Signs and Symptoms of GI Disease - Block 2

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Signs and Symptoms of GI Disease - Block 2
2013-10-22 18:28:58
Signs Symptoms GI Disease Block

Signs and Symptoms of GI Disease - Block 2
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  1. GI Gas: Belching -> Give a definition and some likely causes.
    • -Def: Involuntary or voluntary release of gas from the stomach or esophagus.
    • -Causes: Swallowed air, gum chewing, smoking, rapid eating, or carbonated drinks
  2. What is the normal volume and frequency of flatus?
    • Volume: 500-1500ml/day
    • Frequency: 6-20 times/day
  3. Gases with little odor are derived from _____
    Plant carbohydrates (hydrogen and methane)
  4. Gases that are malodorous are derived from ______
    Meat and eggs (sulfur dioxide)
  5. Excessive amounts of flatus may be an indication of ________
  6. What are some treatment methods for GI gas?
    • -Lactose-free diet
    • -Avoid common gas-producing foods
    • -"Beano" -> reduces gas associated w/beans
  7. What do patients commonly use the term "diarrhea" to refer to?
    • -increased frequency of bowel movements
    • -increased stool liquidity
    • -a sense of fecal urgency
    • -fecal incontinence
  8. What is the official definition of diarrhea?
    -> Increase in stool weight >200 gm/day that may be associated with increased liquidity, stool frequency, perianal discomfort, and urgency with or without fecal incontinence
  9. Acute, persistent, and chronic diarrhea are classified by what time frames?
    • Acute < 2 weeks
    • Persistent 2-4 weeks
    • Chronic >4 weeks
  10. What volume of liquid passes through the ligament of Treitz each day?
    9-10L of fluid
  11. How much does the Jejunum absorb?
    Approx. 6 L
  12. How much does the Ileum absorb?
    Approx. 2.5 L
  13. How much fluid passes through the colon each day, how much is absorbed by the colon, and how much is left in the feces?
    • -1.5 L passes through colon
    • -Colon absorbs more than 90% of this load
    • -Approx 0.1 L is left in the feces
  14. The overall absorptive efficiency for water is 99%. Why is it important to know this, as well as possible reduction in efficiency?
    Reduction of this efficiency by as little as 1% may lead to diarrhea.
  15. Name some causes of acute diarrhea.
    • -Infectious agents   -Bacterial toxins
    • -Drugs  -Community outbreaks (viral, food)
    • -Day care or swimming (protozoal)
    • -Antibiotic-associated (C. Diffcile colitis)
    • -Sexually transmitted
    • -Traveler's diarrhea
  16. What is part of the Acute Diarrhea evaluation process?
    • -Distinguish between mild and serious illness
    • -For > 7 day duration: check stool culture, O & P, fecal leukocytes
    • -Bloody diarrhea, fever, abd pain: Work-up
    • -Physical exam: Tilts, addt'l tests depending on history
  17. What are the four ways of treating acute infectious diarrhea?
    • -Diet: rest bowels -> avoid high-fiber foods, fats, milk products -> take in easily digestible foods
    • -Rehydration: Oral rehydration is best.
    • -Anti-diarrheal agents
    • -Antibiotic therapy -> for select patients
  18. What is the BRAT diet?
    Bananas, Rice, Applesauce, Toast
  19. Why is the BRAT diet effective?
    These foods are low in fiber and digestive residue.
