord injury ```
Metabolic/systemic disease constipation
32
What are three GI signs/sxs that accompany a complaint of constipation?
pain/bloating bleed tenesmus
33
Constipation can be diagnosed if the below are present for what percentage of defecations a week? i. < 3 BMs/week ii. Lumpy/hard iii. Straining iv. Manual maneuvers v. Sensation of obstruction/blockage vi. Incomplete evacuation
25%
34
What part of physical exam for consipation assess for... eval for fissures, hemorrhoids, tenderness, masses, stool, anal stricture, anal sphincter tone, perineal descent, dyssynergic defecation
DRE
35
A pelvic exam is indicated for constipation to identify...
rectocele
36
If refractory constipation, what three diagnostics are available?
Sitz marker study defecography anorectal manometry
37
Which constipation study? Colonic transit, movement of radiopaque marker thru colon via x-ray
Sitz marker study
38
Which constipation study? Radiologic image for defecation mechanics Assess anatomy, fxn of anorectum & pelvic floor
defecography
39
Which constipation study? Anal/sphincter pressure & fxn
anorectal manometry
40
Tx for constipation includes reconciling offending meds, lifestyle and what drug classes? (5)
``` Fiber Stool Softeners Osmotic Laxatives Stimulant laxatives Rx drugs ```
41
What three Rx drugs are available to relieve constipation?
lubiprostone, Linaclotide, Plecanatide
42
What constipation drug class? psyllium, methylcellulose, polycarbophil, benefiber
Fiber
43
3 fiber S/Es
flatulence, bloating, distension
44
What constipation drug class? Docusate
Stool Softener
45
What constipation drug class? polyethylene glycol, milk of magnesia, Mg Citrate, Lactulose
Osmotic laxatives
46
Osmotic laxatives that contain magnesium can cause...
hypermagnesemia if renal insufficiency
47
What constipation drug class? bisacodyl, Senna
Stimulant laxatives
48
3 lifestyle mods that can help w. constipation...
increase fluid/fiber, activity/exercise, bowel habit training
49
3 complications of constipation...
hemorrhoids/fissues lyte imbalance (laxative abuse) fecal impaction/obstruction
50
A patient w. hx of constipation presents w. NV Abd. Pain Distension Paradoxical Diarrhea What is this concerning for?
bowel obstruction
51
How is bowel obstruction treated?
disimpaction and maintenance bowel prep PRN
52
The below populations are high risk for what constipation complication? dementia neuro dz immobile hypomotility meds
fecal impaction/obstruction
53
The below increase your risk of... i. Hospitalization/abx ii. Travel hx iii. Food borne iv. Community outbreak v. Pets/animal vi. New meds
acute diarrhea
54
Definition of acute diarrhea...
3+ unformed stools QD x < 14 days
55
Chronic diarrhea persists for how many days?
30+
56
The below + what condition require prompt evaluation? Volume depletion Fever Wt. loss Blood Nocturnal/persistent/progressive sxs Immunocompromised IDA FHx of colon CA, IBD, celiac
Diarrhea
57
2 MC causes of non-inflammatory diarrhea...
norovirus, giardia
58
Inflammatory or non-inflammatory diarrhea? watery, non-bloody mild cramps/pain +/- low grade fever
non-inflammatory
59
Inflammatory or non-inflammatory diarrhea? fever bloody severe pain
inflammatory
60
If the below are present, what is indicated? i. Inflammatory diarrhea: fever 101.3+, leukocytosis, blood, severe abd pain ii. Intractable vomiting iii. Profuse watery diarrhea/dehydration iv. AKI/Lyte abnormalities v. Elderly/long term care residents vi. Immunocompromised vii. Hospital acquired/abx exposure
Prompt evaluation
61
PE for diarrhea assessment should focus on assessing what?
volume status (BP/HR, turgor, membranes)
62
pertinent positives for abd. exam with diarrhea? (5)
``` distension hyperactive bowel sounds tenderness peritoneal signs masses ```
63
3 components of rectal exam for diarrhea assessment...
tenderness stool guaiac perinal dz assesment
64
Labs for diarrhea...
+/- CBC, CMP, CRP
65
What stool studies should be ordered with diarrhea?
Cx + hemoccult
66
What viral non-inflammatory cause? i. Source: cruise ships, restaurants ii. Duration: abrupt onset, 24-72 hours iii. Tx: supportive
norovirus
67
What viral non-inflammatory cause? Onset 6 mo – 2 yo i. Source: daycare ii. Tx: supportive
rotavirus
68
Tx for Cholera...
supportive +/- Doxy, macrolide, tetracycline FLQ if severe
69
Which bacterial non-inflammatory cause of diarrhea? vomiting predominant i. Source: Creamy foods, egg/potato salad, onset w. in hours ii. Tx: supportive
staph aureus
70
What cause of non-inflammatory diarrhea? chronic diarrhea leads to profound wt. loss i. Source: waterborne ii. Tx: metronidazole
giardia
71
The below cause inflammatory or noninflammatory diarrhea? ``` salmonella c. jejuni shigella EHEC c. diff vibrio parahemolyticus yersinia enterolitica ```
inflammatory
72
The below cause inflammatory or noninflammatory diarrhea? ``` Norovirus rotavirus cholera c. perfringens bacillus cereus staph aureus giardia cryptosporidium cyclospora ```
non-inflammatory
73
bismuth can be used to treat diarrhea if no dysentery. What is a common S/E?
black stool
74
Which cause of inflammatory diarrhea? Source: poultry, livestock, reptiles Tx: supportive +/- abx
Salmonella
75
Which cause of inflammatory diarrhea? linked to Guillain-Barre Source: undercooked poultry, unpasteurized milk Tx: supportive +/- macrolide or FLQ
c. jejuni
76
Which cause of inflammatory diarrhea? dysentery Source: food/water borne Tx: supportive, abx shorten course
Shigella
77
Which cause of inflammatory diarrhea? severe, afebrile bloody diarrhea Source: undercooked ground beef/unpasteurized products Tx: No antidiarrheal/abx for risk of HUS
EHEC
78
Which cause of inflammatory diarrhea? Source: hospitalization, abx use, community acquired Tx: Vanco, fidaxomicin, metronidazole
C. Diff
79
Which cause of inflammatory diarrhea? Source: raw seafood/shellfish Tx: supportive +/- FLQ, doxy
vibrio parahemolyticus
80
Which cause of inflammatory diarrhea? mimics appendicitis Source: undercooked pork, raw dairy, water contamination Tx: supportive
Yersinia enterolitica
81
Three causes of infectious chronic diarrhea? Dx via?
giardia, e. histolytica, CMV stool studies, scope + Bx
82
The below drugs are a common cause of... Mg antacids, metformin, reglan, laxatives, abx, PPIs, colchicine
chronic diarrhea
83
Hx of: IBD, radiation, NSAIDs, malignancy S/S: +/- fever, bloody diarrhea, abd pain What type of chronic diarrhea?
inflammatory
84
Chronic inflammatory diarrhea specific lab...
fecal calprotectin
85
The below are causes of what type of chronic diarrhea? IBD, celiac, resection, pancreatic insufficiency, overgrowth
malabsorptive
86
: Zollinger-Ellison Syndrome, Neuroendocrine d/os can cause what type of chronic diarrhea?
secretory

Clinical Medicine III (21 decks)

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