Small Bowel D/os; Sm And Lg Bwl D/os, Ibs

Front 1

Difference between inflammatory and non-inflammatory diarrhea

Back 1

1) Inflammatory: mucoid/bloody stools with fecal leukocytes, tenesmus, severe abdominal pain and/or fever

2) Non-inflammatory: watery stools, frequently large volume without and blood/pus. Fever or pain may/not be present

Front 2

Most common cause of acute diarrhea

Back 2

Infectious diarrhea

Front 3

Subdivisions of infectious diarrhea

Back 3

1) Invasive

2) non-invasive

Front 4

Shigella, Salmonella, EIEC and C difficile cause what type of diarrhea?

Back 4

invasive

Front 5

Viruses, cryptosporidia, giardia, and ETEC cause what type of diarrhea?

Back 5

non-invasive

Front 6

Ingestion of seafood suggests _____ infection

Back 6

vibrio

Front 7

Most common cause of traveler's diarrhea

Back 7

ETEC

Front 8

Responsible for blood diarrhea and hemolytic uremic syndrome

Back 8

EHEC

Front 9

Giardiasis is treated with __________

Back 9

metronidazole

Front 10

What is secretory diarrhea?

Back 10

Caused by excess secretion of electrolytes and water that typically continues on fasting and causes include enterotoxins (V. cholerae, E Coli, Staph Aureus, B. cereus, Norwalk); Secretory tumors; other factors

Front 11

Occurs due to gluten-induced immune mediated process in genetically susceptible hosts

Back 11

celiac disease

Front 12

Symptoms of celiac disease

Back 12

1) Diarrhea, steatorrhea, flatulence, weight loss

2) Diarrhea often episodic, up to 10/day

3) Extra intestinal features - iron deficiency anemia, osteopenia, bleeding tendency, vitamin defi, etc

Front 13

What is tropical sprue?

Back 13

Mucosal malabsorption occurring in tropical residence or in soliders deputed in tropical areas. Associated with progrsesive diarrhea, malnutrition, and improvement when tropical residence d/c'd.

Front 14

What causes tropical sprue?

Back 14

unclear what exactly causes it, but since it's cured with antibiotics, probably a bacteria or parasite.

Front 15

In what patients does small bowel intestinal overgrowth occur?

Back 15

Patients with multiple ab. surgeries, prolonged narcotic use, or small bowel dysmotility.

Front 16

small bowel intestinal overgrowth causes what symptoms?

Back 16

diarrhea

Front 17

What is short bowel syndrome?

Back 17

Condition characterized by diarrhea and malabsorption when >50% of small bowel is either resected or non-functional.

Front 18

4 causes of short bowel syndrome

Back 18

1) Intestinal gangrene (SMA or SMV thrombosis or CHF)

2) Crohn's disease

3) Strangulated hernia

4) Prolonged intestinal obstruction

Front 19

Treatment of short bowel syndrome

Back 19

1) Maintain fluid and electrolyes

2) Total parenteral nutrition, anti-diarrhea meds, IM B12

3) Stimulate intestinal adaptation by low fat diet, medium chain triglycerides, low lactose, vitamins

4) Small intestine transplant if unable to wean off TPN in 1-2 years

Front 20

4 layers of small intestine

Back 20

mucosa (or mucous membrane), submucosa, muscularis (or muscularis propria), and adventitia (or serosa)

Front 21

To achieve the desired function of digestion & absorption, the mucosa is thrown into folds called _____ that increase the SA by 3 times.

Back 21

Plicae

Front 22

______ are specialized epithelial cells overlying lymphoid follicles in the small intestine and selectively bind, process, and deliver pathogens directly to lymphocytes, macrophages, or other components of the mucosal lymphoid system.

Back 22

M cells

Front 23

___________ are the pacemaker cells of the intestine, they regulate intestinal motility.

Back 23

Interstitial cells of Cajal

Front 24

____ cells contain zinc, antimicrobial peptides, and growth factors and secrete lysoenzymes

Back 24

Paneth

Front 25

While Fe & Ca are primarily absorbed in duodenum, B12 is primarily absorbed in the ___.

Back 25

terminal ileum

Front 26

How is B12 absorbed?

Back 26

Must bind Intrinsic factor in

The sub-sequent binding and uptake of the IF-B12 complex occurs through a specific receptor-mediated process on the brush border membrane of ileal enterocytes.

Front 27

What produces intrinsic factor?

Back 27

parietal cells

Front 28

Cause of osmotic diarrhea

Back 28

Increased luminal osmolarity leads to water influx into the lumen. Caused by ingestion of poorly absorbable solutes.

