_______ accounts for _______ of upper GI bleeding cases, primarily due to bleeding from _______.

Portal hypertension accounts for 10-20% of upper GI bleeding cases, primarily due to bleeding from esophageal varices.

_______ such as _______ are associated with _______ and _______, accounting for _______ of upper GI bleeding cases.

Lacerations such as Mallory-Weiss tears are associated with retching and alcohol use, accounting for 5-10% of upper GI bleeding cases.

_______ are the most common type of _______ causing upper GI bleeding, particularly found in the _______.

Angioectasias are the most common type of vascular anomalies causing upper GI bleeding, particularly found in the right colon.

_______ can be caused by _______, _______, or _______.

Erosive gastritis/esophagitis can be caused by NSAIDs, alcohol, or severe illness.

Signs of _______ may indicate _______ due to portal hypertension.

Signs of liver disease may indicate variceal bleeding due to portal hypertension.

_______ indicate _______, while _______ suggest _______.

Normal vital signs indicate minor hemorrhage, while hypotension or tachycardia suggest significant bleeding.

The initial assessment for acute GI bleeding includes _______, _______, and _______.

The initial assessment for acute GI bleeding includes CBC, PT/INR, and liver enzymes.

Therapeutic interventions for active bleeding during _______ are performed within _______.

Therapeutic interventions for active bleeding during endoscopy are performed within 12-24 hours.

The presence of _______ or _______ during _______ confirms an _______.

The presence of bright red blood or coffee grounds during nasogastric aspiration confirms an upper GI source.

For persistent bleeding after failed endoscopy, _______ may be required.

For persistent bleeding after failed endoscopy, angiographic embolization may be required.

In acute lower GI bleeding, _______ after bowel movement indicates a _______.

In acute lower GI bleeding, bright red blood after bowel movement indicates a rectosigmoid or anorectal source.

_______ suggest a source in the _______, while _______ indicate a source proximal to the _______.

Maroon stools suggest a source in the right colon or small intestine, while black stools indicate a source proximal to the ligament of Treitz.

_______ typically presents as _______.

Diverticular bleeding typically presents as painless, large-volume bleeding.

In patients under _______, common causes of lower GI bleeding include _______ and _______.

In patients under 50 years, common causes of lower GI bleeding include infectious colitis and IBD.

In patients over _______, the most common cause of lower GI bleeding is _______.

In patients over 50 years, the most common cause of lower GI bleeding is diverticulosis.

_______ is the most common cause of major _______ bleeding, presenting as _______, _______ in older adults.

Diverticulosis is the most common cause of major lower GI bleeding, presenting as painless, large-volume hematochezia in older adults.

_______ are flat, _______ often found in the _______ and _______, common in the elderly or those with _______.

Angioectasias are flat, red lesions often found in the cecum and ascending colon, common in the elderly or those with chronic kidney disease (CKD).

_______ such as polyps or malignant _______ may cause chronic _______ or intermittent _______.

Neoplasms such as polyps or malignant carcinomas may cause chronic occult bleeding or intermittent hematochezia.

_______ includes _______ or _______, causing diarrhea with blood mixed in stool, _______, and _______.

Inflammatory Bowel Disease (IBD) includes ulcerative colitis or Crohn’s disease, causing diarrhea with blood mixed in stool, abdominal pain, and tenesmus.

_______ includes _______, which present as bright red blood streaked on stool, and _______, which cause small-volume bleeding with pain.

Anorectal Disease includes hemorrhoids, which present as bright red blood streaked on stool, and anal fissures, which cause small-volume bleeding with pain.

_______ results from transient non-occlusive ischemia and is associated with _______, leading to _______ or _______ with mild cramping.

Ischemic Colitis results from transient non-occlusive ischemia and is associated with atherosclerosis, leading to hematochezia or bloody diarrhea with mild cramping.

Other causes of GI bleeding include _______, _______, _______, _______, or _______.

Other causes of GI bleeding include infectious colitis, chronic radiation damage, vasculitis, NSAID-induced ulcers, or colonic varices.

Signs of _______ include _______, _______, _______, and _______.

Signs of anemia include fatigue, dizziness, pallor, and shortness of breath.

The severity of GI bleeding ranges from mild anorectal bleeding to _______, and is less likely to cause shock compared to _______.

The severity of GI bleeding ranges from mild anorectal bleeding to massive hematochezia, and is less likely to cause shock compared to upper GI bleeding.

_______ & _______ are used for young, healthy patients (<45 years) with small-volume bleeding; if a lesion is found, no further evaluation is needed.

Anoscopy & Sigmoidoscopy are used for young, healthy patients (<45 years) with small-volume bleeding; if a lesion is found, no further evaluation is needed.

_______ is the gold standard for acute, large-volume bleeding; it is performed on stable patients after bowel preparation.

Colonoscopy is the gold standard for acute, large-volume bleeding; it is performed on stable patients after bowel preparation.

_______ is used for massive, active bleeding and hemodynamic instability, identifying arterial bleeding and localizing the source.

CT Angiography is used for massive, active bleeding and hemodynamic instability, identifying arterial bleeding and localizing the source.

_______ or _______ may be required to exclude proximal bleeding if clinically indicated.

Nasogastric aspiration or upper endoscopy may be required to exclude proximal bleeding if clinically indicated.

_______ involves treating high-risk lesions (e.g., diverticular bleeding) with methods such as _______ or cautery.

Therapeutic Colonoscopy involves treating high-risk lesions (e.g., diverticular bleeding) with methods such as epinephrine injection or cautery.

_______ is performed if bleeding persists after endoscopy; it locates the lesion and achieves immediate hemostasis in >95% of patients.

Angiographic Embolization is performed if bleeding persists after endoscopy; it locates the lesion and achieves immediate hemostasis in >95% of patients.

