intestinal disorders Flashcards by Melissa Ring

What is IBS

Recurrent abdominal discomfort/pain that is chronic >3months

How well did you know this?

Not at all

Perfectly

What characteristics does IBS need to be diagnosed

relation to defecation
change in stool frequency
stool consistency change

How well did you know this?

Not at all

Perfectly

What is the treatment for IBS

dietary management and meds
(anticholinergics)

How well did you know this?

Not at all

Perfectly

What are physiologic factors of IBS

Altered intestinal motility
increased intestinal sensitivity

How well did you know this?

Not at all

Perfectly

What is visceral hyperalgesia

intestinal hypersensitivity

How well did you know this?

Not at all

Perfectly

When does IBS typically begin

adolescence / early 20s

How well did you know this?

Not at all

Perfectly

What is the clinical presentation of IBS

Abdominal discomfort (often in lower abdomen) and can be steady or cramping

How well did you know this?

Not at all

Perfectly

What generally helps resolve symptoms of IBS

defecation

How well did you know this?

Not at all

Perfectly

What typically triggers IBS

food / stress

How well did you know this?

Not at all

Perfectly

What are red flags with an IBS workup

older age
fever
weight loss
rectal bleeding
vomiting

How well did you know this?

Not at all

Perfectly

What things should be ruled out before diagnosing someone with IBS

Lactose intolerance
laxative abuse
celiac disease

How well did you know this?

Not at all

Perfectly

What is the Rome criteria

standardized symptom based criteria for a diagnosis

*requires abd pain 1x/week for the last 3 months + 2 IBS criteria

How well did you know this?

Not at all

Perfectly

What tests should be done in the workup of IBS

CBC, CMP, celiac disease markers, Stool examination, TSH, Calcium

How well did you know this?

Not at all

Perfectly

With an IBS workup, when is a sig/colonoscopy recommended

> 50

How well did you know this?

Not at all

Perfectly

What are some treatment options for IBS

Treat any psychologic issues
regular physical activity

How well did you know this?

Not at all

Perfectly

How should diet be managed with IBS

Small/medium and consumed slowly

drink more fluid

dietary fiber supplements

How well did you know this?

Not at all

Perfectly

What pharmacological treatment can be used for IBS-C

Lubiprostone
Linaclotide
plecanatide

How well did you know this?

Not at all

Perfectly

What pharmacological treatment can be used for IBS-D

Diphenoxylate / loperamide
Rifamixin
Elosetron
Eluxadoline

How well did you know this?

Not at all

Perfectly

What type of probiotics can be beneficial in relieving IBS symptoms

Bifidobacterium

How well did you know this?

Not at all

Perfectly

What is lactose intolerance

inability to digest certain carbs due to lack of one or more intestinal enzymes

How well did you know this?

Not at all

Perfectly

What are symptoms of lactose intolerance

diarrhea
abdominal distention
flatulence

How well did you know this?

Not at all

Perfectly

How can you diagnose lactose intolerance

H2 breath test

How well did you know this?

Not at all

Perfectly

How can you treat lactose intolerance

remove causative carb
supplement missing enzyme

How well did you know this?

Not at all

Perfectly

What is the most common form of carbohydrate intolerance

acquired lactase deficiency (primary adult hypolactasia)

How well did you know this?

Not at all

Perfectly

What is secondary lactase deficiency

conditions that damage the small bowel mucosa -celiac, acute intestinal infections

How much daily typically needs to be ingested to see the symptoms of lactose intolerance

8-12oz of dairy product

How will lactose intolerance present in children

diarrhea after ingesting significant amounts of milk not gaining weight

What symptoms suggest a milk allergy

vomiting and GERD * not consistent with carb intolerance

What will the stool pH be with lactose intolerance

acidic <6

What is functional dyspepsia (non-ulcer dyspepsia)

Dyspeptic symptoms with no abnormalities on PE and EGD

What do those who are lactose intolerance need to take daily

calcium supplement (1200-1500/day)

What are red flags with non-ulcer dyspepsia

acute episodes with dyspnea, diaphoresis, or tachycardia (be concerned for coronary ischemia) no response to H2 blockers/PPI

If a patient is >60y/o and new onset of functional dyspepsia red flags, how do you treat them

EGD to rule out cancer

If a patient is <60y/o with no red flags with functional dyspepsia, how do you treat them

PPI therapy x4-8 weeks *EGD if treatment fails

What is constipation

Difficult/infrequent passage of stool, hardness of stool, or feeling of incomplete evacuation

What is normal stool frequency

2-3x/day to 2-3x/week

What is generally the cause of acute constipation

organic causes

When working up constipation, what do you need to ask every patient

presence, amount, duration, any blood in stool

What is anismus

increased anal resting tone

What are red flags with constipation

Distended, tympanic abdomen vomiting blood in stool weight loss severe constipation of recent onset

