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

GI: IBS, Diarrhea, Constipation Flashcards

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
Q

The below drugs help treat…

lubiprostone, linaclotide, plecanatide

5-HT4 Agonist (tegaserod)

A

constipation

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26
Q

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
A

Diarrhea

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27
Q

What type of constipation?

Constipation, no pain
ii.

A

Functional Chronic idiopathic constipation

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28
Q

What type of constipation?

constipation + pain

A

Functional Constipation IBS-C

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29
Q

The below drugs are common causes of…

anticholinergics, antipsychotics
Iron
antacids (Ca, Al)
CCBs
TCAs
A

med induced constipation

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30
Q

The below are what cause of constipation?

Pelvic floor dysfunction
rectal prolapse
rectocele
colon CA
polyps
stricture
impaction
A

Defecation/Obstructive constipation

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31
Q

The below are what cause of constipation?

hyperCa
hyperPTH
hyperthyroid
DM
pregnancy
Hirschsprung
MS
Parkinson
spinal cord injury
A

Metabolic/systemic disease constipation

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32
Q

What are three GI signs/sxs that accompany a complaint of constipation?

A

pain/bloating
bleed
tenesmus

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33
Q

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

A

25%

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34
Q

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

A

DRE

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35
Q

A pelvic exam is indicated for constipation to identify…

A

rectocele

36
Q

If refractory constipation, what three diagnostics are available?

A

Sitz marker study

defecography

anorectal manometry

37
Q

Which constipation study?

Colonic transit, movement of radiopaque marker thru colon via x-ray

A

Sitz marker study

38
Q

Which constipation study?

Radiologic image for defecation mechanics

Assess anatomy, fxn of anorectum & pelvic floor

A

defecography

39
Q

Which constipation study?

Anal/sphincter pressure & fxn

A

anorectal manometry

40
Q

Tx for constipation includes reconciling offending meds, lifestyle and what drug classes? (5)

A 
Fiber
Stool Softeners
Osmotic Laxatives
Stimulant laxatives
Rx drugs
41
Q

What three Rx drugs are available to relieve constipation?

A

lubiprostone, Linaclotide, Plecanatide

42
Q

What constipation drug class?

psyllium, methylcellulose, polycarbophil, benefiber

A

Fiber

43
Q

3 fiber S/Es

A

flatulence, bloating, distension

44
Q

What constipation drug class?

Docusate

A

Stool Softener

45
Q

What constipation drug class?

polyethylene glycol, milk of magnesia, Mg Citrate, Lactulose

A

Osmotic laxatives

46
Q

Osmotic laxatives that contain magnesium can cause…

A

hypermagnesemia if renal insufficiency

47
Q

What constipation drug class?

bisacodyl, Senna

A

Stimulant laxatives

48
Q

3 lifestyle mods that can help w. constipation…

A

increase fluid/fiber, activity/exercise, bowel habit training

49
Q

3 complications of constipation…

A

hemorrhoids/fissues

lyte imbalance (laxative abuse)

fecal impaction/obstruction

50
Q

A patient w. hx of constipation presents w.

NV
Abd. Pain
Distension
Paradoxical Diarrhea

What is this concerning for?

A

bowel obstruction

51
Q

How is bowel obstruction treated?

A

disimpaction and maintenance bowel prep PRN

52
Q

The below populations are high risk for what constipation complication?

dementia
neuro dz
immobile
hypomotility meds

A

fecal impaction/obstruction

53
Q

The below increase your risk of…

i. Hospitalization/abx
ii. Travel hx
iii. Food borne
iv. Community outbreak
v. Pets/animal
vi. New meds

A

acute diarrhea

54
Q

Definition of acute diarrhea…

A

3+ unformed stools QD x < 14 days

55
Q

Chronic diarrhea persists for how many days?

A

30+

56
Q

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

A

Diarrhea

57
Q

2 MC causes of non-inflammatory diarrhea…

A

norovirus, giardia

58
Q

Inflammatory or non-inflammatory diarrhea?

watery, non-bloody
mild cramps/pain
+/- low grade fever

A

non-inflammatory

59
Q

Inflammatory or non-inflammatory diarrhea?

fever
bloody
severe pain

A

inflammatory

60
Q

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

A

Prompt evaluation

61
Q

PE for diarrhea assessment should focus on assessing what?

