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89 Cards in this Set
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What is normal freq. for bowel mvmt?
What is main question for cc of diarrhea |
Range 3 x per week to 3 x per day
----Any w/in is fine so long as its constant/ no change -- Have to make sure that OFTEN SOLID stools is NOT being considered by Pt as diarrhea (D) |
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WHat is pseudo-D
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Inc frequencey with NO change of consistency
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What is fecal incontinence
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Involuntary release of rectal contents
--more common in elderly & women --More common when stool is liquid |
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What is acute/ chronic D
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< 3 wks is acute
more than 3 is chronic |
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How much fluid is presnted in duodenum per 24 hours
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8-10 liters
-2 is from diet --rest is from saliva/excretions |
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How much does Small Intestine absorb?
How much enters colon |
ALL but 1.5 liters
-1.5 L presented to Colon |
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How much of 1.5 L does Colon absorp
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all but 100cc
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2 Categories of D
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Malabsorption --osmotic
Secretion |
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What is Golytely?
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Exogenous Laxative
-sim to Milk of Magnesia |
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List other Exogenous causes of D.
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Antaids: Mg++
Dietetic Foods: Gumes, Mints (with Sorbital) |
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What med can cause diarrhea
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Colchicine
Olestra--fat not absorbed by body--in some ingredients, causes D |
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Main four ways of Acute Infectious D
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Fecal Oral
Contaminated Water Poorly cooked food Improperly Stored Food |
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What orgs are associated with Water/ Acute Infx
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Vibrio, Giardia, Cryptospor
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What orgs are associated with Acute Infx in Cheese/Milk
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Listeria
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Salmonella in what usually?
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Eggs
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What orgs are associated with Acute Infx in mayonnaise?
(2) |
Staph
Clostridium sp |
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What orgs are associated with Acute Infx with Animals
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Parasites, viruses
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What orgs are associated with Acute Infx in Swimming pools
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Giardia, Crypto
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What orgs are associated with Acute Infx in Hospitals
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Clostridium difficile
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What orgs are associated with Acute Infx in Chicken
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Salmonella
Shigella Campylobacer |
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What orgs are associated with Acute Infx in Beef?
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Enterohemorrhagic E. Coli
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What orgs are associated with Acute Infx in Pork?
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Tapeworms
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What orgs are associated with Acute Infx in Seafood (4)
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Vibrio,
Salmonella Hep A, B, C Tapeworm |
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What orgs are associated with Acute Infx in Fried Rice
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Cyclospora sp
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5 most common Travelers D. in ACUTE infex
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Enterotoxigenic E. coli
Shigella Campylobacter Salmonella Noncholera Vibrio spp. |
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What are chemoprophylaxis for Travelers D. in Acute setting?
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Fluoroquinolones
Rifaximin |
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What are the 2 Fluoros Rxed
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Ciprofloxacin --used most
Norfloxacin |
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What orgs are associated with Acute Infx in Day Care
(3 bugs) + (3 viruses |
Shigella
Giardia Crypto Rotavirus, Astrovirus, Adenovirus |
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What D screams infectious D
What is DDx |
Acute Watery
-DDx: Mesenteric Ischemia, Ischemic colitis, Antiobiotic Assc Colitis ---Note Crohns, Ulcerative Colitis CAN present ACUTELY |
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Is Lab work on Stool sensitive?
For what is it most sensitve? |
Not really
< 10% stools are culture Positive for Specific pathogen -- If the Bug is: Salmonella, Shigella, Campylobacter, then stool tests are more sensative |
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Tx for Acute Infectious D
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Symptomatic Therapy: Includes Fluids to correct dehydration
-Definitive Antimicrobial Therapy |
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When CAN you give Pepto or Immodium to safely treat D
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IN UNCOMPLICATED, NON-Infectious cases
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When, in general do you NOT give Anti-Diarrheal agents
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Pts with FEVER or Bloody D.
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What is common to D from:
Shigella Cholera Travelers Pseudomembranous Entercolitis Parasite |
All are causes of D which require definitive Antibiotic therapy
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Up to 1/4 Pts who experience an Acute Infectious D. Illness will have what 4 Sx?