Front 29

Pseudomembranous Colitis caused by _______-

Back 29

C difficile

Front 30

Characteristics of malabsorptive diarrhea

Back 30

Steatorrhea

Weight loss

Nutrient deficiency

Front 31

abetalipoproteinemia: defn

Back 31

Bassen-Kornzweig syndrome is a rare disease passed down through families in which a person is unable to fully absorb dietary fats through the intestines.

Front 32

intestinal lymphangiectasia: defn

Back 32

This disease is characterized by lymphatic vessel dilation,[3] chronic diarrhea and loss of proteins such as serum albumin and globulin. It is considered to be a chronic form of protein-losing enteropathy.

Front 33

refers to patients who have normal villus architecture on a gluten-containing diet, but who, at another time, have had or will have villus atrophy that recovered or will recover on a gluten-free diet.

Back 33

latent celiac sprue

Front 34

What is Whipple's disease?

Back 34

rare, systemic infectious disease caused by the bacterium Tropheryma whipplei.

Primarily causes malabsorption but can affect many systems.

Front 35

Cardinal sx of Whipple's disease

Back 35

Arthralgias
Weight loss
Diarrhea
Abdominal pain

Front 36

Late findings/complications of Whipple disease

Back 36

Ascites
Massive adenopathy
Dementia
Pericarditis
Endocarditis

Front 37

What is chronic intestinal angina?

Back 37

Chronic abdominal pain after eating. Due to atherosclerosis of the SMA.

Can range from mild discomfort to severe ischemic pain.

Front 38

Acute Mesenteric Ischemia (AMI): What is it?

Back 38

Acute ischemia insult to small bowel which threatens viability.

Front 39

Acute Mesenteric Ischemia (AMI): Causes

Back 39

SMA Embolus: 50%

Non-occlusive mesenteric ischemia (NOMI): 25%

SMA Thrombosis : 10%

Mesenteric Venous Thrombosis : 10%

Focal segmental ischemia: 5%

Front 40

Major causes of Acute Mesenteric Ischemia (AMI)

Back 40

SMA Embolus

Non-occlusive mesenteric ischemia (NOMI)

Front 41

Risk factors for Acute Mesenteric Ischemia (AMI)

Back 41

Patients older than 50 years
Long-standing CHF
Cardiac arrhythmias
Recent myocardial infarction
Hypotension
Recent cardiopulmonary resuscitation

Front 42

Acute Mesenteric Ischemia (AMI): Symptoms

Back 42

ABDOMINAL PAIN

N/V

Diarrhea

Constipation

Tachycardia

Front 43

Non Occlusive Mesenteric Ischemia (NOMI): Defn

Back 43

acute mesenteric circulatory disorder that, in contrast to mesenteric arterial occlusion induced by blockage of blood flow by emboli and thrombi, is not caused by organic occlusion of blood vessels.

This pathology results from reduced intestinal microvascular blood supply associated with an acute inflammatory process, culminating with bowel necrosis.

Front 44

Suspect Non Occlusive Mesenteric Ischemia (NOMI) when?

Back 44

Unexplained abdominal distention or GI bleeding

Front 45

first sign of intestinal infarction

Back 45

distension

Front 46

Bacterial concentration in intestine is regulated by

Back 46

Normal motor function (MMC)

Gastric acid

Immunoglobulins, and possibly bile salts

Front 47

What types of things can cause/predispose to bacterial overgrowth in intestine?

Back 47

Anatomical factors: Blind pouches, diverticula

Motility disorders: reduced motility means more time for bacterial to grow.

Front 48

Symptoms of bacterial overgrowth

Back 48

Diarrhea or diarrhea & constipation alternating
Weight loss, bloating & flatulence
(Steatorrhea, and pain less frequent)

Front 49

What type of anemia can be present in bacterial overgrowth of intestine?

Back 49

Macrocytic. This is because the bacteria are competing for B12 and folate.

Front 50

How to diagnose bacterial overgrowth?

Back 50

Bacterial counts > 10(5) organisms/mL in jejunal aspirate
Hydrogen breath test
Schilling test
Empiric treatment with oral non-absorbable antibiotics

Front 51

Tx for bacterial overgrowth

Back 51

Periodic flushing with Polyethylene glycol
Flagyl / ciprofloxacin / rifaximin
Surgical correction

Front 52

What are the two main diseases that are considered Inflammatory Bowel Diseases (IBD?)

Back 52

Crohn's disease

Ulcerative colitis

Front 53

What areas of the intestine do
a) Crohn's disease

b) Ulcerative colitis

affect?

