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58 Cards in this Set
- Front
- Back
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Nonfood-borne causes
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*Usually viral: Rotavirus, Norovirus, Adenovirus, etc**Less often: parasitic: Giardia,Cryptosporidium
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Foodborne
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*Usually bacterial: Salmonella, E.Coli, Campylobacter, Shigella
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Diarrhea Viral
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only 24-48 hrs then beginsto improve. No tests. Encouragehydration, BRAT diet/bland foods, avoid lactose
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Bacterial Diarrhea |
*Bacterial often with fever, bloody stools: order stoolcultures. If recent antibiotic use,order Cdiff stoolspecimen, usually add O & P for giardia, etc.*Drug side effects: antibiotics, alcohol,….
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chronicor recurrent diarrhea |
*Malabsorptive? *Bloating, cramping*Associated with lactose or gluten consumption?
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CeliacDisease (celiac sprue)
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*Immune-mediated response to gluten that destroys thevilli of the small intestine in genetically susceptible individuals. *Onset can be at any age—in children can affect growth *May cause iron deficiency, weight lossPresentation:subtle, vague abd pain, bloating |
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Celiac Disease Diagnosis |
*Gold standard: smallintestinal biopsy *Screening with serum tTGIgA & IgA (sensitivity=>81%,specificity=>99%) |
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Celiac disease management |
*Eliminate gluten from diet *If anemic, check folate & iron. *Check for vit. D deficiency |
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PrimaryLactase Deficiency symptoms |
*Bloating, nausea, cramps and diarrhea post mammal milkconsumption *Usually no weigt loss or steatorrhea |
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Lactose deficiency diagnosis |
*Eliminate lactose & see if sx’s improve *Hydrogen breath test |
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SecondaryLactase Deficiency
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*Occurs after acute gastroenteritis *Underlying IBD or celiac disease |
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Treatment of Lactose deficiency |
*Avoid lactose containing foods *If on a lactose-free diet, need to ensure adequateCalcium & Vitamin D intake. Lactaidsupplements |
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Crohn’sDisease
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*Affects entire GI tract *Discontinuous distribution *Diarrhea, abdominal pain (RLQ), fever, vomiting,perianal pain, weight loss |
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UlcerativeColitis
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*Affects only colon & rectum *Urgency, tenesmus, bloody diarrhea *90% go into remission after initial presentation |
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Crohn’sDisease diagnosis
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*Constipation can be an early sign of obstruction*Labs: anemia, increased ESR/CRP *Diagnosis & severity: colonoscopy & endoscopy. |
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Crohn’sManagement
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*Monitor nutritional status-vitamin & mineraldeficiencies *Smoking cessation *Sulfasalzine, 5-ASAs, glucocorticoids *Azathioprine (have to monitor neutrophils)*Methotrexate *Biologics-Infliximab, adalimumab *Omega-3*Surgery |
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UlcerativeColitis diagnosis
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*Diagnosed with sigmoidoscopy or colonscopy—mucosa is edematous, granular appearance, friable
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UlcerativeColitis Management
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*Remissions/Relapses *Dietary measures during acute flare *Corticosteroids during acute flare *Prevent flares/initial treatment for mild-moderate dz:Sulfasalazine & 5-ASAs (Pentasa, Asacol) *Immunomodulators *Surgery—total colectomy |
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FunctionalGI Disease
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*Irritable Bowel Syndrome (IBS) *Nonulcer Dyspepsia |
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IBS(IrritableBowel Syndrome)
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*50% of all GI complaints *Abnormal motor function *Neurotransmitter imbalance (especiallydysfunctional serotonin release) *Psychopathology—result from and cause |
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Clinicalpresentation of IBS
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*Abdominal pain *Aching, occ. radiating, occ. relieved with passage offlatus or stool. Rarely awaken at night. *Constipation *Diarrhea*Or alternating *Dyspepsia *Usually no loss of weight |
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IBSDiagnostic Criteria
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*Rome Criteria: *Recurrent abd pain 3 days/mo x 3 mos & onset at least 6 mos ago *Improvement w/ defecation, change in stool frequency orstool form. |
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Alarmsymptoms!!!
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*If weight loss, evidence of GI bloodloss, anemia, fever, frequent nocturnal sx’s, positive family hx of colon CA, onset after 50 yrs old, sudden change in sx’s*NEED further work-up!
