Gastroenteritis, Constipation, and Peptic Ulcer Disease Flashcards

100 vocabulary flashcards reviewing clinical concepts, diagnostics, pharmacological treatments, and management algorithms for constipation, gastroenteritis, and peptic ulcer disease.

Constipation Definition

Infrequent or difficult evacuation of stool.

Preferred Constipation Therapy

Dietary and lifestyle modifications, including increased fiber, increased water intake, regular exercise, and stress reduction.

Digital Rectal Examination

A physical exam component for constipation used to check for fecal impaction, stricture, or rectal masses.

Irritable Bowel Syndrome Indicator

The presence of abdominal cramping that is relieved by defecation.

Medications Causing Constipation

Opioids, diuretics, calcium channel blockers, anticholinergics, psychotropics, calcium and iron supplements, and clonidine.

First-Line Laxative Therapy

Osmotic and bulk-forming laxatives, used when lifestyle changes are insufficient.

Second-Line Laxative Therapy

Stimulant laxatives, used when there is an incomplete response to osmotic laxatives.

Third-Line Laxative Therapy

Secretagogues, which stimulate intestinal chloride secretion and are reserved for complex cases due to high cost.

Polyethylene Glycol (MiraLAX)

An osmotic laxative used for long-term treatment of constipation and bowel preparation before medical procedures.

Lactulose

An osmotic laxative used for constipation and prescribed to treat hepatic encephalopathy by helping excrete excess ammonia.

Magnesium Hydroxide

An osmotic laxative commonly known as Milk of Magnesia that can also be used as an antacid.

Glycerin Suppositories

An osmotic laxative in rectal suppository form that provides relief for occasional constipation.

Suprep

A bowel prep solution containing sodium, potassium, and magnesium osmotic compounds.

Senna (Senokot) Dosing

Tablets: 2–8/day; Suppositories: 1 at bedtime (qhs); Granules: 1–4 tsp/day.

Bisacodyl (Dulcolax) Dosing

Tablets: 1–3/day; Suppositories: 1 per rectum daily.

Castor Oil Dosing

15–60 mL/day.

Methylcellulose (Citrucel) Dosing

2–6 g/day.

Psyllium (Metamucil) Dosing

3.4–10.2 g/day.

Polycarbophil (FiberCon) Dosing

1–6 g/day.

Malt Soup Extract (Maltsupex) Dosing

12–64 g/day.

Wheat Dextrin (Benefiber) Dosing

Powder: 1 tbsp daily for ages 6 and up; Chewables: 3 tablets three times daily for ages 12–adult, or 1 ½ tablets three times daily for ages 6–11.

Lubiprostone (Amitiza)

A chloride channel activator secretagogue administered as a 24-mcg capsule twice daily.

Linaclotide (Linzess)

A guanylate cyclase-C agonist administered as a 145-mg capsule daily.

Naloxegol (Movantik)

A peripherally acting mu-opioid receptor antagonist (PAMORA) administered as a 12.5- to 25-mg tablet once daily.

Bulk Laxatives Mechanism of Action

Nondigestible and nonabsorbable agents that increase the bulk and moisture content of stool.

Stool Softeners Mechanism of Action

Agents that lower the surface tension of fecal mass and inhibit fluid and electrolyte reabsorption.

Osmotic Laxatives Mechanism of Action

Largely nonabsorbable sugars metabolized into lactic acid, formic acid, acetic acid, and carbon dioxide, acting via osmosis to draw water into the colon.

Stimulant Laxatives Mechanism of Action

Agents that increase peristalsis through direct action on the intestinal mucosa or nerve plexus (diphenylmethanes & anthraquinones).

Saline Laxatives Mechanism of Action

Agents that attract and retain water to increase intraluminal pressure.

Enemas Mechanism of Action

Form a barrier between feces and colon wall (e.g., mineral oil, soap suds) preventing colonic reabsorption of fecal fluid.

Psyllium Contraindications

Hypersensitivity, fecal impaction, and GI obstruction.

Bulk-Forming Laxative Onset Time

May take up to 3 days to demonstrate clinical effectiveness.

Lactulose Contraindication Caution

Contains lactose and galactose; requires caution in patients with diabetes.

Bulk-Forming Laxatives Drug Interaction

May decrease the effectiveness of quinolones and tetracyclines.

