Small Bowel Flashcards
(35 cards)
Most common cause of pediatric diarrhea
Rotavirus
Types of diarrhea
Infectious, malabsorption, osmotic, increased motility, secretory
Ddx of chronic diarrhea
Secretory: carcinoid tumor or VIPoma
Malabsorption/maldigestive/osmotic: bacterial overgrowth, pancreatic insufficiency, mucosal damage, lactose intolerance, celiac dz, laxative abuse, short bowel syndrome
Inflammatory: IBD
Increased motility: IBS
When to workup acute diarrhea
Further workup if patient has a high fever, bloody diarrhea, or diarrhea > 4-5 days
Watery vs. bloody diarrhea organisms
Watery: Vibrio cholera, ETEC, Giardia, C diff, rotavirus, Cryptosporidium
Bloody: EHEC, Salmonella, Shigella, Campylobacter
Campylobacter:
-Hx, Exam, Tx
Hx: most common etiology of bacterial diarrhea; ingestion of contaminated food/water; affects young children and young adults
Exam: Fecal RBCs and WBCs; p/w bloody diarrhea, fever, and no abdominal pain
Tx: erythromycin
C diff
-hx, exam, tx
Hx: a/w recent antibiotic use (especially clinda) and recent hospitalization
-be careful about toxic megacolon
Exam: p/w fever, abdominal pain, systemic toxicity; fecal RBCs and WBCs
-causes colitis; dx w/ toxin in stool; sigmoidoscopy shows pseudomembranes
Tx: PO metronidazole or PO vanc; IV metronidazole if pt can’t tolerate PO
Entamoeba histolytica
-hx, exam, tx
Hx: 2/2 ingestion of contaminated food or water (Trave)
Exam: severe abdominal pain and fever; fecal RBCs and WBCs; endoscopy shows flask-shaped ulcers”
-mimics IBD if chronic
Tx: steroids can cause fatal perforation. DON’T USE STEROIDS; tx w/ metronidazole
E. coli 0157:H7
-Hx, exam, tx
Hx: bloody diarrhea, ingestion of raw meat; lasts 5-10 days
Exam: p/w severe abdominal pain, low-grade fever, vomiting, and bloody diarrhea; fecal RBCs and WBCs
-rule out GI bleed and ischemic colitis; HUR is a potential complication (thrombocytopenia and renal failure)
Tx: avoid antibiotics or antidiarrhea therapy because they increase HUS risk
Salmonella
-hx, exam, tx
Hx: 2/2 ingestion of contaminated poultry or eggs
Exam: p/w prodromal HA, fever, myalgia, and abdominal pain
- Fecal WBCs
- sepsis is a concern as 5-10% of pts become bacteremic; sickle cell pts are prone to osteomyelitis
Tx: oral quinolone or TMP-SM if pts are bacteremic or have sickle cell
Shigella
-Hx, exam, tx
Hx: very contagious, transmitted fecal-oral
Exam: fecal RBCs and WBCs; bloody diarrhea
-can cause severe dehydration and febrile seizures
Tx: TMP-SMX to prevent spread
Intestinal villous atrophy
a/w Celiac disease
Dermatitis herpetiformis
a/w celiac dz
grouped, papulovesicular pruritic skin lesions
symmetrically located on extensor surfaces of elbows, knees, buttocks, and posterior scalp
Frequent, loose, watery stools which are pale, foul-smelling, bukly
a/w abdominal pain, flatus, bloating, weight loss, nutritional deficiencies, and fatigue
Malabsorptive diarrhea
ddx: mucosal (Celiac, Whipples dz, tropical sprue), bile salt deficiency (bacterial overgrowth), pancreatic insufficiency, or short bowel syndrome
Pellagra
Sx: Diarrhea, dementia, dermatitis, death
-high sensitivity to sunlight; ataxia, confusion, insomnia; beefy, red glossitis; dilated cardiomyopathy;
Vitamin B3 (niacin) deficiency 2/2 decreased niacin or tryptophan intake
Lactose intolerance:
-pathophysiology, common populations, hx/PE, Dx, Tx
Pathophysiology: lack of lactose; can occur after gastroenteritis transiently; common in Asian, Native Americans, and Africans
Hx/PE: abdominal bloating, flatulence, cramping, watery diarrhea after milk ingestion
Dx: empiric lactose-free diet that improves symptoms
-Hydrogen breath test reveals increased hydrogen after ingestion of lactose
Tx: avoid dairy products
Carcinoid syndrome vs. carcinoid tumor
Syndrome: after tumor mets to liver
Tumor: presence of carcinoid tumor
What do carcinoid tumors produce?
Serotonin
Why are there no sx before carcinoid tumor metastasizes?
Serotonin undergoes first-pass metabolism in the liver
Carcinoid syndrome
-sx, dx, tx
Flushing, diarrhea
Abdominal cramps, wheezing, right-sided cardiac valvular lesions
Dx: high urine levels of 5-HIAA; CT and In-111 octreotide scans can localize the tumor
Tx: octreotide and surgical resection
Constipation, abdominal distention, mucous stools and abdominal pain that relieved by bowel movements
Irritable bowel syndrome
Partial vs complete SBO
Partial: continued passage of flatus
Complete: no passage of flatus or stool
Causes of small bowel obstruction
Most common: adhesions, hernias
Neoplasms, intussusception, gallstone ileus, stricture, volvulus
Typical symptoms of an SBO
Crampy abdominal pain at 4-5 minute intervals
Vomiting: proximal = early and bilious; distal = late and feculent
Exam: distention
Bowel sounds: high-pitched tinkles and peristaltic rushes