What may a patient experience if they have a fecal impaction

cramps, watery mucus, fecal material around mass, overflow diarrhea

What is the first treatment option for constipation

fiber / OTC laxative trial

How can colonic transit times be measured

Sitz marker study

Who is laxative abuse seen in

Anorexia nervosa bulimia nervosa elderly

What are the main challenges in treating laxative abuse

the rebound symptoms -weight gain -edema -constipation

What does chronic laxative use put you at higher risk of

colon cancer

What needs to be given with opioids to avoid constipation

laxatives

Why do opioids lead to constipation

they inhibit gastric emptying and peristalsis in GI tract which causes excess fluid absorption

What are alarming symptoms with OIC

weight loss +fecal occult blood test Fe deficient anemia fhx colon cancer

How do you treat OIC

Increase fluid intake, increase dietary fiber, exercise

What is the best treatment for refractory cases of OIC

methylnaltrexone (SQ)

Which patients should methylnaltrexone NOT be used in

PUD, diverticulosis, colon CA or obstruction

What is constipation

Difficult/infrequent passage of stool, hardness of stool, or feeling of incomplete evacuation

What symptoms suggest functional dyspepsia

Ulcer like symptoms dysmotility like symptoms reflux like symptoms

What gender is at highest risk of esophageal cancer | What is the median age at diagnosis

Men | 68

What is the most common type of esophageal cancer | What is it secondary to

Adenocarcinoma from barretts | SCC is more common in asai and sub-sahrara

What are late stage presentations of esophageal cancer

progressive dysphagia weightloss

What is the test of choice to diagnose esophageal cancer

EGD with biopsy

What is the treatment for esopahgeal cancer

Localized = esophagectomy lymph spread = chemo/radiation +esophagectomy | stenting and palliative treatment if there is large metastesis

How can you prevent esophageal cancer

Close monitoring of Barretts NSAIDs + Antacids for protection lifestyle modification

What gender is at higher risk of gastric cancer | what is the median age of diagnosis

Men | 68

What is the strongest risk associated with gastric cancer

H.Pylori gastritis

What is the most common type of gastric cancer | proximal vs distal

Gastric adenocarcinoma proximal is secondary to metaplasia distal is ssecondary to H. Pylori | intestinal is most common ## Footnote diffuse is more hereditary and less H.pylori related

Where do most gastric cancer begin

Antrum

What are the different morphologies of gastric cancer

fungating polypoid ulcerating diffuse spreading superficial spreading

What are the later symptoms of gastric cancer

dyspepsia early satiety spigastric pain anorexia weight loss

What does neo-adjuvent mean

Chemo/radiation before surgery

What are some characteristic PE findings with gastric cancer

Virchow node: palpable L. supraclavicular lymph node Sister Mary Joseph nodule: Unbilical nodule

What is the test of choice to gastric cancer dx | Who should get this

EGD with biopsy | over 55 w/ new epigastric issues, persistent dyspepsia

How do you treat localized gastric cancer

Laprascopic or open gastrectomy | B12 supp s/p gastrectomy

How do you treat advanced gastric cancer

Palliative resection gastrojejunostomy chemo/radiation embo stenting

How can you prevent gastric cancer

Close surveillance on those with hereditary tumor syndrome properly treat H. Pylori infections

What is the most common malignancy of the biliary tract

gallbladder cancer | women most effected

What gender is more effected by cholangiocarcinomas

Men

What are the risk factors for gallbladder cancer

Cholelithiasis salmonella typhii GB polyps porcelain GB genetics (P53 mutation)

What decreases the risk of bile duct cancer | intra-hepatic cholangiocarcinoma?

ASA and statin | metformin

What are the risk factors of cholangiocarcinomas

heavy ETOH consumption smoking

What is the presenting symptom of biliary cancer

progressive jaundice signaling obstruction

What are some PE findings with biliary cancer

Jaundice (if severe) palpable GB hepatomegaly

What is courvoisier sign | What is it indicative of

palpable non-tender GB + obstructive jaundice | suggests malignancy

What tumor marker will be elevated with biliary cancer

CA 19-9

What is the diagnostic test of choice for biliary cancer | What is seen

MRI w/ MRCP -visualize entire biliary tree -defines extent of involvment -elucidates vascular involvment

What test can confirm a biliary cancer diagnosis

EUS w/ FNA

What is the mainstay treatment of biliary cancer

surgery

What are general risk reduction strategies with bilairy cancer

Avoid HCV + HIV maintain healthy weight limit ETOH smoking cessation/avoidance

intestinal disorders Flashcards

(85 cards)