Back 53

A) Mouth to anus
B) Generally the colon

Front 54

What layer of the intestine is inflamed in
a) Crohn's disease

b) Ulcerative colitis

Back 54

A) Transmural inflammation (fistulas and strictures are common)

B) Mucosal inflammation

Front 55

Which of these is there an increased risk of cancer?
a) Crohn's disease

b) Ulcerative colitis

Back 55

Both

Front 56

How are the following affected by smoknig?
a) Crohn's disease

b) Ulcerative colitis

Back 56

A) Higher risk for smokers
B) lower risk for smokers

Front 57

How are the following managed surgically?
a) Crohn's disease

b) Ulcerative colitis

Back 57

a) Returns post sx
b) Surgery is curative

Front 58

Symptoms of IBD

Back 58

There are remissions and flares.

During flares, there is diarrhea, bleeding, abdominal pain.

Anemia and malnutrition are common.

Front 59

Cause of IBD

Back 59

Interaction between genes, environment, and the immune response.

Front 60

How is IBD different from IBS?

Back 60

xcept for certain non-specific symptoms of abdominal discomfort and bowel disturbance, virtually all of the important clinical and laboratory signs of IBD (anemia, malnutrition, bloody stools, tenesmus, fecal WBC, perianal disease, weight loss, fever) are absent in cases of IBS.

Front 61

The typical pattern of _________ is chronic inflammation limited to the mucosa of the colon, occurring in a continuous symmetrical distribution from the rectum proximally to all or part of the rest of the large bowel.

Back 61

ulcerative colitis

Front 62

Crohn's disease most commonly affects which areas?

Back 62

Ileocolic (45%)
Small bowel alone (33%)
Colon alone (20%)

Front 63

T/F There is NEVER an absence of bleeding in ulcerative colitis

Back 63

T. There may be an absence of bleeding in Crohn's disease.

Front 64

T/F Fistulization into surrounding tissues and organs occurs only in Crohn’s disease as opposed to ulcerative colitis.

Back 64

T

Front 65

What are ways to diagnose IBD?

Back 65

Colonscopy

Small bowel x rays

CT Enterography

MR Enterography

Goal is to limit radiation

Front 66

What are goals in IBD treatment?

Back 66

Accurate and timely diagnosis.

Rapid treatment of exacerbations (avoid therapy-related toxicity)

Induction and maintenance of symptoms repression

Improve QoL

Front 67

Drug treatment for mild IBD

Back 67

Antibiotics, Aminosalicylates

Front 68

Drug treatment for moderate IBD

Back 68

Prednisone, corticosteroids, budesonide

Front 69

drug treatment for severe IBD

Back 69

Biologics, surgery

Front 70

Crohn's Disease Activity Index: What is it?

Back 70

research tool used to quantify the symptoms of patients with Crohn's disease. This is of importance in research studies done on medications used to treat Crohn's disease; most major studies on newer medications use the CDAI in order to define response or remission of disease.

Front 71

What are common extra-intestinal and systemic manifestations of Crohn's disease?

Back 71

arthritis, iritis, erythema nodosum, fistulae, fever

Front 72

How does sulfasalazine work?

Back 72

antinflammatory drug that is essentially providing topical relief inside the intestine. It does this via a number of mechanisms such as reducing the synthesis of inflammatory mediators known as eicosanoids and inflammatory cytokines. However, unlike glucocorticoids (another class of drug used in the treatment in inflammatory bowel disease), sulfasalazine has no immunosuppressant action.

Front 73

What causes the toxicity of sulfasalazine?

Back 73

It is converted to sulfapyridine (toxic) and 5-aminosalicylate (the therapeutic agent).

Newer drugs have sought to deliver 5-aminosalicylate directly to bowel

Front 74

budesonide: MOA

Back 74

a rapidly metabolized glucocorticoid steroid

Front 75

Biologic therapy includes recombinant peptides or proteins. What is the goal of this treatment in IBD?

Back 75

Neutralize pro-inflammatory cytokines
Augment anti-inflammatory cytokines

Front 76

What is infliximab?

Back 76

monoclonal antibody against tumour necrosis factor alpha (TNFα). It is used to treat autoimmune diseases.

Front 77

Absolute indications for bowel surgery in Crohn's

Back 77

Free perforation

Massive hemorrhage

Cancer or dysplasia

Chronic high grade obstruction

Front 78

Relative indications for bowel surgery in Crohn's

Back 78

Intractability

Complex fistulae and abscesses

Perianal complciations

Growth retardation

Front 79

In Crohn's, patients using what medications had a higher risk of serious infections and mortality?

Back 79

Steroids, narcotics (NOT infliximab, 6 mercaptopurine, AZA, MTX)

Front 80

T/F Methotrexate and ciprofloxacin should not be used during pregnancy and metronidazole should be avoided in the first trimester.

Back 80

T

Front 81

What is alendronate?

Back 81

used to treat and prevent osteoporosis in IBD