IM - Evals 6 Flashcards by asdfg hjkl

Most common cause of acute diarrhea

Infection

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Most common causative organism in acute diarrhea

Viruses

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Diarrhea characterized by watery large volume stool that is painless and continues even with fasting

Secretory diarrhea

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Diarrhea when you have osmotically active particles in the bowel which attract water which you cannot absorb

Osmotic diarrhea

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Diarrhea accompanied by pain, fever, bleeding and systemic manifestations of inflammation

Inflammatory diarrhea

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Diarrhea caused by the osmotic effects of fatty acids, wherein fatty acids act as an osmotic and attracts water

Steatorrhea

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Diarrhea that occurs due to a reduced transit time which means things move too fast in the bowel, there is reduced
contact between the mucosa and the nutrients

Dysmotile diarrhea

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Diarrhea that is caused by abnormal secretion of fluid and electrolyte transport

Secretory diarrhea

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Diarrhea that stops with fasting and is watery in character without any leukocytes or RBC

Osmotic diarrhea

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Diarrhea is due to exudation so you would see leukocytes or RBC

Inflammatory diarrhea

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Stool character appears greasy, foul smelling, and have a tendency to float because of oil

Steatorrhea

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Most infectious causes fall under this category

Secretory diarrhea

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Patients may also have concomitant urgency and this type of diarrhea would awaken them at night so it also persists even during fasting

Inflammatory diarrhea

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There are usually associated abnormalities such as weight loss and nutritional deficiencies in this type of diarrhea

Steatorrhea

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MIcroorganisms that cause persistent infectious diarrhea

C. difficile
Salmonella
Campylobacter
Aeromonas
E. histolytica
Giardia
Cryptosporidium

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Antidiarrheal medications may be given in patients with diarrhea, except in patients presenting with

Inflammatory diarrhea

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Focused testing for rectal bleeding

Colonoscopy with biopsy

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Focused testing for malabsorption

SB biopsy, aspirate, imaging

Hydrogen breath testing

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Fatty stool, possibly steatorrhea

Quantitative stool testing

Pancreatic exocrine insufficiency testing

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Causes of secretory diarrhea

Stimulant laxative
Certain bacterial infections
Colorectal villous adenoma
Addison’s disease
Chronic ethanol use, environmental toxin
Hormone-producing tumors
Congenital electrolyte absorption deficiency

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Daycare and causative agents

Rotavirus
Shigella
Giardia and Cryptosporidium

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Traveller and causative agents

Norovirus and Coronavirus
E.coli, Campylobacter, Shigella, Salmonella
Giardia and Cyclospora

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Institutionalized and causative agent

C. difficile

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Immunodeficient and causative agents

CMV, HSV, and Adenovirus
Mycobacterium, N. gonorrhea, T. pallidum, Chlamydia, Vibrio and Yersinia
Isopora and Cryptosporidium

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Pathogen found in Poultry

Salmonella, Campylobacter, Shigella

Pathogen found in Ham/Meat

EHEC, C. difficile

Pathogen found in Chinese food and reheated rice

B. cereus

Pathogen found in Mayonaisse, creams and coleslaw

S. aureus and Salmonella

Pathogen found in Eggs

Salmonella

Pathogen found in Shellfish

Vibrio sp and Salmonella

Pathogen found in Raw seafoods

Salmonella

Pathogen found in Cheese

Listeria, Vibrio

Test: WBCs, RBCs, ova, parasite Finding: Possible Diagnosis: ???

Inflammatory causes | Infection

Test: Culture Finding: Specific bacteria Possible Diagnosis: ???

Infection

Test: Toxin immunoassay Finding: C. difficile toxin Possible Diagnosis: ???

C. difficile associated diarrhea

Test: Fecal calprotectin/lactoferrin Finding: Present Possible Diagnosis: ???

Inflammatory causes, IBD (if absent, think IBS)

Test: Sudan stain and quantitative fecal fat testing Finding: >7g/day Possible Diagnosis: ???

Steatorrheal causes 15-25g small bowel disease >32g pancreatic insufficiency

Test: Osmolar gap (290Na+ 2K+) Normal gap: 50-100mosm/kg Finding: Low <50 Possible Diagnosis: ???

Secretory causes

Test: Osmolar gap (290Na+ 2K+) Normal gap: 50-100mosm/kg Finding: High >125 Possible Diagnosis: ???

