Wk 10 Flashcards Preview

Gastro > Wk 10 > Flashcards

Flashcards in Wk 10 Deck (16)
Loading flashcards...
1

what are common non-GI diseases that include constipation as a symptom?

metabolic disorders (Hypothyroid, DM2, etc)
neurological disorders
mechanical obstruction (masses, tumors)
anorectal disorders (prolapse, etc)

2

definition of constipation

Two or more of the following for the past 3 months with symptom onset at least 6 months prior to diagnosis:
-Straining during >25% of BMs
-Lumpy or hard stool for >25% of BMs
-Feeling of incomplete evacuation for >25% of BMs
-Feeling of anorectal blockage for >25% of BMs
-Use of manual maneuvers to facilitate >25% of BMs (digital evacuation or support of pelvic floor)
-Less than 3 BMs per week
-Insufficient criteria for IBS-C

3

Limitations of cathartic herbs in the treatment of constipation

shouldn't be used for more than 10 days
consequence of overuse: dependence/aggravation of constipation, electrolyte imbalance, C/I in PG and with lactation,
useful for severe atonic constipation

4

Why would we be concerned with sudden onset constipation?

colon cancer

5

Why does the Western (S.A.D.) diet often result in constipation

eating food allergens/sensitivities
high carb/fat, high inflammatory foods
low veggies, fruit, fiber
lack of exercise

6

What role does ignoring stool urge have on constipation?

loss of BM reflex

7

Know the homeopathic remedies for constipation
-says he won't ask about remedies

Aesculu
Aloe
Alumen
Alumina
Bryonia
Calc carb
Causticum
Graphites
Lachesis
Lycopodium
Magnesia muriaticum
Nat mur
Nux vom
Opoium
Phosphorus
Platina
Plumbum metallicum
Silicea
Sulphur
Veratrum album

8

How are BUN levels affected by colon bleeding?

blood urea nitrogen levels may be elevated (30-50 mg/dL)
BUN: Creatinine ratio greater than 36:1 likely represents blood loss from GI

9

DDX for colorectal bleeding

Angiodysplasia (AV malformation)
Carcinoma
Colonic diverticula
Ischemic colitis
Trauma
Anal fissure
Colitis- UC, Crohn's, Infective Hemorrhoids
Meckel's diverticulum
Radiation proctitis
Polyps

10

Know which imaging is the best in diverticulitis

Abdominal CT
(may demonstrated bowel wall thickening, abscess formation, diverticula)
Endoscopy is C/I in diverticulitis

11

Understand key dietary principles in diverticulosis prevention

-diet rich in fruits, vegetables, legumes, nuts. Avoid seeds
-whole grain moderation
-overall fiber goal: 50 g daily non-grain based fiber
-decr. grain fed meats and processed foods
-incr. exercise and water (64 oz daily)
-incr omega 3 EFA intake
-elimination diet/food sensitivity testing

12

Know acute diverticulitis therapies

signs of internal bleeding or acute abdomen require immediate hospitalization
otherwise:
-abdominal castor oil pack (w heat) for 60 minutes TID
-probiotics 50-100 billion live organism QID
-water fasting
-acute diverticulitis formula (Yarnell)
-monitor every 12 hrs, if no improvement with 48 hrs, hospitalize

13

Treatment protocols for diverticulosis/diverticulitis

dietary:
increase fluids, short fruit or vegetable juice fast progressing to solid food (for acute), elimination/rotation diet, high fiber, high complex carbs, unrefined diet (chronic)
increase cellulose and hemicellulose fiber to protect against diverticulosis
consume food rich in Vit A, Vit B-complex food, acidophilus
avoid food intolerances and inflammatory foods
supplement:
ground flaxseed, vit B-complex, folic acid, vit C, probiotics, vit E, Yarnell's formula
hydrotherapy:
constitutional hydro, vinegar pack, warm castor oil packs
homeopathy:
belladonna, bryonia, iris tenax, lachesis, mercurius, phosphorus, silicea

14

Know herbal therapies for colorectal cancers

green tea extract
avena sativa
baptisia tinctoria
berberis aquifolium
conium maculatum
echinacea spp
gentiana lutea
Larrea divaricata
Phytolacca decandra
Rumex crispus
Taraxacum officinale
Trifolium pratense
Viola odorata with Galium aparine
Viscum album
Hoxsey-like formula

15

Recommendations for colorectal screening schedule

CRC screening tests are grouped into two categories:

Tests that detect cancer and precancerous polyps*
Flexible sigmoidoscopy (FSIG) every 5 years*, or
Colonoscopy every 10 years, or
Double contrast barium enema (DCBE) every 5 years*, or
CT colonography (CTC) every 5 years*

Tests that primarily detect cancer
Annual guaiac-based fecal occult blood test (gFOBT)* with high test sensitivity for cancer, or
Annual fecal immunochemical test (FIT)* with high test sensitivity for cancer, or
Stool DNA test (sDNA)*, with high sensitivity for cancer, interval uncertain

*Note: All positive screening tests should be followed up with colonoscopy
Exams that are designed to detect both early cancer and precancerous polyps should be encouraged if resources are available and patients are willing to undergo an invasive test
If the full range of screening tests are not available, physicians should make every effort to offer at least one test from each category

16

Homeopathic remedies for colorectal CA/Polyps
said he wouldn't ask about remedies...

Alumen
Cadmium iodatum
Hydrastis candensis
Nitric acid
Ruta graveolens
Scrophularia
Calc carb
Calc phos
Conium maculatum
Formica rufa
Nitric acid
Phosphorus
Sepia
Sanguinaria
Sulphur
Thuja occidentalis
Alcoholus