_______ is rarely required due to the effectiveness of endoscopic and angiographic treatments, but may be considered for recurrent diverticular hemorrhage.

Surgery is rarely required due to the effectiveness of endoscopic and angiographic treatments, but may be considered for recurrent diverticular hemorrhage.

_______ is not visible to the patient and is identified through positive _______ or _______.

Occult GI bleeding is not visible to the patient and is identified through positive fecal occult blood test (FOBT) or fecal immunochemical test (FIT).

Common causes of occult GI bleeding include _______, _______ like angioectasias, and _______.

Common causes of occult GI bleeding include neoplasms, vascular abnormalities like angioectasias, and acid-peptic lesions.

_______ for GI bleeding involves _______ or _______, performed for GI symptoms or as routine colorectal cancer screening.

Initial Testing for GI bleeding involves FOBT or FIT, performed for GI symptoms or as routine colorectal cancer screening.

_______ is performed for asymptomatic patients after a positive FOBT/FIT and for symptomatic patients to identify lower GI sources.

Colonoscopy is performed for asymptomatic patients after a positive FOBT/FIT and for symptomatic patients to identify lower GI sources.

_______ is indicated for patients with iron deficiency anemia or positive FOBT/FIT to evaluate for upper GI sources.

Upper Endoscopy is indicated for patients with iron deficiency anemia or positive FOBT/FIT to evaluate for upper GI sources.

Used to identify or exclude lower GI sources like _______, _______, or _______.

Used to identify or exclude lower GI sources like tumors, angioectasias, or IBD.

Upper Endoscopy is for patients with _______ or _______ to evaluate for _______ (e.g., ulcers, esophagitis).

Upper Endoscopy is for patients with iron deficiency anemia or positive FOBT/FIT to evaluate for upper GI sources (e.g., ulcers, esophagitis).

Celiac Disease Screening involves testing for _______ or performing _______ in patients with _______.

Celiac Disease Screening involves testing for IgA anti-tTG or performing duodenal biopsy in patients with iron deficiency anemia.

Capsule Endoscopy is used to evaluate the _______ if colonoscopy and upper endoscopy fail to identify the _______.

Capsule Endoscopy is used to evaluate the small intestine if colonoscopy and upper endoscopy fail to identify the source.

Further Small Intestine Evaluation may include _______ or _______, and imaging like _______, _______, or _______ as indicated.

Further Small Intestine Evaluation may include push enteroscopy or balloon-assisted enteroscopy, and imaging like abdominal CT, angiography, or laparotomy as indicated.

Empiric Iron Therapy is the first-line treatment for patients with _______ and _______.

Empiric Iron Therapy is the first-line treatment for patients with unexplained occult bleeding and iron deficiency anemia.

The dosage for oral iron is _______, with lower doses (60-100 mg) or alternate-day dosing to improve _______.

The dosage for oral iron is 150 mg elemental iron/day, with lower doses (60-100 mg) or alternate-day dosing to improve tolerance.

A sustained _______ and _______ within 1-2 months may eliminate the need for further _______.

A sustained ferritin and hemoglobin increase within 1-2 months may eliminate the need for further diagnostics.

Management of Medications includes discontinuing _______ (e.g., _______, _______, _______) if possible.

Management of Medications includes discontinuing antiplatelet agents (e.g., aspirin, NSAIDs, clopidogrel) if possible.

Further Investigation is required in patients with poor response to _______, evidence of ongoing _______, or _______ (e.g., weight loss, abdominal pain).

Further Investigation is required in patients with poor response to empiric iron therapy, evidence of ongoing bleeding, or red-flag symptoms (e.g., weight loss, abdominal pain).

Observation is for patients without a _______ after thorough evaluation (colonoscopy, upper endoscopy, capsule endoscopy) who have a low risk of _______.

Observation is for patients without a bleeding source after thorough evaluation (colonoscopy, upper endoscopy, capsule endoscopy) who have a low risk of recurrent bleeding.

Constipation refers to difficulty in stool passage, which may include infrequent stools (<3 per week), _______, or excessive _______.

Constipation refers to difficulty in stool passage, which may include infrequent stools (<3 per week), hard or lumpy stools, or excessive straining.

General Symptoms of constipation include infrequent stools, _______, or excessive _______; Alarm Symptoms include _______.

General Symptoms of constipation include infrequent stools, hard stools, or excessive straining; Alarm Symptoms include hematochezia.

Initial Evaluation for constipation includes a history focusing on _______, stool characteristics, and associated symptoms, along with a _______.

Initial Evaluation for constipation includes a history focusing on onset, stool characteristics, and associated symptoms, along with a digital rectal exam (DRE).

Dietary and Lifestyle Modifications for constipation include proper _______, adequate _______, and _______.

Dietary and Lifestyle Modifications for constipation include proper toileting habits, adequate fluids, and fiber.

Constipation affects _______ and up to _______, being more common in women and older individuals due to comorbidities, medications, and decreased mobility.

Constipation affects 15% of adults and up to one-third of older adults, being more common in women and older individuals due to comorbidities, medications, and decreased mobility.

Primary (Functional) Constipation has no structural or systemic abnormalities and includes subtypes like _______, _______, and _______.

Primary (Functional) Constipation has no structural or systemic abnormalities and includes subtypes like normal transit, slow transit, and defecatory disorders.

Secondary Constipation can be caused by systemic disorders such as _______ (e.g., _______), _______, or medications like _______ and _______.

Secondary Constipation can be caused by systemic disorders such as neurologic dysfunction (e.g., Parkinson’s), endocrine/metabolic disorders, or medications like anticholinergics and opioids.

Specific Presentations of constipation can include _______ requiring unusual positions or _______ with symptoms like decreased appetite, abdominal pain, or paradoxical diarrhea.

Specific Presentations of constipation can include defecatory disorders requiring unusual positions or fecal impaction with symptoms like decreased appetite, abdominal pain, or paradoxical diarrhea.