Mineral Oil Drug Interaction

Decreases absorption of fat-soluble vitamins A, D, E, and K, which may affect warfarin.

Fecal Impaction Symptoms

Complication of constipation presenting with partial or complete obstruction, abdominal pain, nausea, and vomiting.

Gastroenteritis

Also called stomach flu, an infection of the stomach or small intestine caused by viruses or bacteria.

Viral Gastroenteritis Key Symptoms

Abdominal cramps (#1), vomiting, profuse watery stools, myalgias, fever, headaches, and arthralgias.

Bacterial Dysentery Key Symptoms

Small volume stools, fever, tenesmus, bloody mucoid stools, and suprapubic pain relieved by bowel movement.

Rotavirus Incubation and Duration

Incubation period: 1-3 days; Duration: 5-7 days.

Rotavirus Transmission and Seasonality

Predominantly in winter and fall; transmitted via fecal-oral route and respiratory transmission.

Norovirus Incubation and Duration

Incubation period: 12-48 hours; Duration: 1-4 days.

Norovirus Transmission and Seasonality

Year-round, especially in winter; transmitted via fecal-oral route, aerosolization, respiratory transmission, food, fomites, and water.

Sapovirus Characteristics

Incubation period: 1-2 days; Duration: 3-4 days; Year-round seasonality; transmitted via fecal-oral route.

Astrovirus Characteristics

Incubation period: 4-5 days; Duration: 5-6 days; Predominantly in winter; transmitted via fecal-oral route and water.

Enteric Adenovirus (40 and 41) Characteristics

Incubation period: 3-10 days; Duration: 6-9 days; transmitted via fecal-oral route.

Enteric Adenovirus Seasonality

Predominantly in summer.

Salmonella Gastroenteritis Characteristics

Incubation period: 6-48 hours; Duration: 1-7 days.

Salmonella Gastroenteritis Signs

Nausea, vomiting, fever, abdominal pain, and possible blood in stool.

Campylobacter Gastroenteritis Characteristics

Incubation period: 1-10 days; Duration: 5-14 days; Signs include fever, headache, abdominal pain, nausea, vomiting, and possible blood.

Campylobacter Gastroenteritis Signs

Fever, headache, abdominal pain, nausea, vomiting, and possible blood.

Vibrio Gastroenteritis Characteristics

Incubation period: 6 hours–4 days; Duration: up to 3 days; Signs include nausea, vomiting, and diarrhea.

Shigella Gastroenteritis Characteristics

Incubation period: 1-6 days; Duration: 2-3 days; Signs include fever, abdominal pain, diarrhea, and possible blood.

Enterotoxigenic E. coli (ETEC) Characteristics

Incubation period: 1-3 days; Duration: 2-3 days; Primary sign is diarrhea.

Clostridium perfringens Characteristics

Incubation period: 8-16 hours; Duration: <24 hours.

Clostridium perfringens Signs

Nausea, abdominal pain, and diarrhea with blood.

Enterohemorrhagic E. coli (EHEC) Characteristics

Incubation period: 1-9 days; Duration: 1 week; Signs include fever, nausea, abdominal pain, diarrhea, and possible blood.

Clostridium difficile Gastroenteritis Characteristics

Incubation period: 4-5 days; Duration: variable; Signs include fever, nausea, abdominal pain, diarrhea, and possible blood.

Gastroenteritis Stool Testing Criteria

Stool samples are obtained to examine for lactoferrin and WBCs if symptoms are severe or > 1 day in duration.

BRAT Diet Recommendation in Gastroenteritis

Do NOT use; lacks protein, healthy fats, vitamins, and minerals, leading to risk of malnutrition in children and elderly.

Peptic Ulcer Disease (PUD)

A mucosal break > 3 mm involving the stomach or duodenum.

Primary Causes of PUD

H. pylori infection and NSAID/aspirin use.

NSAID Use Prevalence in PUD Patients

Present in 70% of cases, with increased risk in individuals aged > 65 taking NSAIDs at least once a week.

Concomitant Medication Risk with NSAIDs

Co-administration of NSAIDs with bisphosphonates, SSRIs, or anticoagulants increases PUD risk.

PUD Protective Factors

Mucus, bicarbonate, mucosal blood flow, prostaglandins, hydrophobic layer, and epithelial renewal.

