Flashcards in Small Bowel and Colon - McGowan Deck (83):
Ascending paralysis (Guilian Barre) are seen with which infectious agent?
Match each of the following with the bug
A. Spiral comma shaped microaerophilic gram negative organisms that are urease positive
B. Gram(-) rod that forms shiga like toxin
C. Pear shaped trophozoite with 2 nuclei and 4 pairs of flagella
D. Protozoan that stains positive for acid fast bacilli
E. Trophozoite with a single nucleus
A. H. pylori
B. EHEC (most common cause of traveler's diarrhea)
C. Giardia Lambia
D. Cystoisospora Belli
E. Trichomonas vaginalis
How is a patient with Staph aureus mediated N/V and watery diarrhea treated?
Reassurance and supportive care. It's self limited
How would giardiasis present?
- fatty, foul-smelling diarrhea
- bloating and flatulence
- Seen in campers and hikers
Diagnosis: trophozites or cysts in stool
Food poisoning associated with chinese fried rice, food kept warm but not hot, diarrhea with no blood, with or without vomiting, and symptoms start and end quickly. What bug is associated?
Bug causing bloody diarrhea, mimics appendicitis or Crohn's and is associated with hemochromotosis
What bug causing diarrhea is associated with pregnant women and deli meat, diary and cheese and etc?
which bug causing diarrhea is associated with eating ham, and contact with iguanas?
persistent (several days) watery, non bloody diarrhea and diagnosed by modified acid-fast staining of stool. Can occur in immunocompromised and competent
Which bug is associated with HTLV1, contracted by walking around barefoot from soil and diagnosed by presence of rhabditiform larvae in stool
Bug associated with nausea, chills, watery malodorous diarrhea and presence of membrane-like exudates on colonic mucosa. Potential complication includes _
Pt has C-diff. Complication includes colon perforation due to toxic mega colon
which bug is associated with high fever, RUQ colicky abd pain, blanching salmon-colored maculopapular rash, invades macrophages in Peyer's patches, and can produce bacteremia and multiplies within RES organs (liver, spleen, bone marrow and lymph nodes)
Which bug is associated with swimming in crowded swimming pool?
Which bug is associated with bullous lesions, cirrhotic pt, and swimming in salt water such as in coastal water
Which bug is associated with fever, N/V, sore throat, diarrhea with myalgias, disseminated rash that can produce toxic shock syndrome and is diagnosed by isolation of Gram(+) round organisms in long chains
Strep pyogenes (group A)
Which bug is associated with HIGH fever, nausea, faintness, sweating, blood-stained diarrhea and history of recent travel to Asia?
Which bug is associated with eating potato salad, has a rapid onset (6 hrs) with N/V and is selflimited
Which bug, found in rural Southeast US, can be VERY long (20cm), have oval eggs with knobby surface and can obstruct small intestine
Which bug produces bloody stool, liver cysts, esophageal varices, common in Africa, acquired from snails. can lead to bladder cancer
Which bug is a pork tapeworm that is usually asymptomatic, but can cause neuro symptoms
what is the most common carrier site of salmonella typhi?
which bug produces hemolytic uremic syndrome (petechiae, scleral icterus, low HgB, haptoglobin, and increased bili, Cr and LDH, urine will show protein and blood)
explosive rice water diarrhea caused by motile comma-shaped gram(-) bacillus is _
which bug causing watery diarrhea, N/V abd cramping, is associated with eating raw oysters
most common infectious causes of bloody diarrhea includes:
3. E coli (0157:H7; STEC producing)
5. Yersinia enterocolitica (pseudo appendicitis)
an idiopathic functional colon disorder in teens and 20s, characterized by abd pain, irregular bowel habits (alternating diarrhea and constipation), rarely awakens pts at night and stool is described as mucoid stools. 50% has comorbid psychiatric disorder
Irritable bowel syndrome
what would be an alarming symptom of IBS
fever. needs to be worked up for something other than IBS
what kind of diet is recommended for pts with IBS?
low FODMAP diet
Noninfectious, profuse diarrhea that's tea colored, no ordor, and persists even with fasting. Pts are often found to be hypokalemic. sometimes it's termed pancreatic cholera syndrome
VIPoma, associated with MEN1
These pt presents with profuse watery diarrhea, flushing of the face. It's due to a tumor that's commonly seen in midgut and secretes serotonin
type of diarrhea that decreases with fasting, has increased osmotic gap, low stool Na. Common causes are Mg antacids, sorbitol, lactose intolerance, and laxatives
Type of diarrhea that is large volume, normal osmotic gap, stool Na is high, little change with fasting. Common causes includes _
Secretory diarrhea. Causes: Hormones (Vasoactive intestinal peptide (VIPoma), carcinoid, medullary thyroid CA, zollinger-ellison
Type of diarrhea that accompanies abd pain, increased ESR and/or CRP, fecal luekocytes, and lactoerrin may be present
what are some serum diagnostic tests for diarrhea?