_______ refers to _______.

Cal diarrhea refers to liquid stool leakage.

Anatomic abnormalities such as _______, _______, and _______ can contribute to cal diarrhea.

Anatomic abnormalities such as strictures, rectocele, and rectal prolapse can contribute to cal diarrhea.

_______ is assessed during _______.

Pelvic floor function is assessed during simulated defecation.

Indications for further testing include _______, _______, or _______.

Indications for further testing include systemic disease signs, alarm symptoms, or unexplained recent onset.

Screening tests include _______ such as _______, _______, _______, _______, and _______.

Screening tests include laboratory tests such as CBC, serum electrolytes, calcium, glucose, and TSH.

_______ or _______ is recommended for patients >_______, with _______, or a _______ of colon cancer/IBD.

Colonoscopy or flexible sigmoidoscopy is recommended for patients >50 years, with alarm symptoms, or a family history of colon cancer/IBD.

For refractory cases, _______ includes a _______ that assesses the ability to expel a balloon filled with _______.

For refractory cases, anorectal manometry includes a balloon expulsion test that assesses the ability to expel a balloon filled with 50 mL of water.

_______ assesses pelvic floor function and identifies _______.

Defecography assesses pelvic floor function and identifies structural abnormalities.

_______ are used for _______ after excluding _______.

Colonic transit studies are used for slow transit constipation after excluding defecatory disorders.

_______ like _______ are preferred, but may not help in _______ or _______.

Soluble fiber supplements like psyllium are preferred, but may not help in colonic inertia or defecatory disorders.

_______ reduces the risk of _______.

Regular physical activity reduces the risk of constipation.

_______ may improve _______ and _______.

Probiotics may improve stool frequency and consistency.

_______ (first-line) promote _______ in the stool, softening it. Examples include _______, _______, _______, and _______.

Osmotic laxatives (first-line) promote water retention in the stool, softening it. Examples include polyethylene glycol (PEG), sorbitol, lactulose, and magnesium hydroxide.

_______ like _______ or large-volume PEG solutions are used for _______.

Rapid agents like magnesium citrate or large-volume PEG solutions are used for acute constipation.

_______ stimulate colonic contractions (e.g., _______, _______).

Stimulant laxatives stimulate colonic contractions (e.g., bisacodyl, senna).

_______ increase chloride and water secretion (e.g., _______, _______).

Secretagogues increase chloride and water secretion (e.g., lubiprostone, linaclotide).

_______ like _______ are used for increased _______.

Serotonin 5-HT4 receptor agonists like prucalopride are used for increased spontaneous bowel movements.

_______ like _______ and _______ are used for _______.

Opioid receptor antagonists like methylnaltrexone and naloxegol are used for opioid-induced constipation.

Initial treatment for _______ includes _______ (saline, mineral oil) or _______.

Initial treatment for fecal impaction includes enemas (saline, mineral oil) or manual disimpaction.

Long-term management of fecal impaction involves ensuring _______ with dietary changes and laxatives.

Long-term management of fecal impaction involves ensuring regular bowel movements with dietary changes and laxatives.

_______ improves _______ for defecatory disorders.

Biofeedback therapy improves pelvic floor muscle coordination for defecatory disorders.

Surgical options for fecal impaction are rarely required and indicated for severe cases of _______ or _______ (e.g., _______, _______).

Surgical options for fecal impaction are rarely required and indicated for severe cases of colonic inertia or structural abnormalities (e.g., rectocele, prolapse).

_______ is characterized by _______ lasting >_______ associated with altered bowel habits (Rome IV criteria).

Irritable Bowel Syndrome (IBS) is characterized by abdominal pain lasting >3 months associated with altered bowel habits (Rome IV criteria).

Rome IV criteria for IBS include recurrent abdominal pain at least _______, plus ≥_______ of: _______, _______, or _______.

Rome IV criteria for IBS include recurrent abdominal pain at least 1 day/week, plus ≥2 of: pain related to defecation, change in stool frequency, or change in stool appearance.

Women account for _______ of IBS cases, with onset often in the _______.

Women account for ⅔ of IBS cases, with onset often in the teens to 20s.

Abnormal motility in IBS includes _______ (slow transit or pelvic floor dyssynergia) and _______ (rapid transit or bile acid malabsorption).

Abnormal motility in IBS includes IBS-C (slow transit or pelvic floor dyssynergia) and IBS-D (rapid transit or bile acid malabsorption).

Visceral hypersensitivity in IBS is characterized by heightened pain perception with minimal stimuli (e.g., _______, _______).

Visceral hypersensitivity in IBS is characterized by heightened pain perception with minimal stimuli (e.g., bloating, urgency).

_______ can lead to post-infectious IBS in ~_______ after gastroenteritis.

Intestinal inflammation can lead to post-infectious IBS in ~10% after gastroenteritis.

_______ issues such as _______ may cause bloating and distention.

Gut microbiome issues such as Small Intestinal Bacterial Overgrowth (SIBO) may cause bloating and distention.

Psychosocial factors affect IBS, with _______ of patients reporting _______, _______, or _______.

Psychosocial factors affect IBS, with 50% of patients reporting depression, anxiety, or somatization.

Key symptoms of IBS include _______ that is intermittent, crampy, and usually in the lower abdomen, which improves or worsens with defecation.

Key symptoms of IBS include abdominal pain that is intermittent, crampy, and usually in the lower abdomen, which improves or worsens with defecation.

Altered bowel habits in IBS can be classified as _______ (loose, watery stools), _______ (infrequent, hard stools), or _______ (mixed diarrhea and constipation).

Altered bowel habits in IBS can be classified as IBS-D (loose, watery stools), IBS-C (infrequent, hard stools), or IBS-M (mixed diarrhea and constipation).

Associated symptoms of IBS include _______, _______, _______, _______, _______, _______, and psychological symptoms (_______, _______).

