Term
What is the definition of diarrhea?
What is Pseudo diarrhea?
Criteria for IBS?
When is diarrhea chronic? |
|
Definition
AMA says: loose stool production
Typically >200g
Pseudo: Frequent stool without change in weight or consistency
IBS:
Improves with defecation
Stool Frequency Change
Stool Form Change
Chronic: >4 weeks |
|
|
Term
What is the difference between large volume and small volume diarrhea?
Does osmotic or Secretory diarrhea resolve with fasting?
What does steatorrhea suggest about the cause?
What does blood suggest about the cause? |
|
Definition
Large volume is Small intestine origin
Fasting: Resolves osmotic diarrhea
Steatorrhea: Small bowel or Pancreatic cause
Blood: IBD or Bacterial |
|
|
Term
| What is the cause of diarrhea with bloating Flatus, and Cramping? |
|
Definition
| Carbohydrate malabsorption |
|
|
Term
What are the major test that are run on the stool to determine the etiology?
What eating requirement is made before a stool collection? |
|
Definition
Requirement: High fat diet 70-100g/day for a couple days
Tests: Osmolarity,pH,FOBT,WBC,Fat
Osmolarity: 290 -2(Na+K(of the stool))
>125mOsm/Kg-Osmotic diarrhea(ingestion of non-absorbable solute, aka resolves with fasting)
<50mOsm/KG(Na>90)-Secretory(salt secretion causes water loss, aka does not resolve with fasting)
pH: <5.3-carb malabsorption
FOBT: IBD/Neoplasm/Celiac's/Infectious
WBC: IBD
Fat: Sudan or Quantitative
>14g/24 hrs-fat malabsorption |
|
|
Term
Major things to rule out in a patient with secretory diarrhea that requires more than stool analysis
What are some major causes? |
|
Definition
Secretory
Infection
Structural Disease
Endocrine Tumors or Metabolic Disease
Major causes
Structural lesion with bacterial growth
Bile Acid Malabsorbtion
IBD
Neuroendocrine tumors
Non-osmotic laxative abuse |
|
|
Term
Major causes of osmotic diarrhea?
What should you measure? |
|
Definition
Carb Malabsorption
Ingestion of undigestable solutes
Mg salts
General Malabsorption if w/ Steatorrhea
Microscopic Colitis
Measure:
Mg,
If low ph, give Hydrogen breath test or measure lactase in mucosa |
|
|
Term
| Major causes of Fatty stool? |
|
Definition
Mucosal disease(whipple, celiac's)
Short bowel syndrome
Bacterial overgrowth
Bile Acid deficiency
Pancreatic insufficiency |
|
|
Term
If Small bowel disease is suspected in steatorrhea, what are some tests to run?
If pancreatic disease is suspected in steatorrhea, what are some tests to run? |
|
Definition
SB steatorrhea
Structural: Radiograph/Capsule Endoscopy
Mucosal: tTG and biopsy
Rule out Bacterial
Pancreatic Steatorrhea
X-ray for calcifications
Secretin test |
|
|
Term
| How is long ileal resections treated differently than short ileal resections? |
|
Definition
Long>100cm:
Low fat diet
MC-FA replacement
B12 replacement
Short<100cm
Cholestyramine
B12 supplement |
|
|
Term
What is the pathogenesis of Celiac's disease?
Symtoms?
Diagnosis? |
|
Definition
Pathogenesis: HLADQ2, DQ8 or B8 bind gliadin from glutein foods causing a T-cell reaction
Symptoms:
Diarrhea with fat, flatus
Fe, Folate deficiency, or Osteopenia
Diagnosis
Biopsy: Villous atrophy, Crypt hyperplasia
IgA tTG Ab(not if IgA deficient)
Test with Glutein-free diet |
|
|
Term
| What malignancies and diseases is Celiac's disease associated with? |
|
Definition
Malignancies
T-cell Lymphoma of SB
Esophogeal Sq cell
Lung
Breast
Diaseases
Autoimmune
Dermatitis Herpitaformis
IgA Deficiency
Down's
Diabetes Mellitis |
|
|
Term
Signs of whipple disease?
Diagnosis? |
|
Definition
Signs
Steatorrhea Diarrhea
Skin Hyperpigmentation
Joint pain
Encephalopathy
Diagnosis:
Biopsy showing mac with organism
Stain PAS
Stain with Acid fast to rule out MAC |
|
|
