functional
Most common IBS subtype in the U.S?
what is IBS-D
Crohn’s disease inflammation is often described as this
transmural with skip lesions
2 types of microscopic colitis
lymphocytic and collagenous colitis
Most common functional disorder associated with bloating
IBS
Most common infectious cause of acute diarrhea worldwide
daycare centers?
norovirus
- rotavirus
Rome IV requires abdominal pain at least this often.
What is 1 day per week in the last 3 months
First-line treatment for mild UC
mesalamine
Classic symptom of microscopic colitis
bonus (patient population)
chronic watery diarrhea
(middle aged woman)
Breath testing can diagnose this cause of bloating
BONUS- what is the test
SIBO
hydrogen breath test
PO administration of a fixed dose of typically 75 g of glucose or 10 g of lactulose—followed by serial measurement of exhaled hydrogen usually every 15–20 minutes for up to 2–3 hours. hydrogen of ≥20 parts per million (ppm) above baseline within 90 minutes
First key step in evaluating acute diarrhea severity
hydration status
Key difference between IBS and functional diarrhea
abdominal pain (absent in functional diarrhea)
Major complication of UC requiring emergent care
toxic megacolon
strongest medication association
PPI, SSRI, NSAIDs
Prolonged greasy stools and weight loss suggest this mechanism
Malabsorption
define acute and chronic diarrhea
Acute <2 weeks
Chronic >4 weeks
persistent 2-4 weeks
First-line diet for IBS
low FODMAP
fermentable, oligosaccharides, disaccharide, monosaccharide AND polyols
other- antispasmodics like bentyl, TCA and loperamide
Pain after drinking alcohol
pancreatitis
best diagnostic test for celiac disease
duodenal biopsy showing villous atrophy and scalloped duodenal folds
43yo M with 1st degree relative with colon cancer at 55y. screened at 40y and it what normal, when should c.scope be repeated?
45 yo; repeat in 5 years after initial screen if normal
Patient with chronic diarrhea, alarm features present (blood, anemia, weight loss). Next step?
colonoscopy
Alarm features that rule out IBS diagnosis
weight loss, blood in stool, anemia, or family history of CRC/IBD
Screening colonoscopy interval for IBD patients with long-standing colitis
8 years after diagnosis and 1-3 years after that
First-line treatment for microscopic colitis
budesonide
most common complication of EHEC
- toxin strain?
HUS- hemolytic anemia, thrombocytopenia and AKI
-- O157:H7
indications for stool testing
Severe illness (fever ≥38.5°C [101.3°F], hypovolemia, ≥6 unformed stools per 24 hours, severe abdominal pain, weight loss, or hospitalization)
●bloody diarrhea, nocturnal pain
●High-risk host features (age ≥70 years, cardiac disease, immunosuppression, IBD, pregnancy)
●Symptoms persisting >1 week
●Public health concerns (eg, diarrheal illness in food handlers, health care workers, and individuals in day care centers)