Associated symptoms of IBS include bloating, distention, rectal urgency, dyspepsia, fatigue, myalgias, and psychological symptoms (anxiety, depression).

Red flags requiring further workup for IBS include _______ such as _______, _______, and _______, especially with acute onset in patients >_______.

Red flags requiring further workup for IBS include alarm symptoms such as hematochezia, weight loss, and anemia, especially with acute onset in patients >45 years.

Initial evaluation for IBS includes _______ of duration, triggers, and bowel patterns, along with a _______.

Initial evaluation for IBS includes history of duration, triggers, and bowel patterns, along with a physical exam.

_______ include _______, _______, and _______.

Alarm symptoms include hematochezia, weight loss, and anemia.

Acute onset of symptoms is particularly concerning in patients older than _______.

Acute onset of symptoms is particularly concerning in patients older than 45 years.

Initial evaluation includes _______ of duration, triggers, and _______.

Initial evaluation includes history of duration, triggers, and bowel patterns.

Physical exam may reveal tenderness in the _______.

Physical exam may reveal tenderness in the lower abdomen.

Indications for further testing include alarm symptoms or age greater than _______ with no prior evaluation.

Indications for further testing include alarm symptoms or age greater than 45-50 years with no prior evaluation.

Laboratory testing includes checking _______ for anemia and _______ or fecal calprotectin to screen for _______.

Laboratory testing includes checking CBC for anemia and CRP or fecal calprotectin to screen for inflammation.

Celiac serology involves testing for _______ for celiac disease.

Celiac serology involves testing for IgA anti-tTG for celiac disease.

Stool tests for _______ like _______ and _______ should be conducted in at-risk patients.

Stool tests for parasites like Giardia and E. histolytica should be conducted in at-risk patients.

Colonoscopy is recommended for patients older than _______ or those with alarm features.

Colonoscopy is recommended for patients older than 45-50 years or those with alarm features.

A _______ can help detect pelvic floor dysfunction in cases of _______.

A rectal exam can help detect pelvic floor dysfunction in cases of constipation.

SIBO testing can be done using _______ or _______ for bloating cases.

SIBO testing can be done using lactulose or glucose breath test for bloating cases.

General measures include _______ and _______ to reassure that IBS is chronic but manageable.

General measures include education and support to reassure that IBS is chronic but manageable.

FODMAP elimination involves avoiding foods high in _______, _______, _______, and _______.

FODMAP elimination involves avoiding foods high in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.

Specific modifications include avoiding _______ and using _______ supplements for high-galactoside foods.

Specific modifications include avoiding lactose and using alpha-galactosidase supplements for high-galactoside foods.

For moderate to severe symptoms, _______ like OTC peppermint oil should be used with caution.

For moderate to severe symptoms, antispasmodics like OTC peppermint oil should be used with caution.

_______ is an antidiarrheal that reduces stool frequency but does not improve _______.

Loperamide is an antidiarrheal that reduces stool frequency but does not improve abdominal pain.

_______ is used as an anti-constipation agent to improve stool frequency and consistency.

Polyethylene glycol (PEG) is used as an anti-constipation agent to improve stool frequency and consistency.

_______ are effective for IBS-D, providing relief from pain and bloating.

Tricyclic antidepressants are effective for IBS-D, providing relief from pain and bloating.

_______ is a nonabsorbable antibiotic used for refractory bloating and IBS-D.

Rifaximin is a nonabsorbable antibiotic used for refractory bloating and IBS-D.

Psychological therapies include _______ and relaxation techniques for stress-related symptoms.

Psychological therapies include cognitive-behavioral therapy (CBT) and relaxation techniques for stress-related symptoms.

Acute diarrhea is defined as lasting less than _______ with ≥_______.

Acute diarrhea is defined as lasting less than 2 weeks with ≥3 bowel movements/day.

Infectious causes of diarrhea include _______ agents like _______ and _______, and _______ agents like _______ and _______.

Infectious causes of diarrhea include viral agents like norovirus and rotavirus, and bacterial agents like E. coli and Shigella.

Risk factors for diarrhea include _______, exposure to unpurified water, and _______.

Risk factors for diarrhea include antibiotic use, exposure to unpurified water, and immunosuppression.

Non-inflammatory diarrhea is characterized by _______, non-bloody diarrhea with _______.

Non-inflammatory diarrhea is characterized by watery, non-bloody diarrhea with periumbilical cramps.

Inflammatory diarrhea presents as _______ with fever and _______.

Inflammatory diarrhea presents as bloody diarrhea with fever and LLQ cramps.

Severe symptoms of diarrhea include _______, altered mental status, and signs of _______.

Severe symptoms of diarrhea include hypotension, altered mental status, and signs of sepsis.

History and exam should focus on recent _______, dietary changes, and _______.

History and exam should focus on recent travel, dietary changes, and antibiotic use.

Severe symptoms of HUS with STEC include _______, _______, and _______.

Severe symptoms of HUS with STEC include hypotension, shock, and severe dehydration.

In history and exam for HUS, focus on _______, _______, _______, or _______.

In history and exam for HUS, focus on recent travel, antibiotic use, diet, or exposure to sick contacts.

Red flags during examination for HUS include _______, _______, _______, and _______.

Red flags during examination for HUS include fever, bloody stools, abdominal pain, and dehydration.

Stool testing indications include _______, _______, and _______ (more than _______).

Stool testing indications include dysentery, severe illness, and persistent diarrhea (more than 7 days).

Stool tests include _______ for fecal leukocytes, _______ to identify bacteria, and _______ to rapidly detect pathogens.

Stool tests include microscopy for fecal leukocytes, culture to identify bacteria, and multiplex PCR assays to rapidly detect pathogens.