PUD Aggravating Factors

H. pylori, NSAIDs, acid, pepsin, smoking, ethanol, bile acids, aspirin, steroids, and stress.

PUD Protection Age Threshold

Decreases after age 50, increasing ulcer risk.

Gastric Ulcers Demographics

Common in late middle age; incidence increases with age; Male:Female ratio is 2:1.

Gastric Ulcers Blood Group Association

More common in patients with blood group A.

Gastric Ulcers NSAID Risk Factor

NSAID use is associated with a 3- to 4-fold increase in the risk of gastric ulcers.

Gastric Ulcers H. pylori Rate

Associated with H. pylori in about 80% of cases (less than duodenal ulcers).

Gastric Ulcers Pain Pattern

Epigastric pain exacerbated by food and relieved by vomiting.

Duodenal Ulcers Frequency and Male-to-Female Ratio

4 times as common as gastric ulcers; Male:Female ratio is 4:1 with peak onset at 30-50 years of age.

Duodenal Ulcers Blood Group Association

More common in patients with blood group O.

Duodenal Ulcers Pepsinogen Finding

Associated with increased serum pepsinogen.

Duodenal Ulcers H. pylori Association

H. pylori infection is present in up to 95% of cases.

Duodenal Ulcers Pain Pattern

Occurs 1-3 hours after a meal, may awaken the patient from sleep, and is relieved by food, antacids, or vomiting.

PUD Epigastric Pain Description

Gnawing, burning, or aching pain located in the epigastrium.

PUD Red Flags / ED Referral Signs

Abdominal rigidity and signs of peritoneal irritation require urgent referral to the Emergency Department.

Dyspepsia Management (>55 Years or Alarm Features)

Perform Esophagogastroduodenoscopy (EGD) directly.

Alarm Features in Dyspepsia

Unexplained weight loss, anemia, and GI bleeding.

Dyspepsia Management (Age

Test and treat for H. pylori; if it fails, initiate a PPI trial; if that fails, consider EGD.

Dyspepsia Management (Age <=55, No Alarm Features, HP Prevalence <10%)

Initiate a PPI trial; if it fails, test and treat for H. pylori; if that fails, consider EGD.

Non-Invasive H. pylori Diagnostic Tests

Urea breath test, stool antigen test, and serology.

Uncomplicated NSAID/ASA-Induced PUD Treatment

PPI for 4-6 weeks and avoidance of aspirin/NSAIDs.

Uncomplicated Non-NSAID Duodenal Ulcer Treatment Duration

PPI for 4 weeks.

Uncomplicated Non-NSAID Gastric Ulcer Treatment Duration

PPI for 8 weeks.

Dexlansoprazole Adult Dose

30 to 60 mg orally daily before breakfast.

Esomeprazole Adult Dose

20 to 40 mg orally daily before breakfast.

Lansoprazole Adult Dose

30 mg orally daily before breakfast.

Omeprazole Adult Dose

20 to 40 mg orally daily before breakfast.

Pantoprazole Adult Dose

40 mg orally daily before breakfast.

Rabeprazole Adult Dose

20 mg orally daily before breakfast.

Optimized Bismuth Quadruple Therapy Regimen

Standard-dose PPI twice daily + Bismuth subsalicylate (300 or 524 mg 4x daily) + Tetracycline (500 mg 4x daily) + Metronidazole (500 mg 3-4x daily) for 14 days.

Pylera Combination Capsule Regimen

Standard-dose PPI twice daily + 3 Pylera capsules 4 times daily (delivering bismuth subcitrate 420 mg, metronidazole 375 mg, tetracycline 375 mg) for 10 days.

Talicia (Rifabutin-Amoxicillin-PPI) Regimen

4 combination capsules 3 times daily (omeprazole 40 mg, rifabutin 50 mg, amoxicillin 1 g) for 14 days.

Voquezna Dual Pak Regimen

Vonoprazan 20 mg twice daily + Amoxicillin 1 g 3 times daily for 14 days.

Voquezna Triple Pak Regimen

Vonoprazan 20 mg twice daily + Amoxicillin 1 g twice daily + Clarithromycin 500 mg twice daily for 14 days.

H. pylori Initial Selection with Penicillin Allergy & Prior Metronidazole Use

Bismuth quadruple therapy.

PUD Bleeding Complication Statistics

Occurs in 25-33% of PUD cases and accounts for 25% of ulcer-related deaths.