Incorrectz Flashcards
(25 cards)
What is the typical stool osmotic gap (SOG) range in healthy individuals?
50 to 125 mOsm/kg
The SOG helps determine the etiology of watery diarrhea.
What type of diarrhea is suggested by a low stool osmotic gap?
Secretory diarrhea
It is characterized by secretion of electrolytes and water into the intestine.
What are common causes of secretory diarrhea?
- Toxins (e.g., Vibrio cholerae)
- Hormones (e.g., VIPomas)
- Congenital disorders of ion transport (e.g., cystic fibrosis)
- Bile acids (in postsurgical patients)
Secretory diarrhea persists while fasting.
What is the characteristic stool osmotic gap in secretory diarrhea?
<50 mOsm/kg
This indicates a low osmotic gap due to electrolyte secretion.
What distinguishes osmotic diarrhea from secretory diarrhea?
Osmotic diarrhea has a high SOG (>125 mOsm/kg) and occurs after ingestion of a causative substance
It does not occur during fasting.
What is one common cause of osmotic diarrhea?
Nonabsorbed, osmotically active solute (e.g., polyethylene glycol, sorbitol, lactose)
These substances inhibit water resorption.
What is the primary mechanism behind secretory diarrhea in postsurgical patients?
Unabsorbed bile acids reaching the colon stimulate luminal ion channels
This can occur after bowel resection or cholecystectomy.
What symptoms are typically associated with factitious diarrhea?
- Psychiatric disorders
- Volume depletion signs (e.g., lightheadedness, tachycardia, hypotension)
- Enhanced gastrointestinal mobility (e.g., hyperactive bowel sounds)
Factitious diarrhea is more common in women with a history of health care work.
True or False: Secretory diarrhea typically occurs during fasting.
True
This type of diarrhea is large in volume and persists even at night.
Fill in the blank: The stool osmotic gap in osmotic diarrhea is typically _______.
> 125 mOsm/kg
This indicates that the diarrhea is caused by a nonabsorbed solute.
What is the effect of resection of the ileocecal area on the intestines?
Reduces the ability to actively absorb sodium ions against the electrochemical gradient
This can contribute to secretory diarrhea.
What is the Roux-en-Y gastric bypass?
A surgical procedure that creates a small gastric pouch and bypasses most of the stomach
It includes a gastrojejunal anastomosis and a jejunojejunal anastomosis.
What are the two main mechanisms of weight loss in Roux-en-Y gastric bypass?
Restricting food consumption and inducing malabsorption
Nutrients are absorbed only in the common limb.
What is stomal stenosis?
Progressive narrowing of the gastrojejunal (GJ) anastomosis leading to obstruction
It is a common postoperative complication of Roux-en-Y gastric bypass.
When does stomal stenosis typically occur after Roux-en-Y gastric bypass?
Within the first year after surgery
Likely due to local tissue ischemia and ulceration.
What are the common symptoms of stomal stenosis?
Nausea, postprandial vomiting, gastroesophageal reflux, and dysphagia
Symptoms can progress to the point of not tolerating liquids.
What is required for the diagnosis of stomal stenosis?
Visualization of the GJ anastomosis via esophagogastroduodenoscopy (EGD)
Balloon dilation can also be performed during this procedure.
What is the purpose of balloon dilation in the context of stomal stenosis?
To open the narrowing of the GJ anastomosis
This is done during EGD.
What may be required if balloon dilation fails to relieve stomal stenosis?
Surgical revision
This is considered if conservative measures are unsuccessful.
What is dumping syndrome?
Rapid emptying of food from the gastric pouch into the intestines, causing symptoms like abdominal pain, nausea, and diarrhea.
Symptoms include hypotension, tachycardia, diaphoresis, lightheadedness, or syncope.
What test is the choice for diagnosing gastroparesis?
A gastric emptying scan is the test of choice.
However, recent bypass surgery can render this test inaccurate.
What is a common complication after Roux-en-Y surgery?
Cholelithiasis is a common complication, especially with rapid weight loss.
Right upper quadrant ultrasound is useful in diagnosing it.
What symptoms are not typical for symptomatic cholelithiasis?
Severe reflux and regurgitation are not typical.
These symptoms are more associated with other conditions.
What can marginal ulcers at the GJ anastomosis present like?
Marginal ulcers can present symptomatically like stomal stenosis.
They can be treated with proton pump inhibitors after confirmation by EGD.