C. difficile testing is performed for _______.

C. difficile testing is performed for antibiotic-associated diarrhea.

Other tests for HUS include _______ (check for anemia, leukocytosis), _______ (marker of inflammation), and _______ (assess electrolytes, renal function).

Other tests for HUS include CBC (check for anemia, leukocytosis), CRP (marker of inflammation), and CMP (assess electrolytes, renal function).

Imaging for severe symptoms includes _______ to detect colonic dilation and _______ for complications like perforation.

Imaging for severe symptoms includes X-ray to detect colonic dilation and CT scan for complications like perforation.

General management for dehydration includes _______ for mild to moderate cases and _______ for severe dehydration.

General management for dehydration includes oral rehydration therapy for mild to moderate cases and IV fluids for severe dehydration.

Homemade ORS consists of _______, _______, _______, and _______ in _______.

Homemade ORS consists of ½ tsp salt, 1 tsp baking soda, 8 tsp sugar, and 8 oz orange juice in 1 L water.

Diet management for diarrhea includes avoiding _______ and encouraging easily digestible foods like the _______ (bananas, rice, applesauce, toast).

Diet management for diarrhea includes avoiding irritating foods and encouraging easily digestible foods like the BRAT diet (bananas, rice, applesauce, toast).

Antidiarrheal agents like _______ are preferred for mild-moderate diarrhea but should be avoided in _______, _______, or _______.

Antidiarrheal agents like loperamide are preferred for mild-moderate diarrhea but should be avoided in bloody diarrhea, fever, or systemic toxicity.

Empiric antibiotics for severe diarrhea include _______ and _______ for pregnant women or resistant pathogens.

Empiric antibiotics for severe diarrhea include fluoroquinolones and azithromycin for pregnant women or resistant pathogens.

Specific infections requiring treatment include _______, _______, _______, _______, and _______.

Specific infections requiring treatment include Shigella, Cholera, Extraintestinal Salmonella, Listeriosis, and C. difficile.

Antibiotics should be avoided in _______ due to increased risk of _______.

Antibiotics should be avoided in STEC due to increased risk of HUS.

Admission is required for severe dehydration, persistent _______, severe abdominal pain, or suspected complications like _______.

Admission is required for severe dehydration, persistent bloody diarrhea, severe abdominal pain, or suspected complications like toxic megacolon.

Chronic diarrhea is defined as diarrhea lasting more than _______.

Chronic diarrhea is defined as diarrhea lasting more than 4 weeks.

Pathophysiologic categories of chronic diarrhea include _______, _______, _______, and _______.

Pathophysiologic categories of chronic diarrhea include medications, osmotic diarrhea, secretory conditions, and inflammatory conditions.

Common medications implicated in chronic diarrhea include _______, _______, _______, and _______.

Common medications implicated in chronic diarrhea include laxatives, antacids, antibiotics, and NSAIDs.

Stool appearance can indicate different types of diarrhea: _______ for osmotic, _______ for secretory, and _______ for malabsorption.

Stool appearance can indicate different types of diarrhea: watery for osmotic, high volume for secretory, and greasy for malabsorption.

Associated symptoms of chronic diarrhea include _______, _______, and _______.

Associated symptoms of chronic diarrhea include weight loss, malnutrition, and abdominal pain.

Initial evaluation of chronic diarrhea should include history of _______, _______, and _______.

Initial evaluation of chronic diarrhea should include history of onset, duration, and stool characteristics.

Fatigue can have _______ or _______ causes.

Fatigue can have inflammatory or infectious causes.

In the physical exam, assess for _______, _______, and _______.

In the physical exam, assess for dehydration, malnutrition, and abdominal tenderness.

In the initial evaluation, gather _______ on onset, duration, and stool characteristics, as well as associated symptoms like _______ or _______.

In the initial evaluation, gather history on onset, duration, and stool characteristics, as well as associated symptoms like fever or weight loss.

Routine laboratory testing includes CBC which may indicate _______ suggesting malabsorption or chronic inflammation.

Routine laboratory testing includes CBC which may indicate anemia suggesting malabsorption or chronic inflammation.

Electrolytes can show _______ and _______, indicating secretory diarrhea.

Electrolytes can show hyponatremia and metabolic acidosis, indicating secretory diarrhea.

Liver enzymes are tested to rule out _______.

Liver enzymes are tested to rule out hepatobiliary disease.

A low _______ level may indicate malabsorption or _______.

A low albumin level may indicate malabsorption or protein-losing enteropathies.

Elevated _______ may suggest _______.

Elevated CRP/ESR may suggest Inflammatory Bowel Disease (IBD).

General management includes identifying and treating the _______ and providing _______.

General management includes identifying and treating the underlying cause and providing nutritional support.

For symptomatic treatment, antidiarrheal agents like _______ reduce stool frequency and liquidity.

For symptomatic treatment, antidiarrheal agents like Loperamide reduce stool frequency and liquidity.

Cholestyramine or Colesevelam are used for _______.

Cholestyramine or Colesevelam are used for bile salt-induced diarrhea.

Dietary modifications include avoiding dairy for _______ and a _______ for IBS.

Dietary modifications include avoiding dairy for lactose intolerance and a low-FODMAP diet for IBS.

_______ is characterized by carbohydrate malabsorption and resolves with fasting.

Osmotic diarrhea is characterized by carbohydrate malabsorption and resolves with fasting.

_______ does not resolve with fasting and is caused by conditions like _______.

Secretory diarrhea does not resolve with fasting and is caused by conditions like endocrine tumors.

_______ like IBD are characterized by mucosal damage and inflammation.

Inflammatory conditions like IBD are characterized by mucosal damage and inflammation.

_______ lead to steatorrhea and can be caused by _______ or pancreatic insufficiency.

Malabsorptive conditions lead to steatorrhea and can be caused by celiac disease or pancreatic insufficiency.

_______ such as _______ can lead to diarrhea.

Motility disorders such as Irritable Bowel Syndrome (IBS) can lead to diarrhea.

