Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
22 Cards in this Set
- Front
- Back
|
163. Indications for bacterial stool culture?
|
a. Suspicious of invasive bacterial enteritis.
b. If pt has moderate to severe illness or fever c. If the pt requires hospitalization d. If stool sample is positive for fecal leukocytes. |
|
|
164. What do most lab tests for stool culture look for?
|
a. Only 3 organisms:
1. Shigella 2. Salmonella 3. Campylobacter |
|
|
165. False-negative rate of C. diff assay?
|
a. 10%.
b. Treat pt empirically even before lab results are back if suspicion is high. |
|
|
166. What should you suspect if N/V are present w/diarrhea?
|
a. Viral gastroenteritis or food poisoning.
b. If food poisoning is the cause, diarrhea appears w/in hours of the meal. |
|
|
167. Note: Remember that occult blood in the stool MAY be present in all types of acute infectious diarrhea, but it is much less common to have gross blood.
|
167. Note: Remember that occult blood in the stool MAY be present in all types of acute infectious diarrhea, but it is much less common to have gross blood.
|
|
|
168. With what conditions is a finding of fever and blood together with diarrhea typical of?
|
1. Shigella
2. Campylobacter 3. Salmonella (may also be w/o blood) 4. Enterohaemorrhagic E. coli. |
|
|
169. With what conditions is No fever and no blood w/diarrhea typical of?
|
a. Viruses (Rota, Norwalk)
b. Enterotoxic E. coli c. Food poisoning (S. aureus, Clostridium perfringens). |
|
|
170. Important parts of history in pt w/diarrhea?
|
a. Is the stool bloody or melanotic
b. Are there are other symptoms (e.g. fever, abdominal pain, vomiting) c. Is there anyone in the family or group w/a similar illness d. Has there been any recent travel outside the US, or any hiking trips e. Are symptoms linked to ingestion of certain foods (e.g. milk) f. Are there any medical problems (AIDS, hyperthyroidism) g. Have there been recent changes in medications (e.g., abx w/in the past few weeks). |
|
|
171. Important aspects of physical exam in person with diarrhea?
|
a. Assess volume status (dehydration is a concern)
b. Perform an abdominal exam c. Check stool for occult blood in pts w/diarrhea. d. In mild to moderate cases of acute diarrhea, further workup is unnecessary. |
|
|
172. Causes of diarrhea w/fecal leukocytes and often blood?
|
1. Salmonella
2. Campylobacter 3. Shigella 4. Enteroinvasive E. coli. |
|
|
173. What is the most common electrolyte/acid-base abnormality seen w/severe diarrhea?
|
a. Metabolic Acidosis with Hypokalemia.
|
|
|
174. Causes of constipation?
|
a. Diet-lack of fibre.
b. Medications c. IBS d. Obstruction e. Ileus, Pseudo-obstruction f. Anorectal g. Endocrine/metabolic causes h. Neuromuscular disorders i. Congenital disorders |
|
|
175. What meds cause constipation?
|
a. Anticholinergic drugs (antipyschotics)
b. Antidepressants c. Narcotic analgesics d. Iron e. Calcium-channel blockers f. Aluminum- or calcium-containing antacids g. Laxative abuse and dependence. |
|
|
176. Obstructive causes of constipation?
|
a. Colorectal cancer (always keep this in mind)!
b. Anal stricture c. Hemorrhoids d. Anal fissure. |
|
|
177. Endocrine/metabolic causes of constipation?
|
a. Hypothyroidism
b. Hypercalcemia c. Hypokalemia d. Uremia e. Dehydration |
|
|
178. Neuromuscular disorders that cause constipation?
|
a. Parkinson’s disease
b. Multiple Sclerosis c. CNS lesions d. Scleroderma e. DM (autonomic neuropathy |
|
|
179. Congenital cause of Constipation?
|
a. Hirschsprung’s disease.
|
|
|
180. Complications of chronic constipation?
|
a. Haemorrhoids
b. Rectal Prolapse c. Anal fissures d. Fecal impaction |
|
|
181. Diagnostic tests in evaluation of constipation?
|
a. TSH
b. Serum Calcium levels c. CBC (if colon cancer is suspected) d. Electrolytes (if obstruction is suspected). e. Always attempt to r/o obstruction. |
|
|
182. If H&P is suggestive of obstruction with constipation?
|
a. Order abdominal films
b. Consider flex sig in select cases (if an obstructing colorectal mass is suspected. c. A rectal exam may help ID fissures, hemorrhoids, fecal impaction, or masses. |
|
|
183. If no cause of constipation is found with above measures?
|
a. More specialized tests are available
i. E.g., radiopaque marker transit study ii. Anorectal motility study. |
|
|
184. Tx of Constipation?
|
a. Diet and behavioural modifications are the most important aspects of treatment.
b. Advise pt to: 1. Increase Physical Activity 2. Eat 3. high-fibre foods 4. Increase fluid intake c. Use an enema, such as disposable fleet enema, for temporary relief if no bowel movement occurs despite the above measures of if the pt is bedridden. d. If obstruction is present, urgent surgery consultation is indicated. |
