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Clinical - Winter > 19 - Diarrhea > Flashcards

19 - Diarrhea Flashcards

1
Q

What are the signs of dehydration in adults?

A
  • Dry mucous membranes
  • Thirst
  • Decreased urination
  • Decreased skin turgor
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2
Q

What is the definition of diarrhea?

A
  • Symptom characterized by increased frequency of defecation, w/ the stools being loose and watery
  • 3 or more loose stools in 24 h
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3
Q

When is a person considered to have diarrhea?

A

When there is increased frequency in bowel movements from the px baseline w/ decreased consistency

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4
Q

What are some complications of diarrhea?

A
  • Electrolyte imbalances
  • Risk of dehydration
  • Hemorrhoids
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5
Q

What is the difference between acute and chronic diarrhea?

A
  • Acute = lasts less than 14 days

- Chronic = lasts longer than 14 days or recurring diarrhea lasting less than 14 days each

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6
Q

What are common causes of acute diarrhea?

A
  • Infections (most common cause of diarrhea; caused by bacteria, viruses, parasites)
  • Medications, and/or
  • Diet/nutrition
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7
Q

What are common viral causes of diarrhea?

A
  • Norovirus
  • Rotavirus
  • Adenovirus
  • Calicivirus
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8
Q

What are common bacterial causes of diarrhea?

A
  • Campylobacter
  • Salmonella
  • Escherichia coli
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9
Q

What are common parasitic causes of diarrhea? Are they an automatic referral?

A
  • G. lamblia, E. histolytica, Isospora belli, and cryptosproridium
  • Referral b/c not self limiting
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10
Q

What are some medications that can cause acute diarrhea?

A
  • Broad spectrum antibiotics (penicillins, cephalosporins, erythromycins)
  • Usually occurs 2-3 days after starting antibiotic
  • Resolves when antibiotic withdrawn
  • Others = laxatives, antacids, metoclopramide, orlistat, misoprostol
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11
Q

Which medications can cause pseudomembranous colitis (C. difficile)?

A

Clindamycin, fluoroquinolones, penicillins, and cephalosporins

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12
Q

Which foods can cause acute diarrhea?

A
  • Intolerances to food components or food allergies (most common = gluten and lactose)
  • Foods w/ large amounts of sorbitol or mannitol
  • Fatty, spicy, highly salted foods
  • Rapid increases in dietary fibre
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13
Q

What are some risk factors for infectious diarrhea?

A
  • Attendance or employment at daycare centres
  • Occupation as food handler or caregiver
  • Congregate living conditions (ex: nursing homes, prisons)
  • Consumption of unsafe foods (ex: raw meat, eggs, shellfish)
  • Presence of certain medical conditions
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14
Q

What are some causes of chronic diarrhea?

A
  • Most common = inflammatory process (IBD, UC, Crohn’s)
  • Tumours
  • Chemotherapy
  • Malabsorption of carbohydrates
  • Diabetes
  • IBS
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15
Q

Is chronic diarrhea a referral?

A

Yes b/c don’t know unknown/known underlying causes

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16
Q

What are some red flags for diarrhea?

A
  • Fever over 38.5, extensive abdominal pain or cramping
  • Blood or abnormal mucous in stool
  • Signs of debilitating dehydration or weight loss due to diarrhea
  • Vomiting more than 4 h
  • Age under 2 y/o or frail elderly
  • Severe diarrhea, more than 6 loose stools/day for more than 48 h
  • Chronic medical conditions (that could experience complications from dehydration)
  • Suspected laxative abuse
  • Pregnancy
  • Immunocompromised px
  • Recent antibiotic use (particularly those associated w/ C difficile)
  • Worsening, persistent or chronic diarrhea
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17
Q

What are signs and symptoms of dehydration in children?

A
  • Dry mouth, tongue and skin
  • Few or no tears when crying
  • Sunken eyes, cheeks, and/or abdomen
  • Decreased urination (less than 4 wet diapers in 24 h)
  • Sunken soft spot (fontanel) in infants
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18
Q

What are the self treatment goals for diarrhea?

A
  • Determine specific etiology and recommend appropriate tx
  • Relieve symptoms and re-establish normal stools
  • Prevent or correct fluid and electrolyte loss or imbalances
  • Prevent complications (hemorrhoids)
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19
Q

What are some non-pharms for prevention of diarrhea?

A
  • Wash hands before preparing and eating food, as well as after going to the toilet or changing a diaper
  • Prevent food poisoning (avoid unpasteurized milk and fruit juice; cook red meat, poultry and eggs thoroughly; keep hot foods hot and cold foods cold; rinse foods that aren’t cooked before eating; use separate cutting boards for raw meats and vegetables; reheat foods completely)
  • Oral rehydration therapy good for children and elderly (only used to prevent dehydration; doesn’t work if px already dehydrated)
  • Dietary management (avoid fatty foods and simple sugars, avoid spicy foods, avoid caffeine)
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20
Q

What are contraindications to oral rehydration therapy for diarrhea?

A
  • Protracted vomiting despite small frequent feedings
  • Worsening diarrhea and unable to keep up w/ losses
  • Stupor or coma
  • Intestinal ileus
21
Q

What is the ideal sodium to glucose ratio for oral rehydration therapy?

A

1:1

22
Q

Are sports drinks recommended for oral rehydration therapy?

A

No b/c high in sugar and low in electrolytes

23
Q

What is the dosing for pedialyte?

A
  • Infants and children = 100-150 mL/g per day

- Children 4 years and older = 2 L or more daily

24
Q

What is the MOA of loperamide?