Chronic infections may involve protozoa like _______ or bacteria such as _______.

Chronic infections may involve protozoa like Giardia or bacteria such as C. difficile.

Systemic diseases can include _______ and _______ affecting gut function.

Systemic diseases can include thyroid disorders and diabetes affecting gut function.

Celiac testing includes measuring _______ antibody.

Celiac testing includes measuring IgA tissue transglutaminase (tTG) antibody.

Stool studies can rule out _______ and assess for malabsorption using _______.

Stool studies can rule out parasitic infections and assess for malabsorption using Sudan stain.

_______ like colonoscopy with biopsy is used for diagnosing IBD and microscopic colitis.

Endoscopic examination like colonoscopy with biopsy is used for diagnosing IBD and microscopic colitis.

Advanced testing includes a _______ where stool weight >300 g suggests diarrhea.

Advanced testing includes a 24-hour stool collection where stool weight >300 g suggests diarrhea.

For _______, remove offending agents like laxatives and poorly absorbed carbohydrates.

For osmotic diarrhea, remove offending agents like laxatives and poorly absorbed carbohydrates.

For _______, treat underlying conditions such as _______.

For secretory diarrhea, treat underlying conditions such as neuroendocrine tumors.

For _______, treat IBD with _______ or _______.

For inflammatory diarrhea, treat IBD with anti-inflammatory or immunosuppressive agents.

For malabsorptive conditions like _______, a _______ is recommended.

For malabsorptive conditions like celiac disease, a gluten-free diet is recommended.

For infections like _______, specific antiparasitic therapy such as _______ is used.

For infections like Giardia, specific antiparasitic therapy such as metronidazole is used.

Antibiotic Associated Colitis is caused by disruption of normal gut flora due to antibiotic use, leading to overgrowth of _______ (C. diff), a _______ bacterium.

Antibiotic Associated Colitis is caused by disruption of normal gut flora due to antibiotic use, leading to overgrowth of Clostridioides difficile (C. diff), a toxin-producing bacterium.

The toxins produced by _______ include _______, which causes diarrhea, and _______, which damages the colonic lining.

The toxins produced by C. diff include TcdA, which causes diarrhea, and TcdB, which damages the colonic lining.

High-risk antibiotics for developing _______ infection include _______, _______, third-generation cephalosporins, and _______ (FQs).

High-risk antibiotics for developing C. diff infection include Clindamycin, ampicillin, third-generation cephalosporins, and fluoroquinolones (FQs).

Risk factors for _______ infection also include _______, _______, IBD, PPIs, feeding tubes, or prolonged hospitalization.

Risk factors for C. diff infection also include older age, immunosuppression, IBD, PPIs, feeding tubes, or prolonged hospitalization.

Transmission of _______ occurs in hospital settings via contaminated surfaces, and prevention includes proper _______ and glove use.

Transmission of C. diff occurs in hospital settings via contaminated surfaces, and prevention includes proper handwashing and glove use.

Symptoms of mild _______ disease include _______ and lower abdominal cramping.

Symptoms of mild C. diff disease include greenish, foul-smelling watery diarrhea and lower abdominal cramping.

Severe _______ disease may present with _______, shock, ileus, or toxic megacolon, and can also lead to fulminant disease.

Severe C. diff disease may present with hypotension, shock, ileus, or toxic megacolon, and can also lead to fulminant disease.

Diagnosis of _______ infection can be made using stool testing for _______, _______, and _______.

Diagnosis of C. diff infection can be made using stool testing for Glutamate Dehydrogenase (GDH), PCR, and Enzyme Immunoassays (EIAs).

Imaging for _______ may include _______ to detect colonic dilation and non-contrast CT scans for thickening, ileus, or perforation.

Imaging for C. diff may include abdominal X-rays to detect colonic dilation and non-contrast CT scans for thickening, ileus, or perforation.

Lab findings indicating severe _______ disease include _______, _______, and elevated lactate and serum creatinine (>1.5 mg/dL).

Lab findings indicating severe C. diff disease include WBC >30,000/mcL, serum albumin <2.5 g/dL, and elevated lactate and serum creatinine (>1.5 mg/dL).

Prevention of _______ infection involves contact precautions such as gloves, gowns, and proper handwashing, along with discontinuing the _______.

Prevention of C. diff infection involves contact precautions such as gloves, gowns, and proper handwashing, along with discontinuing the offending antibiotic.

Pharmacologic therapy for non-severe _______ disease includes _______ 200 mg BID for 10 days and _______ 125 mg orally 4x daily for 10 days.

Pharmacologic therapy for non-severe C. diff disease includes Fidaxomicin 200 mg BID for 10 days and Vancomycin 125 mg orally 4x daily for 10 days.

For fulminant _______ disease, treatment includes _______ 500 mg orally 4x daily and _______ 500 mg IV every 8 hours.

For fulminant C. diff disease, treatment includes Vancomycin 500 mg orally 4x daily and Metronidazole 500 mg IV every 8 hours.

Surgical intervention for _______ is indicated in cases of _______, perforation, or hemodynamic instability, with options including total abdominal colectomy.

Surgical intervention for C. diff is indicated in cases of toxic megacolon, perforation, or hemodynamic instability, with options including total abdominal colectomy.

Fecal Microbiota Transplantation (FMT) is used for patients with multiple recurrences of _______ or intolerance to surgery, with a success rate of _______.

Fecal Microbiota Transplantation (FMT) is used for patients with multiple recurrences of C. diff or intolerance to surgery, with a success rate of 92-96%.

For the treatment of _______ relapse, the first recurrence may be treated with repeat _______ or _______ taper.

For the treatment of C. diff relapse, the first recurrence may be treated with repeat fidaxomicin or vancomycin taper.

Celiac disease, also known as _______, is a permanent autoimmune disorder triggered by an inappropriate immune response to _______.

