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03 GI Nutrition > 12b Diarrhea > Flashcards

12b Diarrhea Flashcards

0
Q

Normal BMs

A

One every 3 days –> 3 every day

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1
Q

Diarrhea definition

A

> 200 gm / 200ml per 24 hrs

Malabsorptive: inadequate absorption- steatorrhea- improves with fasting

Exudative: Purulent- cotinues during fasting

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2
Q

Practical diarrhea definition

A
  • > 3 watery stools per day

* Clear increase in frequency or decrease in consistancy over baseline

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3
Q

Real diarrhea clues

A
  • Truly watery- or soupy
  • Urgency
  • Incontinence (not leakage)
  • Nocturnal urgency (waking up to poop)
  • Flatuphobia
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4
Q

Small bowel diarrhea

A
  • Colon acts as “silencer”
  • Watery diarrhea large in volume and less frequent
  • Bloating, cramping, gas, weight loss
  • Evvidence of malabsorption
  • WBC or blood rare
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5
Q

Large bowel diarrhea

A
  • Frequent small regular stools
  • Tenesmus “rectal dry heaves”
  • Painful BM
  • Fever, bloody mucoid stools
  • RBC/WBCs
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6
Q

Osmotic diarrhea

A

Goes away with fasting- does not have nocturnal BMs

  • Mannitol- sorbitol
  • Dissacharidease deficiency- i.e. lactase D

ELECTROLYTE LEVELS USUALLY LOW
Osmotic gap is very high –> >100

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7
Q

Secretory diarrhea

A
  • Usually infectious- enterotoxins blocking absorption, stimulating secretion
  • Sometimes endocrine tumor causes
  • <50 mOSM osmotic gap
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8
Q

Accute vs. Persistentvs. Chronic

A

4wks

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9
Q

Normal stool osmolarity

A

290 mOsm/kg

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10
Q

72 hour fecal fat collection

A

eat 70-100g
7-14g in feces is abnormal
>14 is diagnostic for fat malabsorption

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11
Q

Severe Community Acquired Diarrhea

A

> 4 fluid stools per day
3 days

87% of these are bacterial

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12
Q

Diarrheal bacteria

A 
Salmonella
Shigella
Campylobacter
E. coli 0157:H7
C.diff
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13
Q

Diarrheal viruses

A

Calcivirus- Norwalk
Rota
Adeno
Astro

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14
Q

Diarrheal protozoa

A

Giardia
Cryptosporidium
Entamoeba Histolytica

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15
Q

Salmonella Typhi

A

(non typhoid more common in us)

  • Gram neg encapsulated
  • Poultry eggs, milk, pet turtles
  • Colonic or dysenteric disease
  • multiplies n phagosome of cell

Typhoid fever: Anorexia, abd pain, bloating , NVD (bloody), bacteremia fever

Sickle cell anemic patients succeptible to osteomyelitis

Microbiome is protective: antibiotics may worsen disease

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16
Q

Shigella

A
  • Gram neg facultative anaerobes
  • 10% pediatric diarrheal disease
  • VERY CONTAGEOUS FECAL ORAL- daycare/instituttional
usually self limited- usually left colonic involvement
Antibiotics shorten duration
antidiarrheals contraindicated (slow clearance)

RARE:HUS, seizures or arthritis

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17
Q

Campylobacter Jejuni

A 
Leading cause of acute bacterial diarrhea
33% of foodbourne illness,
Undercooked poultry, raw milk, contaminated water
500 organisms infective
*8 day incubation
*influenza like prodrome
*Dysenteryin 15-50% of ppatients
*Self limited
*Watery or hemorrhagic- Large or small
*Can mimic appendicitis

Assocaited with guillian barre, reactive arthritis, erythema nodosum (painful nodular bumps on shins)

18
Q

Giardia Lamlia

A
  • Unfiltered fecal oral water contamination

* acute or chronic small bowel disease

19
Q

E. coli

A

Gram neg Bacill, usually commensual

20
Q

ETEC

A

Enterotoxogenic E. coli

  • Travvelers diarrhea - heat labile toxin, or heat stable toxin
    • ^ cAMP- Cl secretion, and prevention of villous NaCl resorption
21
Q