- CBC, CMP, Phos, TSH, Vit A, D, INR, ESR, CRP
- IgA tTG (celiac)
- Iron studies
- other (chromogranin A for VIPoma; calcitonin for medullary thyroid cancer, and gastrin for ZE)
what can be tested in urine in pts suspected of Carcinoid tumor?
5-hydroxyindoleacetic acid (5-HiAA)
what are the ROME III criteria for IBS dx?
- abd discomfort or pain at least 3 days/month for past 3 months, with symptom onset >6 months before diagnosis and at least 2/3: relieved by defecation; onset associated with change in frequency of stool and change in form of stool.
what is FODMAPS?
- fermentable monosaccharides and chain carbs; restriction may help improve symptoms of IBS
How is C diff treated?
- Metronidazole (IV or PO)
- Vanco (PO)
- Fecal microbiota transplant
- Surgery for severe cases
If pt gets mild and self limited diarrhea a day or two after starting an abx, what's most likely causing the diarrhea?
Probably a side effect of the abx they're taking, NOT c-diff
Pt patient presents with severe diarrhea/colitis 5-7 days after starting a round of abx. what's most likely causing the colitis?
what the two toxins of C-diff?
- TcdA (enterotoxin)
- TcdB (cytotoxin)
How is c-diff diagnosed?
Test stool for toxin assay in most cases
what are the risk factors for c-dff?
- recent abx use (esp ampicillin, clindamycin, 3rd gen cephalosporins, and fluoroquinolones)
- Other (PPI, IBD, chemo, enteral tube feedings)
Some common causes of constipation in the elderly
- Calcium supplementation
- Inadequate fiber and fluid intake
- hypothyroidism (high TSH)
- Calcium channel blocker
New onset of pencil like stool with constipation and family history of colon cancer, likely cause of the constipation is _
These lesions are explosive onset of multiple seborrheic keratoses often with an inflammatory base and is an sign of internal malignancy as part of paraneoplastic syndrome. Commonly seen with GI adenocarcinomas (colon, stomach, liver, colorectal and pancreas)
Differentiate the colitis seen in medication induced, ischemia, and in ulcerative colitis.
med induced: microcytic colitis, colonscopy will be normal
Ischemia: crampy abd pain with current jelly stool after the pain. abnormal colonscopy
UC: bloody diarrhea. abnormal colonscopy
How is microscopic colitis treated?
- stop offending meds
- Loperamide, budesonide, bile salt binding agents or 5-ASA's
what's the difference in symptoms of diverticulosis vs diverticulitis?
Diverticulosis: often asymptomatic, LLQ pain and tenderness, painless GI hemorrhage, multiple pockets seen in colonoscopy,
Diverticulitis: constipation, looks like appendicitis but on left N/V/F, LLQ pain and tenderness, and diarrhea. May require ABX. Can perforate and show free air margins on xray
what factors increase risk of diverticular disease of the colon?
- inc age
- Connective tissue disorders: Ehlers-Danlos, Marfan, Scleroderma
How is diverticulitis treated?
+/- ABX and NPO/clear liquid diet
what are the most common types of colonic polyps?
Mucosal adenomatous polyps (tubular, tubulovillous, villious)
Which colonic colyps are hyperplastic?
Mucosal serrated polyps
Most common type of colon adenocarcinoma
what is the gold standard for detecting colonic polyps?
which stool-based screening for colon cancer is guaiac-based and detects pseudoperoxidase activity of heme or hemoglobin?
Which stool-based screening test detects human globin and is more sensitive than guaiac based tests
Fecal immunochemical test (FIT), tests for hemoglobin by detecting human globin
which stool-based screening of colon cancer tests for stool Hgb and can measure for mutated genes and methylated gene markers?
what is the treatment for FAP?
what gene mutation is associated with FAP?
_A_ is a inherited syndrome with multiple nonmalignant hamartomatous polyps in GI tract and mucocutaneous hyperpigmentation, commonly seen on lips.
B. What gene mutation is associated
C. what bowel obstruction is common with it
D. polyps are most in which part of the GI tract?
E. which other type of cancer is it associated with 30-50% of the time?
A. Peutz-Jeghers syndrome. Can become malignant 40-60% of the time
D. small intestine
_A_ syndrome consists of colonic polyp (lipoma) and also seen with breast cancer, thyroid cancer. Pts will present with hair follicle tumor (trichilemmomomas) on the face.