Celiac disease, also known as gluten enteropathy, is a permanent autoimmune disorder triggered by an inappropriate immune response to gluten.

Celiac disease, also known as _______ or _______, is a permanent autoimmune disorder triggered by an inappropriate immune response to _______, a protein in _______, _______, and _______.

Celiac disease, also known as gluten enteropathy or celiac sprue, is a permanent autoimmune disorder triggered by an inappropriate immune response to gluten, a protein in wheat, rye, and barley.

In genetically predisposed individuals (_______ or _______), gluten ingestion leads to small intestinal mucosal damage, causing _______.

In genetically predisposed individuals (HLA-DQ2 or HLA-DQ8), gluten ingestion leads to small intestinal mucosal damage, causing malabsorption.

The global prevalence of celiac disease is approximately _______ of the population, with biopsy-confirmed cases at _______.

The global prevalence of celiac disease is approximately 1.4% of the population, with biopsy-confirmed cases at 0.5%.

Typical symptoms of celiac disease include: - _______: Chronic, often with steatorrhea. - _______: Often accompanied by muscle wasting. - _______: Due to bloating and gas. - _______: Resulting from malabsorption of nutrients.

Typical symptoms of celiac disease include: - Diarrhea: Chronic, often with steatorrhea. - Weight loss: Often accompanied by muscle wasting. - Abdominal distention: Due to bloating and gas. - Weakness and fatigue: Resulting from malabsorption of nutrients.

Atypical symptoms of celiac disease include: - _______ (microcytic anemia). - _______: Due to calcium and vitamin D deficiency. - _______: Peripheral neuropathy, ataxia. - _______: An intensely itchy rash.

Atypical symptoms of celiac disease include: - Iron deficiency anemia (microcytic anemia). - Osteoporosis or osteomalacia: Due to calcium and vitamin D deficiency. - Neurological symptoms: Peripheral neuropathy, ataxia. - Dermatitis herpetiformis: An intensely itchy rash.

Extraintestinal symptoms of celiac disease can include: - _______, _______, _______, _______. - _______ or _______ in children.

Extraintestinal symptoms of celiac disease can include: - Fatigue, depression, infertility, amenorrhea. - Delayed puberty or growth retardation in children.

Silent celiac disease is characterized by positive serologic markers with _______.

Silent celiac disease is characterized by positive serologic markers with no or minimal symptoms.

Routine laboratory tests for celiac disease may show: - _______: Microcytic anemia from malabsorption. - _______: From folate or B12 deficiency. - _______: Elevated alkaline phosphatase, low calcium.

Routine laboratory tests for celiac disease may show: - Iron Deficiency Anemia: Microcytic anemia from malabsorption. - Megaloblastic Anemia: From folate or B12 deficiency. - Calcium and Vitamin D Deficiency: Elevated alkaline phosphatase, low calcium.

The _______ test is the _______ for diagnosing celiac disease, with sensitivity and specificity greater than _______.

The IgA Tissue Transglutaminase (IgA tTG) test is the GOLD STANDARD for diagnosing celiac disease, with sensitivity and specificity greater than 98%.

Mucosal biopsy findings in celiac disease may show _______.

Mucosal biopsy findings in celiac disease may show mild intraepithelial lymphocytosis.

The _______ is essential therapy for celiac disease, requiring complete avoidance of gluten from sources such as _______, _______, and _______.

The Gluten-Free Diet (GFD) is essential therapy for celiac disease, requiring complete avoidance of gluten from sources such as wheat, rye, and barley.

Management of lactose intolerance in celiac disease involves avoiding dairy until symptoms improve on a _______.

Management of lactose intolerance in celiac disease involves avoiding dairy until symptoms improve on a gluten-free diet.

Nutritional supplementation in celiac disease may include: - _______, _______, _______, _______, _______, _______, _______, _______, _______.

Nutritional supplementation in celiac disease may include: - Iron, folate, zinc, calcium, vitamin D, A, B6, B12, E.

Refractory celiac disease can be classified into two types: - _______: Treated with corticosteroids (e.g., _______, _______). - _______: Poor prognosis; risk of lymphoma.

Refractory celiac disease can be classified into two types: - Type I: Treated with corticosteroids (e.g., prednisone, budesonide). - Type II: Poor prognosis; risk of lymphoma.

Dermatitis herpetiformis resolves with a _______ and may require additional treatment with _______.

Dermatitis herpetiformis resolves with a gluten-free diet and may require additional treatment with dapsone.

Long-term management of osteoporosis in celiac disease includes calcium and vitamin D supplementation, and _______ for severe bone loss.

Long-term management of osteoporosis in celiac disease includes calcium and vitamin D supplementation, and bisphosphonates for severe bone loss.

Refractory Celiac Disease (RCD) is characterized by persistent symptoms despite a strict _______ (GFD) and may progress to _______.

Refractory Celiac Disease (RCD) is characterized by persistent symptoms despite a strict gluten-free diet (GFD) and may progress to enteropathy-associated T-cell lymphoma (EATL).

Additional tests for celiac disease may include a _______ for osteoporosis screening and _______ to assess the small intestine.

Additional tests for celiac disease may include a DEXA Scan for osteoporosis screening and Capsule Endoscopy to assess the small intestine.

Prognosis for celiac disease is _______ with proper diagnosis and adherence to a gluten-free diet, with most symptoms resolving within _______.

Prognosis for celiac disease is excellent with proper diagnosis and adherence to a gluten-free diet, with most symptoms resolving within weeks to months.

Complications of celiac disease include _______ and potential progression to lymphoma.

Complications of celiac disease include Refractory Celiac Disease (RCD) and potential progression to lymphoma.

The prognosis for lifelong compliance is _______ with proper diagnosis and adherence to _______.

The prognosis for lifelong compliance is excellent with proper diagnosis and adherence to GFD.

