Week 3

Question 1

what are the 4 IBS subtypes

Answer 1

IBS-d (with diarrhea)
IBS-c (with constipation)
IBS-m (mixed with const. and diarrhea)
IBS-u (unsubtyped IBS)

Question 2

Rome Criteria IV

Answer 2

Question 3

Bristol stool scale

Answer 3

Question 4

Brain-Gut Pathway

Answer 4

Question 5

Gut-Brain Axis

Answer 5

Question 6

Some things that happen with IBS

Answer 6

Question 7

Alarm features for IBS

Answer 7

• Age ≥50 years old
• Blood in stools
• Nocturnal symptoms
• Unintentional weight loss
• Change in symptoms
• Recent antibiotic use
• Family history of organic GI
  disease

Question 8

Peruse some ways of screening some things

Answer 8

Question 9

Why is colonoscopy not necessary without alarm features?

Answer 9

Because low occurrence of abnormal visual structures

Question 10

Diagnostic flow for IBS

Answer 10

Question 11

safety of some foods

Answer 11

Question 12

What the fuck is FODMAP. You want low FODMAP with IBS, typical diets are considered high FODMAP

Answer 12

Question 13

High FODMAP Foods

Answer 13

Question 14

Low FODMAP BAMMM!!

Answer 14

Question 15

Does just going GF help all people with IBS?

Answer 15

nah brah, you gotta test other foods dudes

Question 16

Use peppermint oil, duh

Answer 16

Question 17

Antidepressants help

Answer 17

ok

Question 18

Treat predominant symptoms. Ab Pain

Answer 18

Question 19

Treat predominant symptoms. Constipation

Answer 19

Question 20

Treat predominant symptoms. Diarrhea

Answer 20

Question 21

Treat predominant symptoms. Bloating

Answer 21

Question 22

Two types of IBD

Answer 22

Crohn’s
Ulcerative colitis

Question 23

3 legs of IBS stool of treatment

Answer 23

-motility agents (laxatives, anti-diarrheal)
-Neuromodulators, antidepressants
-Dietary changes

Question 24

Sx of Crohn’s

Answer 24

-Skip lesions, skip areas (from mouth to rectum, typically starts at terminal ileum, affects any part of digestive tract.
-cobblestoning
-creeping fat and fistula
-diarrhea
-x-ray-String Sign (bowel wall thickening)
-Histopathology ~ non-reseating granuloma, Th 1 mediated inflammation, transmural inflammation

Question 25

Sx of Ulcerative colitis

Answer 25

-Inflammation limited to colon -continuous information, always involves rectum -Deep ulcerations and pseudo polyps -Bleeding diarrhea -X-ray lead-pipe sign (loss of haustra) -histopathology -> crypt abcess, th2 mediated inflammation, involves mucosa, submucosa

Question 26

Good to explore what's going on in intestines

Answer 26

Question 27

The ravages of IBD

Answer 27

Question 28

Compare risk factors of IBD types (Crohn's and Ulcerative)

Answer 28

Question 29

Review CDAI scoring for Crohn's

Answer 29

Question 30

Mayo clinic scoring

Answer 30

Question 31

Therapeutic goals in IBD

Answer 31

Question 32

Is IBD increased risk for colon cancer?

Answer 32

Yes, 10% at 20 years...

Question 33

Recommended surveillance?

Answer 33

Question 34

Red flags in GI: Mid-epigastric pain and vomit blood

Answer 34

condition assumed present until proven otherwise -upper GI hemorrhage from inner lining of ST/esophagus -possible consequences of misdiagnosis is massive bleeding from upper GI leading to death

Question 35

Signs of Mid-epigastric pain with vomit blood

Answer 35

Refer to ER

Question 36

Red flags in GI: Daily heartburn for many years

Answer 36

Refer to Doc

Question 37

Red flags in GI: Mid-ab pain followed by vomiting then pain moving to RLQ

Answer 37

ACUTE APPENDICITIS, Refer to ER

Question 38

Signs of appendicitis

Answer 38

* Only 50% of case has the above symptoms * Absence of appetite * Vomit follows onset of pain * RLQ tenderness * Rebound tenderness, pain on percussion, rigidity, guarding * Invariably absence of bowel sounds * Low grade fever -> Rupture of appendix

Question 39

what can mimic appendicitis symptoms?

Answer 39

ectopic pregnancy

Question 40

Tests for appendicitis?

Answer 40

Question 41

Red flags in GI: mid to lower Ab colicky pain, vomit, constipation, ab distension

Answer 41

Condition assumed present until proven otherwise: BOWEL OBSTRUCTION

Question 42

Possible consequences of Bowel Obstruction?

Answer 42

Death. Refer to Emergency Department

Question 43

four types of bowel obstruction?

Answer 43

Question 44

bowel obstruction key feature?

Answer 44

persistent vomit

Question 45

acute small intestine obstruction Sx

Answer 45

* Pain appears first and followed by vomit, distension, constipation

Question 46

large intestine bowel obstruction Sx

Answer 46

* Constipation is followed by distension, pain, vomit

Question 47

sign always present with any bowel obstruction?

Answer 47

distended abdomen

Question 48

GI red flags: Acute bloody diarrhea (6-8 stools/day) and fever of over 101.5 F

Answer 48

Serious Enteritis (Gastroenteritis if persistent vomit in addition to diarrhe)

Question 49

possible consequences of serious enteritis?

Answer 49

serious disability and/or death from dehydration and electrolyte imbalance

Question 50

2 types of serious enteritis?

Answer 50

acute infectious (viruses, bacteria, parasites) inflammatory autoimmune bowel disease (UC, Crohn's, etc)

Question 51

What to ask and look for in serious enteritis?

Answer 51

Inquire: * Number of stools daily * Presence of blood in stool * Presence of fever Objective Findings: * Visible blood * Temp > 101.5 F * Hyperactive bowel sound (borborygmi) * Generalized abdominal tenderness to palpation, esp. if on LLQ

Question 52

Risk factors for infectious enteritis:

Answer 52

* Age < 5 y.o. * Exposure to unclean water / food * Lack of hand washing

Question 53

risk factors for IBD

Answer 53

* Cigarette smoking * Family history

Question 54

Red flags in GI: new onset constipation + unexplained weight loss in person over 40 years old

Answer 54

Carcinoma of colon (and rectum)

Question 55

Possible consequences of missing carcinoma

Answer 55

metastasis, death

Question 56

what do to if you see new onset constipation + unexplained weight loss in person over 40 years old

Answer 56

Refer to doctor