A

volume status (BP/HR, turgor, membranes)

62
Q

pertinent positives for abd. exam with diarrhea? (5)

A 
distension
hyperactive bowel sounds
tenderness
peritoneal signs
masses
63
Q

3 components of rectal exam for diarrhea assessment…

A

tenderness
stool guaiac
perinal dz assesment

64
Q

Labs for diarrhea…

A

+/- CBC, CMP, CRP

65
Q

What stool studies should be ordered with diarrhea?

A

Cx + hemoccult

66
Q

What viral non-inflammatory cause?

i. Source: cruise ships, restaurants
ii. Duration: abrupt onset, 24-72 hours
iii. Tx: supportive

A

norovirus

67
Q

What viral non-inflammatory cause?

Onset 6 mo – 2 yo

i. Source: daycare
ii. Tx: supportive

A

rotavirus

68
Q

Tx for Cholera…

A

supportive +/-

Doxy, macrolide, tetracycline

FLQ if severe

69
Q

Which bacterial non-inflammatory cause of diarrhea?

vomiting predominant

i. Source: Creamy foods, egg/potato salad, onset w. in hours
ii. Tx: supportive

A

staph aureus

70
Q

What cause of non-inflammatory diarrhea?

chronic diarrhea leads to profound wt. loss

i. Source: waterborne
ii. Tx: metronidazole

A

giardia

71
Q

The below cause inflammatory or noninflammatory diarrhea?

salmonella
c. jejuni
shigella
EHEC
c. diff
vibrio parahemolyticus
yersinia enterolitica
A

inflammatory

72
Q

The below cause inflammatory or noninflammatory diarrhea?

Norovirus
rotavirus
cholera
c. perfringens
bacillus cereus
staph aureus
giardia
cryptosporidium
cyclospora
A

non-inflammatory

73
Q

bismuth can be used to treat diarrhea if no dysentery. What is a common S/E?

A

black stool

74
Q

Which cause of inflammatory diarrhea?

Source: poultry, livestock, reptiles

Tx: supportive +/- abx

A

Salmonella

75
Q

Which cause of inflammatory diarrhea?

linked to Guillain-Barre

Source: undercooked poultry, unpasteurized milk

Tx: supportive +/- macrolide or FLQ

A

c. jejuni

76
Q

Which cause of inflammatory diarrhea?

dysentery

Source: food/water borne

Tx: supportive, abx shorten course

A

Shigella

77
Q

Which cause of inflammatory diarrhea?

severe, afebrile bloody diarrhea

Source: undercooked ground beef/unpasteurized products

Tx: No antidiarrheal/abx for risk of HUS

A

EHEC

78
Q

Which cause of inflammatory diarrhea?

Source: hospitalization, abx use, community acquired

Tx: Vanco, fidaxomicin, metronidazole

A

C. Diff

79
Q

Which cause of inflammatory diarrhea?

Source: raw seafood/shellfish

Tx: supportive +/- FLQ, doxy

A

vibrio parahemolyticus

80
Q

Which cause of inflammatory diarrhea?

mimics appendicitis

Source: undercooked pork, raw dairy, water contamination

Tx: supportive

A

Yersinia enterolitica

81
Q

Three causes of infectious chronic diarrhea?

Dx via?

A

giardia, e. histolytica, CMV

stool studies, scope + Bx

82
Q

The below drugs are a common cause of…

Mg antacids, metformin, reglan, laxatives, abx, PPIs, colchicine

A

chronic diarrhea

83
Q

Hx of: IBD, radiation, NSAIDs, malignancy

S/S: +/- fever, bloody diarrhea, abd pain

What type of chronic diarrhea?

A

inflammatory

84
Q

Chronic inflammatory diarrhea specific lab…

A

fecal calprotectin

85
Q

The below are causes of what type of chronic diarrhea?

IBD, celiac, resection, pancreatic insufficiency, overgrowth

A

malabsorptive

86
Q

: Zollinger-Ellison Syndrome, Neuroendocrine d/os can cause what type of chronic diarrhea?

A

secretory

Clinical Medicine III (21 decks)

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