Icm Winter 2 Irritable Bowel

Front 1

is irritable bowel common

Back 1

YES, most common GI dx

Irritable- abd pain w/alt bowel habits. dx of exclusion bc you need to make sure there is no organic cause

recall INFLAMATORY bowel is chrons adn UC

Front 2

36 YOWF with a long Hx of migraine H/A and diffuse achiness presents c a 1 year Hx of alternating constipation and diarrhea. There has been some abdominal cramping and bloating partially relieved by bowel movements. She has experienced no weight loss, F/C, N/V or blood in the stool. PMH: Illnesses: fibromyalgia. Surg: none. Meds: cyclobenzaprine, Tylenol, OCPs.
SH: married. No tobacco or alcohol. 2 children. No recreational drugs.
FH: unremarkable
Exam: anxious appearing but occ. teary F. Ab: mild diffuse tenderness. No HSM. Rectal: sphincter tone nl and stool hemoccult neg. MS: diffuse tenderness c posturing and grimacing on pressure. Full ROM all joints s swelling or warmth.
A clinical diagnosis is made.

what was it

Back 2

irritable bowel

Front 3

what is IBS

Back 3

abd pain w/alternating bowel habits- WITHOUT organic cause. its a dx of exclusion

3 days/month in last 3 months assicated with 2 or more of the following:
gets better w/pooping
onset assoc w/change in frewuency
onset assoc w/change in form (appearance) of poop

Front 4

who gets IBS more, we knoe its pretty common

Back 4

N america 10-15
Europe 11

**common in young wome, not many get help

Front 5

what is some of the pathophys associated with IBS

Back 5

altered GI motility
visceral afferent HS
microscopic inlfmaation
post infectious
psychosocial dysfx

Front 6

is there post infectious IBS

what are risk factors

Back 6

you bet, campylobacter or E coli


Risk: femal, young, bloody stool, abd cramps, weight loss, prolonged diarrhea

Front 7

what is in the hx of pts with IBS

Back 7

age of onset, system progression
GI cancer, inflamm bowel disease, associatedns, psychosocial- stress, depression, abuse

all the tings you would expect, take a good hx ALWAYS

Front 8

ok so IBS is a disease of exclusion, what are some things in the hx that are RED FLAGS

Back 8

1. unintentional weight loss
2. onset in OLD pts (more common in young females)
3. fx cancer, IBD (chrons, UC)

Front 9

what are some red flags in the lab workup of pt w complainted of abd pain adn change in bowel habits

Back 9

decreased HGB
increased WBC
increased CRP
chem panel abnormalities
abnormal TSH

Front 10

what are some red flags on the PE for pt w/IBS

Back 10

abnormalities (duh)
rectal bleed/obstruction
fecal occult blood

Front 11

in a pt with IBS w/o red flag do you do colonoscopy

Back 11

nope

*8can test for celiac (anti tranglutaminase AB)

**if its an old person (red flag) get colonscopy

Front 12

whats the goal of IBS tx

Back 12

normalize Gi motility
relieve sx

**pt education, diet modification, psychotherapy, meds

Front 13

what is teh psychosocial component of IBS

Back 13

common in ppl with sexual abuse

Front 14

what are some meds for IBS tx

Back 14

Antispasmodic agents
Antidepressants
Antidiarrheals
Benzodiazepines
Anticonvulsants
Serotonin 5HT3 receptor agonists
Chloride channel activators
Probiotics/ Antibiotics
Peppermint oil

Front 15

what are some early signs of hepatitis

Back 15

fatigue
nausea
weight loss
myalgia

fever, NV, DARK urine, LIGHT poo, RUQ pain, jaundice

Front 16

what types of hepatitis are fecal oral

Back 16

A and E, the ends like the mouth and butt

Front 17

what are the complication and chronic sequela of Hep A

Back 17

complications: fulminant hepatitis, choestatic hepatitis, relapsing hepatitis

no chronic sequela

Front 18

how is Hep A transmitted

Back 18

fecal oral

close contact, contaminated food, blood exposure is super rare

Front 19

how can you prtect yourself against Hep A

Back 19

1. dont eat poo
2. get a prea nad post exposure vaccine

**travelers to endemic get preexposure
**in US we start Hep A vaccine at 1 year

Front 20

when you you get hep A vaccine

Back 20

1 year old
immunocomprimised, pts with liver disease
ppl traveling to endemic areas etc

Front 21

whats tx for hep A

Back 21

supportive
self limited

*can do Ig

Front 22

tell me a little about hep B

incubation
clinical illnedd seen in what age
chronic
can it kill you

Back 22

60-90 days
more in ppl over 5 yo
ya
not super deadly but can cause premature mortality from chronic liver disease

Front 23

what AB does a person who is vaccinated for HEP B have

Back 23

HB-surface
not HB-core

Front 24

what is this personse history

+ HBs
+HBc

Back 24

+HBs- vaccinated
+HBc- had hep B

Front 25

where is Hep B conc in the tissues

Back 25

HIGH: blood, serum, wound

Mod: semen, vagina, spit

Front 26

what is teh transmission of Hep B

Back 26

1. sexual: mod virus load in saliva, semen, vagina

2. paraenteral: high in serum, blood, wounds

3. perinatal: low in breast milk

Front 27

tell me a little about hep C

Back 27

LONG incubation (7 weeks)
not realy an acute illness but lots of chronic infection seen

Front 28

which heps are assoicated with hepatocellular carcinoma

Back 28

B and C

HVC is MORE COMMON

Front 29

what things make having hep C even worse

Back 29

EtOH
old man
HIV, HepB

Front 30

when do we get chronic hep C

Back 30

when the body cant clear the hep C RNA,

chronic infection is common (increased risk of liver cancer)

passed: drug use, transfusion, needle stick, sex

Front 31

which hep is assicated with sex, drugs, and work related needle sticks

Back 31

hep C

can go to chronic really easily if you cant clear the RNA

Front 32

tell me about occupational transmission of HepC

Back 32

not really efficient transmission (it like sex and drugs more, transfusion)

LOW

if you get stuck take blood immediatly for baseline, then repeat in 6 months. treat with antivirals if significant injury

Front 33

when is it good to routinely test for HCV

Back 33

1. IVDA (at any time in past)
2. clotting factors beefore 87
3. organs before 92
3. liver disease, chronic hemodialysis

*keep in mind occupational transmission is not super common but of course if you were stuck with a HCV + needle get checked

Front 34

who gets hep D

Back 34

ppl with Hep B

**you MUST have B to get D

*not everyone with B gets D, but everyone with D has B

Front 35

what are some causes of hepatitis other than viral

Back 35

autoimmune
non alcoholic fatty liver: obese ppl with glucose intolerance adn dyslipidemia
alcoholic

mono, toxins- carbon tet, drugs