EIEC

A

Enteroinvasive ecoli
Much like shigella
*bloody diarrhea
*invasion of gut epithelials

22
Q

EAEC

A

Enteroaggreative E.coli
Attach to enterocytes with fimbria- flagellan ^ IL8 and intestinal inflammation
*Shiga like and Labile toxin- little histologic damage

23
Q

EHEC

A

Enterohemorragic E. coli 0157:H7
Undercooked beef
4% foodbourne illness
associated with HUS- especially with antibiotics

24
Q

Vibrio Cholerae

A
  • Gram neg bacteria
  • seafood and contaminated water
  • noninvasive
  • Choleratoxin —> cAMP –> opens CFTR

Mostly mild diarrhea
1-5 day incubation
can get SEVERE DIARRHEA- treat with supportive care

25
Q

Norovirus

A

1/2 of all gastroenteritis
food, water, person to person
Any place people gather
Self limited NVD(watery) abdominal pain

26
Q

Rotavirus

A

*Now a vaccine- previously most common cause of childhood diarrhea and diarrhea death
*6 mos - 2 years
NVD (watery)

27
Q

Ascaris lumbrocoides

A

Nematode-

Fecal oral —> hepatic to pulmonary

28
Q

Strongyoloides

A

Skin infecting threadworm

Migrate to lungs cough and reswallow

29
Q

Necator and ancyclostoma

A

Hookworms that penetrate skin
Cause IDA from ingesting blood in duodenum
Cough and swallow

30
Q

Immunocompromised diarrhea pathoggens

A

Cryptosporidium
MAC
CMV

31
Q

Staph diarrhea

A

Eggs poultry and meat left at room temp- NVD shortly after eating

32
Q

Bacillius Cerus

A

Reheated fried rice

NVD within 6 hours of rice

33
Q

Clostridium perfringens

A

8-14 hours after ingestion

34
Q

When are stool studies useful

A
  • > 2weeks of diarrhea- otherwise is probably self limited
  • Severe illness
  • Oubreaks
  • requiring of hospitalization
  • Immunocompromised
  • Inflammatory bowel patients
  • some employees need clearance for work
35
Q

Ova and parasite studies

A

Intermittent shed
Repeat 3X 24 hours apart over 3 consecutive days

When to order:
>14 day diarrhea
Travel to mountains
Exposure to infants in daycare
immunocompromised
Community outbreaks
36
Q

ELSA and DFA microscopy

A

Giardia and cryptosporidium

37
Q

Infectious diarrhea treatment

A

Hydration- with some salt and glucose

gatorade has too much sugar and can worsen symptoms

38
Q

Travelers diarrhea treatment

A

Moderate to severe disease can be treated with TMP-SMZ or floroquinolone IF IT IS NOT EHEC

39
Q

Empiric diarrheal antibiotics

A

IF NOT EHEC or C.Diff
* >8 stools per day, volume depletion, hospitalized, immunocompromised

Fluoroquinolone or Azithromycin and Erythromycin

40
Q

C. Diff

A

Usually precipitated by clindamycin usage

  • Treat with metronidazole or oral Vanko. Also : diffacid
  • toxin A or B
  • Hypervirulant strains with 16X more A and 23X more B

Can precipitate toxic megacolon

41
Q

C. diff illness

A 
Bloody, watery diarrhea
Fever
Abdominal pain
Leukocytosis
Pseudomembranous colitis

Sometimes megacolon, sepsis, perforation and death

10-35% recurrence (risk: Continued antibiotics, age and comorbid conditions, antacids, immunnosuppression or deficiency)

42
Q

Severe Cdiff

A

Age> 65 yrs
Cr > 1.5X baselinee
WBC >15K

complications:
Shock/hypotension
Ileus
Megacolon

43
Q

Fidaxomicin

A

Vancomycin alternative

  • inhibition of RNA poly
  • treats gram pos anaerobes and anaerobes
  • does not affect gram negs- preserves intestinal flora
  • High fecal concentration low serum concentration

Less recurrence but much more expensive

03 GI Nutrition (20 decks)

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