  20. What do you need to rule out during chronic diarrhea evaluation?
    • -acute diarrhea causes
    • -lactose intolerance
    • -previous gastric surgery
    • -parasites
    • -medications
    • -systemic disease
  21. True or false: During chronic diarrhea evaluation, you should perform a physical exam, to include an abdominal exam.
  22. What tests should be performed during a chronic diarrhea evaluation?
    • -Fecal leukocytes, stool culture, O & P
    • -CBC, electrolytes, LFTs, albumin, TSH
    • -Flex sig or C-scope w/biopsy
    • -UGI, BE
  23. What are some causes of chronic diarrhea?
    • -Osmotic  -Secretory
    • -Inflammatory  -Malabsorption syndromes
    • -Motility disorders  -Chronic infections
    • -Irritable bowel
  24. What is the main clue for osmotic chronic diarrhea?
    -Stool volume decreases with fasting
  25. What are the causes for osmotic chronic diarrhea?
    • -Medications: antacids, Lactulose, sorbitol
    • -Disaccharides deficiency- Lactulose intolerance
    • -Factitious diarrhea - magnesium use
  26. What is the main clue to indicate secretory chronic diarrhea?
    -Large volumes (>1 L/day) -> little change with fasting
  27. What are the causes of secretory chronic diarrhea?
    • -Hormonal: Carcinoid, ZE, thyroid ca
    • -Medications
    • -Factitious diarrhea - laxative abuse
    • -Villous adenoma
    • -Bile salt malabsorption (post-op, Crohn's)
    • -Celiac Sprue
  28. What are the main clues for inflammatory chronic diarrhea?
    • -fever
    • -hematochezia
    • -abdominal pain
    • -> Systemic symptoms/signs: arthralgias, rash
  29. What are the causes of inflammatory chronic diarrhea?
    • -ulcerative colitis
    • -Crohn's disease
    • -Malignancies - lymphoma, adenoma
    • -Radiation enteritis
  30. What are the main clues for malabsorption chronic diarrhea?
    • -weight loss
    • -fecal fat
  31. What are the causes for malabsorption chronic diarrhea?
    • -Small bowel mucosa disease: Sprue, Crohn's, Whipple's, short bowel syndrome
    • -Lymphatic obstruction- lymphoma, TB, carcinoid
    • -Pancreatic disease- chronic pancreatitis, pancreatic carcinoma
    • -Bacterial overgrowth-motility disorders (DM, vagotomy, scleroderma), fistulas, small intestinal diverticula
  32. What are the main clues for chronic diarrhea motility disorders?
    • -systemic disease
    • -prior abdominal surgery
  33. What are the causes of chronic diarrhea motility disorders?
    • -Post surgical: vagotomy, partial gastrectomy, blind loop with bacterial overgrowth
    • -Systemic disorders: scleroderma, DM, hyperthyroidism
    • -IBS
  34. What is the main clue for chronic diarrhea -> chronic infections?
    -Immunosuppressed patients
  35. What are the causes for chronic diarrhea -> chronic infections?
    • -Parasites- Giardia lamblia, Entamoeba histolytica, Cyclospora
    • -AIDS-related (viral, bacterial, protozoal)
  36. What does voluminous stool suggest?
    -small bowel or proximal colon
  37. What does small stool with urgency suggest?
    -left colon or rectum
  38. What does blood suggest?
    -mucosal damage or inflammation
  39. What does frothy stool and flatus suggest?
    -carbohydrate malabsorption
  40. What does foul smelling or greasy stool suggest?
    -fat malabsorption
  41. What kinds of items need to be included in the patient's diarrhea history?
    • -Patient's normal bowel pattern
    • -Medications  -Past medical history
    • -Past surgical history
    • -Family history  -Social history
    • -Alarm symptoms
  42. What information needs to be included in a patient's History of Present Illness (OPQRST)?
    • -Onset and location  -Provocation or Palliation
    • -Quality of the pain  -Region and radiation
    • -Severity  -Time (history): determine whether pt's symptoms are acute or chronic
  43. What are the diarrhea alarm symptoms?
    • -Signs of dehydration  -bloody stool
    • -Fever >101 
    • -Passage of greater than 6 stools per 24 hrs or illness that lasts more than 48 hrs
    • -Severe abdominal pain  -weight loss
  44. What elements make up a stool analysis test?
    • -24 hour stool collection for weight and quantitative fat
    • -Stool laxative screen  -Stool osmolality
    • -Fecal Leukocytes  -Stool for ova and parasites
    • -stool cultures
  45. What are the routine lab tests for diagnosing chronic diarrhea evaluation diagnostic tests?
    • -CBC  -Electrolytes
    • -Liver function tests
    • -TSH  -PTT
  46. What are some other labs used in diagnostic tests for chronic diarrhea?
    • -Suspected sprue: serologic tests
    • -Secretory diarrhea due to tumors: VIP, calcitonin, gastrin, glucagon, VMA, metanephine
  47. What types of endoscopic evaluation tests are there for chronic diarrhea?
    • -Inflammatory bowel dz: Flex sig/C-scope
    • -Malabsorption: Upper endoscopy w/Bx
  48. What are some other imaging tests used for chronic diarrhea evaluation?
    • -Plain abdominal radiographs: Calcification of pancreas
    • -UGI w/small bowel follow through: Lymphoma, Crohn's, carcinoid
  49. What do you do for chronic diarrhea treatment?
    • -Loperamide
    • -Diphenoxylate with atropine (Lomotil)
    • -Clonidine: Inhibits electrolyte secretion