Most symptoms of Celiac Disease resolve within _______.

Most symptoms of Celiac Disease resolve within weeks to months.

Refractory Celiac Disease (RCD) occurs in _______ of cases.

Refractory Celiac Disease (RCD) occurs in 0.5–1.5% of cases.

Risk of progression to _______ is a complication of RCD.

Risk of progression to enteropathy-associated T-cell lymphoma (EATL) is a complication of RCD.

EATL has a _______ even with chemotherapy or transplant.

EATL has a poor prognosis even with chemotherapy or transplant.

Other autoimmune conditions associated with Celiac Disease include _______, _______, and _______.

Other autoimmune conditions associated with Celiac Disease include Addison's disease, type 1 diabetes, and Graves disease.

Lactase deficiency occurs when the enzyme lactase, responsible for hydrolyzing lactose, is _______.

Lactase deficiency occurs when the enzyme lactase, responsible for hydrolyzing lactose, is absent or reduced.

Lactase deficiency is most common in _______ such as _______.

Lactase deficiency is most common in non-European ancestries such as 90% Asian Americans.

Primary deficiency of lactase occurs as levels decline steadily from _______.

Primary deficiency of lactase occurs as levels decline steadily from childhood/adolescence into adulthood.

Symptoms of lactase deficiency include _______, _______, and _______.

Symptoms of lactase deficiency include bloating, abdominal cramps, and osmotic diarrhea.

Symptoms of lactase deficiency appear within a few _______ of lactose ingestion with no weight loss or other signs of malabsorption.

Symptoms of lactase deficiency appear within a few hours of lactose ingestion with no weight loss or other signs of malabsorption.

The _______ indicates lactase deficiency if breath hydrogen >_______ within 90 minutes after ingestion of 50 g lactose.

The Hydrogen Breath Test indicates lactase deficiency if breath hydrogen >20 ppm within 90 minutes after ingestion of 50 g lactose.

An empiric lactose-free diet can suggest lactase deficiency if there is a _______ like bloating and diarrhea.

An empiric lactose-free diet can suggest lactase deficiency if there is a resolution of symptoms like bloating and diarrhea.

The goal of dietary management in lactase deficiency is to achieve patient _______ by managing symptoms and maintaining adequate _______.

The goal of dietary management in lactase deficiency is to achieve patient comfort by managing symptoms and maintaining adequate nutrition.

High-lactose foods include _______, _______, and _______.

High-lactose foods include milk, ice cream, and cottage cheese.

Low-lactose or well-tolerated foods include _______ and _______ with lactase-producing bacteria.

Low-lactose or well-tolerated foods include aged cheeses and unpasteurized yogurt with lactase-producing bacteria.

Calcium supplementation for patients who restrict dairy includes _______ to prevent osteoporosis.

Calcium supplementation for patients who restrict dairy includes calcium citrate: 650 mg orally, twice daily to prevent osteoporosis.

Acute Paralytic Ileus is characterized by neurogenic failure or loss of _______ in the intestines without mechanical obstruction.

Acute Paralytic Ileus is characterized by neurogenic failure or loss of peristalsis in the intestines without mechanical obstruction.

The pathophysiology of Acute Paralytic Ileus involves disruption of coordinated intestinal motility due to _______.

The pathophysiology of Acute Paralytic Ileus involves disruption of coordinated intestinal motility due to neurogenic or inflammatory causes.

Post-surgical causes are common for Acute Paralytic Ileus, especially after _______.

Post-surgical causes are common for Acute Paralytic Ileus, especially after abdominal or GI surgery.

_______ due to neurogenic or inflammatory causes leads to _______.

Coordinated intestinal motility due to neurogenic or inflammatory causes leads to bowel stasis.

Post-Surgical Causes of bowel stasis are common after _______ or _______.

Post-Surgical Causes of bowel stasis are common after abdominal or GI surgery.

Postoperative Ileus: Small intestinal motility recovers first after _______.

Postoperative Ileus: Small intestinal motility recovers first after hours.

Symptoms of bowel stasis include: - _______ - _______ - _______ or passing gas.

Symptoms of bowel stasis include: - Mild, diffuse, continuous abdominal discomfort. - Nausea and vomiting. - Absence of bowel movements or passing gas.

Signs of bowel stasis include: - _______ - _______ with no signs of peritoneal irritation unless there is a primary disease.

Signs of bowel stasis include: - Generalized abdominal distention. - Minimal tenderness with no signs of peritoneal irritation unless there is a primary disease.

Bowel sounds in bowel stasis are typically _______.

Bowel sounds in bowel stasis are typically diminished or absent.

Laboratory Tests for bowel stasis should check _______ such as sodium, potassium, magnesium, phosphorus, and calcium.

Laboratory Tests for bowel stasis should check electrolytes such as sodium, potassium, magnesium, phosphorus, and calcium.

Imaging for bowel stasis includes: - _______ showing gas-filled loops of small and large intestines.

Imaging for bowel stasis includes: - Plain abdominal radiography showing gas-filled loops of small and large intestines.

CT scan is used to exclude _______ in bowel stasis.

CT scan is used to exclude mechanical obstruction in bowel stasis.

General Management of bowel stasis includes: 1) _______ such as infections, electrolyte imbalances, or surgical complications.

General Management of bowel stasis includes: 1) Addressing underlying cause such as infections, electrolyte imbalances, or surgical complications.

In dietary adjustments for bowel stasis, initially keep the patient _______ (nothing by mouth) and gradually reintroduce diet starting with _______.

In dietary adjustments for bowel stasis, initially keep the patient NPO (nothing by mouth) and gradually reintroduce diet starting with clear liquids.

Gradual reintroduction of diet in bowel stasis should advance to a _______ as bowel function improves.

Gradual reintroduction of diet in bowel stasis should advance to a normal diet as bowel function improves.