B. What gene mutation is it associated with?
A. Cowden syndrome
Hereditary nonpolyposis colorectal cancer aka Lynch syndrome
A. due to detect in _
B. Extra-colonic cancers includes _
C. colon cancer is usually on which side?
A. DNA mismatch repair (MLH1, MSH2)
B. Endometrial carcinoma; carcinoma of ovary, small bowel, stomach, pancreas
C. Right sided (70% proximal to splenic flexure)
Family Juvenile polyposis is greater than 10 juvenile hamartomatous polyps mostly in the colon is associated with what genetic defect?
MADH4 and BMPRIA
How is Lynch Syndrome diagnosis confirmed?
- Bethesda Criteria
- tumor tissue immunohistochemical staining for mismatch repair proteins
- microsatellite instability testing
- genetic testing
Pts with Lynch syndrome should have screening with colonoscopy every _A_.
B. women should be screened for what else, and starting at what age
C. upper endoscopy screening should be done every _ years starting at _ age
A. 1-2 years starting at age 25 or 5 yrs younger than age of youngest affected family member at diagnosis.
B. Pelvic exam, transvaginal US and endometrial sampling starting at 30-35
C. 2-3 yrs starting at 30-35
what is the Bethesda Criteria
Guideline for testing colorectal tumors for microsatelite instability (MSI). They include:
1. CRC under age 50
2. synchronous or metachronous CRC or lynch syndrome-associated tumors (endometrial, stomach, ovary etc)
3. CRC with one or more 1st degree relations with CRC or Lynch before age 50
4. CRC with two or more second degree relative with CRC or lynch before 50
5. tumors with infiltrating lymphocytes, mucinous/signet rings or medullary growth pattern in pts <60
Gardner's syndrome is adenomatous colon polyps associated with what other extra intestinal manifestation?
Osteomas of mandible, skull and long bones
Turcot's syndrome is adenomatous colon polyps associated with what extracolonic manifestation?
Autoimmune destruction of fundic glands leading to loss of fundic glands can lead to _A_ and decreased _B_ which leads to Vit B12 malabsorption (pernicous anemia). Achlorhydria leads to _C_ which is similar to ZE. These induce hyperplasia of gastric _D_ cells and can eventually lead to multicentric _E_ tumors
B. Intrinsic factors
C. pronounced hypergastrinemia (>1000)
the diagnosis of celiac disease in a pt who is IgA deficient, can be done by what serologic test?
anti-DGP. Normally without IgA def you'd do anti-tissue transglutaminase
Pt with bulky light colored stools and passing a lot of gas, mild LE edema and inguinal LAD, 2/4 murmur over RSB. A. what's the diagnosis.
B. what are you likely to see in biopsy
A. whipple (tropheryma whipplei )
B. PAS(+) macrophages with gram (+) bacilli
Celiac disease damages which part of the GI?
proximal small intestinal mucosa
Celiac disease is most commonly undiagnosed or asymptomatic, and only devleops in people with class II molecules such as _
HLA-DQ2 and DQ8
Common physical findings on Celiac pts include
Wt loss, chronic diarrhea, abd distention, growth retardation, dermatitis herpetiformis, iron def anemia and osteoporosis
Common S/S of whipple disease
- Fever, LAD, arthralgias, wt loss, malabsorption, chronic diarrhea, encephalitis, ocular abnormalities
with bacterial overgrowth, what kind of diarrhea is common?
osmotic and secretory
how is bacterial overgrowth diagnosed? Tx?
Breath tests (hydrogen, methane, glucose, lactulose, or C-xylose)
- jujunal aspiration with culture
what are complication of short bowel syndrome?
Short bowel syndrome is removal of significant segments of small intestine (due to crohn, mesenteric infarction, radiation enteritis, etc)
- TI secretion --> bile salts and vit B12 malabsorption (give IV b12, bile salt binding resins, low fat diet, fat sol vitamin replacemennt)
- increased chance of oxylate kidney stones (give calcium supplements)
- increased chance of cholesterol gallstones
If colon is removed but 100cm of proximal jejunum preserved what diet modification need to be made?
oral nutrition with low fat, hgih complex carb diet. Still may have fuid and electrolyte losses
If small bowel and colon is removed what dietary changes are required?
- At least 200cm of proximal jejunum is need to maintain oral nutrition-- thus pt needs to get parenteral nutrition if more than 200cm of proximal jejunum is removed.
- anti-diarrhea agent to slow transit and reduce diarrhea volume
-needs octreotide and PPI
how is lactase def diagnosed?
hydrogen breath test and symptomatic improvement with lactose free diet