A
  • Synthetic opioid agonist
  • Slows intestinal motility allowing absorption of electrolytes and water through intestine
  • Decreases GI secretion
  • Reduction of daily fecal volume, increase viscosity and bulk volume, reduce fluid and electrolyte loss
25
Q

What is loperamide indicated for?

A
  • Non-specific acute diarrhea, traveler’s diarrhea
  • Adjunct to rehydration therapy
  • Only for children over 2 y/o
  • Only used in pregnancy if recommended by physician
26
Q

What are some SE of loperamide?

A
  • Abdominal pain, distention, cramps
  • N/V
  • Dry mouth, constipation
  • Drowsiness, fatigue
  • Skin rash
27
Q

What is the dosing for loperamide?

A
  • Adults = 4 mg (2 tablets) initially, followed by 2 mg after each subsequent loose stool; max 16 mg per 24 h
  • Children 2-12 y/o must consult physician before use
  • Max duration = 2 days
28
Q

What are some contraindications for loperamide?

A
  • Individuals w/ blood or mucous in stool
  • Fever
  • Infectious diarrhea or TD
  • Acute ulcerative colitis
  • Pseudomembranous colitis associated w/ broad spectrum AB
  • Age under 2 y/o
29
Q

What is the onset of loperamide?

A

30 mins to 1 h

30
Q

What drugs interact w/ loperamide?

A
  • Saquinavir (major)

- Ritonavir, gemfibrozil, itraconazole, St. John’s wort, valerian, quinidine (moderate)

31
Q

What are sx of loperamide abuse?

A
  • Dizziness
  • Urinary retention
  • Syncope
  • Shortness of breath
  • Palpitations
  • Dystonia
32
Q

What is the MOA of bismuth subsalicylate for diarrhea?

A
  • Bismuth has antimicrobial effect against diarrhea-causing pathogens
  • Salicylates exert antisecretory effects that rescue fluid and electrolyte losses in acute diarrhea
  • Decrease frequency of unformed stools and increase stool consistency
33
Q

When is bismuth subsalicylate indicated?

A
  • Symptomatic relief of milk non-specific diarrhea

* Don’t use in children under 18 y/o w/ febrile viral illnesses (like chicken pox) b/c of risk of Reye’s syndrome

34
Q

What are some SE of bismuth subsalicylate?

A
  • Impaction (infants and debilitated px)
  • Grayish-black stools/tongue
  • Tinnitus
  • Headache and confusion
35
Q

What is the MOA of attapulgite (adsorbent)?

A
  • Reduces number of bowel movements, improves stool consistency
  • Relieves cramps associated w/ diarrhea
36
Q

What is the indication for attapulgite?

A
  • Children over 3 y/o

- Not used for more than 2 days unless under physician supervision

37
Q

What is a disadvantage to attapulgite?

A

Long onset of action (12-19.5 h) while self-limiting diarrhea should only last 2-3 days

38
Q

Can fibre be a tx for diarrhea?

A

Yes

39
Q

What should be monitored w/ diarrhea?

A
  • Signs and sx of dehydration; if occurs, refer to physician for evaluation
  • Refer if condition doesn’t resolve in 48 h, diarrhea worsens, px has high fever, or blood/mucous in stool
  • Some improvement should be seen w/in 24-48 h w/ tx
40
Q

What is traveller’s diarrhea?

A

3 or more loose, unformed stools per day along w/ at least 1 sx of enteric infection (fever, abdominal cramps, nausea, fecal urgency, or blood/mucous in feces)

41
Q

Is traveller’s diarrhea generally self-limiting?

A

Yes, lasts max. 3-4 days

42
Q

What is the most common cause of traveller’s diarrhea?

A

Non-invasive type E coli

43
Q

Which px are considered at high risk of traveller’s diarrhea? What is our recommendation for them?

A
  • Recommendation = go to physician for Rx prophylaxis
  • Travellers visiting high risk areas on critical business that could be jeopardized if ill
  • Px w/ underlying health problems that make them more susceptible to diarrhea or complications due to TD
  • Px taking PPIs, H2 blockers, or antacids
  • Px in which dehydration could cause medical complications
  • Px w/ underlying disease
44
Q

What are some non-pharms for traveller’s diarrhea?

A
  • Education on prevention (boil it, cook it, peel it, or forget it)
  • Use purified water to brush teeth
  • Avoid drinking local water, drink water from sealed bottle
  • Avoid consuming water while swimming
  • Wash hands before eating and drinking
  • Eat fully cooked food
  • Avoid food from street vendors
  • Avoid unpasteurized dairy products
45
Q

What can be used for prevention of traveller’s diarrhea?

A
  • Bismuth subsalicylate; may be used up to 3 weeks

- Vaccine; provides protection for 3 months

46
Q

What is the tx for traveller’s diarrhea?

A
  • Either loperamide or bismuth subsalicylate (if no red flags)
  • Rx also available
47
Q

When are probiotics used for traveller’s diarrhea?

A
  • Can be started 3 days prior to departure for prevention

- Can treat TD w/ 2 capsules or sachets (500 mg) once daily for 5 days

48
Q

What are the 3 main types of lactose intolerance?

A

1) Primary – late onset, occurs w/ increasing age and individuals exhibit tolerance to various levels of lactose
2) Secondary – transient, develops secondary to illness or disease involving mucosal injury
3) Congenital – extremely rate and requires lifelong lactose-free or very low lactose diet

49
Q

What are the tx options for lactose intolerance?

A
  • Lactase supplements taken immediately prior to ingestion of dairy product
  • Px must experiment w/ how many tablets/drops protect against certain amounts of lactose-containing foods

Clinical - Winter (24 decks)

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