Osmotic causes

Differential for chronic inflammatory diarrhea

Inflammatory bowel disease (Crohn's disease or ulcerative colitis)

Causative agents for watery diarrhea

``` V. cholera ETEC Salmonella Listeria Most viruses ```

Causative agents for prominent vomiting

B. cereus S. aureus C. perfringens

Causative agents for dysentery

``` Campylobacter Salmonella E.coli 0157-H7 EIEC EHEC V. parahemolyticus V. vulnificus Y. enterocolitica Shigella E. histolytica ```

Causative agents for reactive arthritis

Salmonella Shigella Campylobater Yersinia

Causative agents for hemolytic-uremic syndrome

Shigella | E. coli 0157:H7

Presence is indicative of a gastric outlet (pylorus) obstruction, may be accompanied by a LUQ mass, pain, and non-bilious vomiting

Succussion splash

Obstruction of portal venous flow --> portal hypertension --> shunting of blood to capillaries which are shared by the systemic and portal circulations --> esophageal varices + splenomegaly

Traube's space

Presents as retching prior to painful hematemesis

Mallory Weiss Tear

Effortless passage of gastric contents into the mouth

Regurgitation

Passage of black, tarry, foul-smelling stools; stools are black due to contact of blood with HCl; can originate from both the lower and upper GIT but usually upper GIT in origin

Melena

Passage of bright-red stools; usually lower GIT in origin

Hematochezia

Yellow discoloration of the skin, with the earliest symptom presenting as scleral icterus (yellow discoloration of the sclera); caused by an increase in serum bilirubin with a value >2.5 mg/dL

Jaundice

Conjugated hyperbilirubinemia

Rotor's syndrome Dubin-Johnson syndrom Progessive Familial Intrahepatic Cholestasis Benign Recurrent Intrahepatic Cholestasis

Unconjugated hyperbilirubinemia

Crigler Najjar Type I Criglet Najjar Type II Gilbert Syndrome

Problem with hepatic storage of bilirubin

Rotor’s Syndrome

Defect is a point mutation in the gene for canalicular multi-specific organic anion transporter

Dubin Johnson syndrome

Associated with high serum levels of gamma glutamyl transferase activity

Progressive Familial Intrahepatic Cholestasis

Rare disorder characterized by recurrent attacks of | pruritus and jaundice; Familial recessive pattern of inheritance

Benign Recurrent Intrahepatic Cholestasis

Complete absence of bilirubin UDP glucuronosyl transferase activity. This will cause accumulation of bilirubin because there will be no conjugation. Patient will not be able to excrete bilirubin because it is not conjugated

Crigler Najjar Type I

Only effective treatment for Crigler Najjar Type I

Orthotopic liver | transplantation

Mutation in bilirubin UDP glucuronsyl transferase gene; Patients live to adulthood

Crigler Najjar Type II

Treatment for Crigler Najjar Type II

Phenobarbital

Marked by impaired conjugation of bilirubin due to reduced bilirubin UDP glucuronosyl transferase activity

Gilbert Syndrome

Causes of Hepatomegaly

Vascular congestion Bile duct obstruction Infiltrative Disorders ○ Bone Marrow and reticuloendothelial cells – Extramedullary hematopoiesis, Leukemia, Lymphoma ○ Fat – Fatty liver (alcohol, diabetes or toxins) ○ Glycogen (diabetes, esp. after insulin excess) ○ Amyloid ○ Iron (hemochromatosis and hemosiderosis) Inflammatory disorders – e.g. Hepatitis, Cirrhosis Tumors Cyst

Falsely INCREASES liver span

Consolidation (pneumonia) Pleural effusion Atelectasis/fibrosis

Falsely DECREASES live span

Pneumothorax | Emphysema

Metabolic causes of chronic constipation

``` Hypercalcemia Hypothyroidis Hypokalemia Diabetes mellitus Uremia Addison’s disease Porphyria Pregnancy ```

Drug-induced constipation

``` Opiates Antidepressant Anticholinergic Antipsychotic Antacids Calcium channel blocker Iron supplement ```

Common causes of Steatorrhea

Malabsorption (Celiac sprue, Whipple’s disease) Maldigestion (Bariatric surgery, pancreatic insufficiency) Lymphatic obstruction - bowel wall becomes edematous which can cause diarrhea

Causes of recent onset constipation

Anal sphincter spasm: fissures or hemorrhoids Colonic obstruction: neoplasm, stricture, ishemic, inflammatory, diverticular Medication

Causes of chronic primary constipation

Functional constipation IBS-C Dyssynergic defecation

Urobilinogens are excreted mainly (80- 90%) in the

Feces

Bilirubin glucoronides are excreted across the canalicular membrane into the bile canaliculi by a transport process involving

Multidrug resistance associated protein

Conjugation of glucoronic acid to bilirubin is catalyzed by

Glucuronosyl transferase

Mild unconjugated hyperbilirubinemia <6 mg/dl; Serum bilirubin levels may fluctuate and jaundice often identified only during periods of fasting

Gilbert syndrome

Most common causes of indigestion

GERD and dyspepsia

Most common endocrinologic cause of nausea and vomiting

Pregnancy

IM - Evals 6 Flashcards

(77 cards)