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Pain
Bloating Urgency Sense of Incomplete Evacuation |
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What is Tx for Acute Infectious D. Illness the lasts up to 6 moths/ is Irritable bowel Syndrome
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Bile Acid Binders:
-condition is presemed due to Bile Acid Malabsorption |
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With Nosocomial acquired D, what is common with Fecal Impaction
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Can present as D. or Incontinence as water squirts around impaction
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Note: 50% of NosoCom D is due to C-diff. Much else is due to Hemorrhagic E. coli
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What nosocomial Tx causes osmotic D
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Elixirs --contain lots of Sorbitol (like gum)
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What Nosocom D is epecially common in ICU patients
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Enteral Feeding D
--bacteria in feeds --Hypertonicity of feeds=Dumping Syndrome --Lactose feeds-- |
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What Dx do ALL Pts have D
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Cancer Tx
-regimens or Radiation =100% get D |
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This is a Persistent contamination of the Entire Small Intestine by toxigenic strains of Coliform Bacilli
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Tropical Sprue
--think: Klebsiella, Enterobacter, E Coli |
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Sx of Tropical Sprue?
Complications? |
Acute Onset, Watery
Comps: Megaloblastic Anemia--Folate & B12 def |
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Tx for Tropical Sprue
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Tetracycline or Sulfa Drugs x 3-6mos
-Folate and B12 --Leave Tropics |
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Who gets runners D
MOA? |
10-25%
> in Women Self Limited MOA: release of Gastrin OR Inflammatory Mediators --may be induced by intestinal ischemia |
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Moving on to what?
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CHRONIC D.
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3 cause of Steatorrhea in Chronic D. (CD)
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Intralumenal Maldigestion
Mucosal Malabsorption Postmucosal Malabsorption due to Lymphatic Obstruction |
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In CD: what are 2 causes of Intralumenal Maldigestion?
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1. Cirrhosis and Bile Duct Obstruction=pancreatic & bile salt insuff
----25-100% of Pts with cirrhosis have mild Steatorrhea 2. Pancreatic Exocrine Insufficiency ---90% fxn is gone=malabsorb. --Which Pts often have Pancreatic Exo Insuf? |
Pts with CF or Chronic Pancreatitis
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In CD: How do, 1, Drugs induce Mucosal Malabsorption?
2. Infectious Dzz induce Mucosal Malabsorption |
1. Drugs: Cholestyramine, neomycin, NSAIDs---can induce Steatorr by damagining enterocytes or by binding bile salts (cholestyramine dzz)
2. Infectious Dzz: giardia, Cryptospor, Strongyloides, Atypical Mycobacteria --Again these are causes of Mucosal Malabsorption in chronic D. |
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What sort of CD does Whipples cause?
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Whipples causes a Mucosal Malabsorption CD
What is whipples/cause? |
Systemic infectious Dzz caused by Tropheryma whipellii
Men: 5:1 40-50 yrs |
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What are Sx of Whipples
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Weight Loss--20-30 pds (can be greater than 100_
Diarrhea (steatorrhea) Arthralgias (in large joints) FEVER Abdominal Pain |
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What is Diagnostic for Whipples?
On Histo? |
Biopsy of Small Intestine (gold standard)
--PAS positive, round or sickle shaped inclusions in Macs |
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Tx for Whipples
(2) include duration |
Parenteral Ceftriaxone x 2 wks
Bactrim 2x/day for 1 year |
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What Dx is prototype of Mucosal Malabsorption causing CD
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Celiac (nontropical sprue)
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What is increased risk with Celiac
(2 Cx) |
Small In. Lymphoma
& Adenocarcinoma |
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What is offending agent in Celiac
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Gluten (Gliaden)
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Sx of Celiacs
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Anemia
Abdom Pain/Bloating D. Weight Loss Failure to Thrive Onset when kids begin eating cereal |
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What is Lab for celiac diagnosis?
Sensitivity? 2nd Dx that will be Positive |
Serum Anti-Gliaden Abs
--90% Crohns will be positive |
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What are good foods for Celiacs
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Corn, Rice, Sorghum Buckwheat, Millet
---avoid wheat, rye, barley, oats |
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What Causes Postmucosal Obstruction CD
(name 2) |
1. Obs of Lymphatic System--> protrusion of Lymph nodes Thru mucosa
2. Leakage of Lymph into Intestinal Lumen causes Protein, Fat and Lymphocyte loss |
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What cause of Inflammatory CD is described by Bloody D. containing Mucus. OFten preceeded by Stress?
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Ulcerative Colitis
--Chronic and Relapsing -Cramping and Lower Abd Pain - FEVER |
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Typically, where does Ulcerative Colitis begin
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Begins in Rectum, extends CONTINUOUSLY throughout the colon.