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Managementof IBS
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*Multifaceted approach *CBT, relaxation, biofeedback *TCA: amitriptyline 25-75mg QHS (avoid in IBS-C)*SSRI: fluoxetine 20mg/day *IBS-D: avoid triggers (fatty foods, caffeine, sorbitol, lactose, alcohol),only occasional Imodium 4mg BID PRN*Antispasmotics *IBS-C: exercise, fiber, MiraLax 17g/day in 8 oz of fluid*Zelnorm (CV events?) and Amitiza |
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When it burns |
*Functional dyspepsia *GERD *Dysphagia *Esophagitis *Barrett’s esophagusGastritis/PepticUlcer Dz—H |
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Nexium side effects |
*Hypomagnesemia *Increased risk for fractures *Altered GI microbial environment (i.e. Cdiff)*Malabsorption of iron, vitamin B12, CalciumCommunityacquired pneumonia |
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Alarmsymptoms
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*Black or bloody stools *Choking *Chronic coughing *Dysphagia *Early satiety *Hematemesis *Iron deficiency anemia *Odynophagia *Weight loss |
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Testing for GERD |
*Endoscopy (risk factors for Barrett’s esophagus—white, male,>45 yrs, longduration of sx’s). *Can test for PUD, H.Pylori, esophagitis, gastritis. *H.Pylori: stool antigen test is best for initial *Urea breath test best to test for eradication*Can use serum IgG for initial but not for eradication testing. *Barium UGI if suspect anatomical deformities: malrotation, volvulus (can alsoidentify PUD)*Esophageal pH monitor |
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GERDtreatment=PPI + Lifestyle Modification
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*AVOID: acidicfoods, large meals, high fat meals, certain meds, recumbancy 3-4 hrs after meals,tight clothing*DO: Loss weight, stop smoking elevate HOB 4-8 inches
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Cholelithiasis/Cholecystitis
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*By age 75 years, 35% of women and 20% of men willdevelop gallstones. *The four Fs (female, fat, forty, fertile) |
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Gallbladderdisease diagnosis
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LABS: *CBC*Amylase & Lipase (pancreatitis risk)*ALP (alkaline phosphatase)*AST & ALT (liver function)*Bilirubin Imaging:*Ultrasound (BEST)*Cholecystitis: calculi, gallbladder wall thickening, & sludge*HIDA scan (biliary scintigraphy)*ERCP*Surgery |
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Hepatitis
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*Autoimmune *Metabolic disorders *Toxic poisoning *Meds: acetaminophen, isoniazid *Viral |
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AcuteHepatitis
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Labs elevated: *Serum bilirubin*TransaminasesALP levels Alarm s/s:*Mental status changes*Asterixis*Ascites*Prolongation of PT*Requires hospitalization |
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Cirrhosis—12thleading cause of death in US
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*Vast majority from alcohol, hep B & C andobesity. Nonalcoholic fatty liverdisease. *40% are asymptomatic *Complications: ascites, bacterial peritonitis, hepatorenal syndrome,encephalopathy, and GI bleeding r/t portal hypertension and varices.*Hepatocellular carcinoma |
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Pancreatitis--causes
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*Gallstones (>50%)*Alcohol (30%) *Other: *Hypertriglyceridemia*Trauma*Medications*ERCP*Neoplasms*Perforated PUD*Viral infections*Idiopathic |
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Pancreatitisdiagnosis
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*Amylase *Lipase *Contrast enhanced CT *Ultrasound and possibly ERCP is d/t duct obstruction |
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Pancreatitis Treatment |
*NPO and IV fluids/nutrition *Pain control *For chronic: may needpancreatic enzymes, substance abuse treatment, diabetes treatment |
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Cancer gastric
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*Presenting symptom: epigastric tenderness
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Cancer Pancreatic |
*Also silent but deadly*Average age: 71*Wt. loss, jaundice, itching, N/V, Abd/Back pain
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Colorectal Cancer |
*Risk factors: age, polyps, IBD, fam. Hx, DM II, African American, Ashkenazi Jew |
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TheScreening Colonoscopy
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*Colonoscopy at age 50 yrs and every 10 yrs until age 75yrs.
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4categories of abdominal pain causes in the elderly
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*1. Peritonitis*2. Bowel obstruction*3. Vascular catastrophe*4. Medical
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Diverticulosis
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*20% of 40 y/o’s and 70% of 70 y/o’s .*LLQ pain, bleeding, constipation *Treat with high fiber diet |
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Diverticulitis
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*LLQ pain *Fever *Leukocytosis Complications:abscess, fistula, stricture, bowel obst, peritonitis |
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Diverticulitis diagnosis/treatment |
*Diagnosed by CT*Hospitalization?*Bowel rest, hydration*Cipro + metronidazole*Avoid seeds, nuts, corn, etc.
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AcuteViral Hepatitis
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¨Self-limited illness—usually within 3months fully recovered. (except HCV) ¨Incubation period varies from 2-24 weeks¨Prodromal symptoms: 1-2 weeks of anorexia,malaise, nausea, vomiting, change in senses of taste & smell, low-gradefever, RUQ or epigastricabd. discomfort & fatigue.¨Jaundice might appear toward endof prodromal symptoms. Pale stool and dark urine |
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HepatitisA
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¨Fecal-oral route—hygiene, crowded, kids,restaurants ¨Only acute: diagnosed with positive anti-HAVIgM ¨2-dose vaccine spaced by 6 months¨ |
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ManagingHepatitis A & E
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¨No therapy for acute HAV & HEV ¨Goals of care: maintainnutrition, comfort & avoid hepatocellular insult (alcohol, hepatotoxicmeds) & prevent transmission. |
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Hepatitis B vaccine |
¨Vaccinate at birth, 1 month, 6 months
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Prevention Hep B |
¨Vaccinate!¨Screen pregnant women for HBsAg¨Infants born to HBsAgpositive mothers—give Hep Bvaccine & Hep Bimmunoglobulin within 12 hrs ofbirth¨Safe sexual practices¨Universal precautions¨
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Prevention Hep C |
¨No vaccine and immunoglobulin not useful¨Blood screenings r/t transfusions¨Identifying & treating infectedpersons¨Discourage sharing needles¨Conflicting data on sexual transmission
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Whoshould we test for HCV?
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¨Born from 1945 through 1965 ¨Received blood products with clotting factorbefore 1987 ¨Received blood transfusion or organ transplantbefore July 1992 ¨Have ever injected drugs, even if onlyone time ¨Have HIV¨ Have been on kidney dialysis for severalyears¨Health workers who have been stuck with a needleor other sharp object with blood from a person with hepatitis C or unknownhepatitis C status ¨Born to mother with hepatitis C¨ |
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HCVHow to diagnose
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¨First order anti-HCV (antibody to HCV) ¨If positive, means they have beeninfected with HCV, but not certain that they are currently infected. ¨Need to do follow-up blood test to verifycurrent infection: reverse transcriptasepolymerase chain reaction to detect HCV RNA. |
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HCV how to treat |
¨Refer to specialist¨Combo of pegylated interferon & ribavirin
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HBV and HDV |
¨Hepatitis D (delta)—onlyoccurs in those already infected with HBV—not common in USA
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HBV—Interpretationof Serologic Tests
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¨Hepatitis B surface antigen (HBsAg)=acute & chronic infection ¨Hepatitis B surface antibody (anti-HBs)=recovery & immunity &successfully vaccinated ¨Total hepatitis B core antibody (anti-HBc)=onset of symptoms & persistsfor life¨IgM antibody to hepatitis B coreantigen (IgManti-HBc)=recent infection, acute <6months¨ |
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HBVtreatment
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¨Acute: rest, nutrition, fluids, hospitalizations if necessary ¨Chronic: monitor liver status, avoidliver toxic meds & alcohol Consult with hepatologist forbest current medications and close monitoringnParental: interferon alfanOral: nucleoside (lamivudine, entecavir, telbivudine)& nucleotide (adefovir, tenofovir)analogues |
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Labsmust report the following for hepatitis
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¨IgM antibody to HAV (IgM anti-HAV)¨ ¨Hep B surface antigen (HBsAg)¨ ¨IgM antibody to Hep Bcore antigen (IgM anti-HBc)¨ ¨Antibody to HCV (anti-HCV) |