--If Entire colon = PAN-colitis |
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What is seen endoscope in UColitis
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SUPERFICIAL Mucosal Hemorrhages and Ulcerations
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What is formed when the superficial ulcers become confluent to eachother?
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Forms PseudoPolyps
--lateral formation within the Submucosa |
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What is diagnostic for UC
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GI does Endoscopy
--Confirmed by Biopsy --b/c of bloody D., have to rule out Infection |
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With Ulcerative Colitis:
What is big sign? Relation to Stress |
Blood & Mucus Diarrhea
STRESS does NOT cause UC, it CAN induce a Relapse |
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What are the Extra-Intestinal Manifestions of UC on Joints?
Skin? Eyes? |
Arthridites--ankles, knees,
Skin: Pyoderma--pre-tibial ulcer , Erythema nodosum (red nodules on Pre-tibial areas) Iritis, Sclerosing Cholangitis ?? |
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What 2nd Dz is at increased risk with UC?
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Colon Cx
--Postively related risk with severity of UC. ie, greater risk if Pancolitis for: 1% at 10 yrs 3.5% at 15 yrs 10-15% at 20yrs 30% for 30 yrs |
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If dysplasia in colon is found in UC Pt, what should be performed
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Colectomy if dysplasia found
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What is acute complication of Colon with UC?
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Toxic Megacolon: acute dilatation of colon
--Assc/ Shock -Emergency |
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What procedure is Absolute Contraindicated if UC with Toxic Megacolon
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Barium Enema
--Causes Greater Dilatation = Perforation |
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What is Tx for UC if Mild
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Steroids or 5-ASA enemas given nightly for 3 weeks
--taper if responding |
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Note:
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Don't worry about Tx for UC and Crohns
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What is Tx for Isolated Proctitis?
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5-ASA suppositories or corticosteroid foam
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Tx with Pancolitis
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Sulfasalazine or oral 5-ASA
--Oral Prednisone if > bowel mvmt |
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Tx if Severe UC
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Cyclosporine IV x 7 days
--if no response, consider Colectomy --25% need surgery (refractory fulminant colitis or severe hemorrhage or perforation or Toxic megacolon) --Is surgery indicated in NON-Urgent?Emergency cases of UC? |
Yes:, if:
Failure of Meds Or AEs of Meds Dysplasia Carcinoma |
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aka for Regional Enteritis?
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Crohns--Primarily Involves the Small Intestine--thus Regional
--Terminal Ileum is MOST COMMON location ---others are Cecum or Right colon---only occasionally in rectum --Less than 5% have in UPPER GI tract |
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what is major Diff with UC and Crohns
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UC is superficial, Crohns is transmural and Involves ALL areas but IS NOT continuous---
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What is common, non-continous lesion in Crohns
--Histo Features |
Skip Lesions
Histo: GRANULOMAS (differentiates it from UC too) -Intestine becomes Thickend and Inflexible |
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Complications of Crohns
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Obstruction due to Fibrosis
Fistula to Perforation--colon, urinary bladder, vagina, anus, skin -Abscesses: mesenteric, perirectal -Malabsoption due to mucosal involvement |
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What are systemic Sx of Crohns
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Arthralgia--migratory (UC is just large joints)
Arhritis--sacroileitis, ankylosing spondylitis-- -Uveitis (UC is Iritis) -Erythema nodosum (also in UC) |
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Can Crohns be resected?
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No--it has skip lesions, unlike UC which is continuous where you can remove affected, contious tissue
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Indications for Surgery in Crohns?
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IS NOT CUrative
--done in: -Obstruction Fistulae Abscesses |
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Differentiate UC from Crohns in the following way:
Pattern? |
UC: Ascending/ Continuous from Rectum
Crohns: Skip Lesions |
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Differentiate UC from Crohns in the following way:
Ulcers? |
UC: Superficial, Mucosal
Crohns: Deep, Transmural |
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Differentiate UC from Crohns in the following way:
Involvement of Rectum? |
UC: +++
Crohns: + |
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Differentiate UC from Crohns in the following way:
Fistulae? |
UC: (+)
Crohns: ++ |
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Differentiate UC from Crohns in the following way:
Pseudopolyps? |
UC: ++
Crohns: + |
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Differentiate UC from Crohns in the following way:
Involvement of Ileum? |
UC: NO
Crohns: +++++++++ (terminal ileitis aka) |
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Dont need to kNow but,
Tx of Mild Crohns |
Sulfasalazine or 5-ASA prep
--If no response, Prednisone |
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