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GEM > 2.13 Diarrheal Diseases > Flashcards

2.13 Diarrheal Diseases Flashcards

1
Q

Medical definition of diarrhea?

A

Stool weight over 300g (or ml)
Increases frequency and decreased consistency of bowel movements

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2
Q

How would you characterize the MAJORITY of acute diarrhea?

A

Less than two weeks
Mild and self limiting

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3
Q

How can acute diarrhea be life threatening?

A

Severe depletion of body fluids = profound dehydration

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4
Q

What characterizes inflammatory diarrhea (dysentery)?

A

Fever, bloody diarrhea, severe abdominal pain

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5
Q

What are diarrhea red flags?

A

Inflammatory diarrhea
Six or more unformed stool in 24 hrs
Hospital acquired
+ Patients that are frail/older, systemic illness , and immunocompromised

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6
Q

Most common causes of acute diarrhea?

A

Bacterial toxins, infectious agents, and drugs

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7
Q

Clinical findings for non-inflammatory diarrhea?

A

Fecal leukocytes and blood absent (-FLT)
More common and usually Viral
Tends to be cvoluminous
Small bowel (periumbilical pain, bloat, nausea, vomit)

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8
Q

Clinical findings of inflammatory diarrhea?

A

Fecal leukocytes and RBCS may be present
Bloody diarrhea
Fever, left lower quadrant (colon) cramps, urgency, tenesmus
Invasive orgs + toxins cause

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9
Q

How does the phrase “Silly Sally Eats Your Cake and Cookies” help you remember your invasive organisms that can lead to inflammatory diarrhea?

A

Shigellosis (Shiga toxin), Salmonellosis, Entamoeba histolytic, Yersenia, CMV, & Campylobacter

+CDiff

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10
Q

If positive for FLT, what other labs could you get?

A
  • Ova and parasites
  • Rectal swab/cultures (sex active proctitis suspicion)
  • C Diff toxin assay (hospital/antibiotics)
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11
Q

Diet treatment protocol for diarrhea?

A

Oral fluids - carbs and electrolytes
Avoid high fiber foods, fats, caffein, alcohol, and milk products

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12
Q

When to use med treatment for diarrhea?

A

Only non-inflammatory
BUT NO opioids or anti diarrheal drugs for patients with bloody diarrhea, high fever, or systemic toxicity

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13
Q

What is a common opioid agent used to treat diarrhea by decreasing stool number/liquidity and control fecal urgency?

A

Loperamide

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14
Q

How does loperamide work?

A

Inhibits peristaltic activity by acting directly on circular and longitudinal muscles of intestinal wall

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15
Q

When do you consider antibiotics to treat diarrhea?

A

Moderate to sever fever, tenesmus, bloody stools, FLT +, immunocompromised people

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16
Q

Most common antibiotics to treat C diff?

A

Vancomycin and Fidaxomicin

17
Q

Persistent diarrhea?

A

> 2 weeks but less than 4 weeks
“Acute diarrhea that tends to last longer”

18
Q

At what point is it considered chronic diarrhea?

A

> 4 weeks

19
Q

What should you exclude before a big work up for diarrhea?

A
  1. Medications (caffeine + laxative abuse)
  2. Chronic infections (parasites)
  3. Irritable Bowel Syndrome*
20
Q

Medications that can cause diarrhea?

A

“A SON CAMP”
Angiotensin II blockers
SSRIS
Orlistat
NSAIDS
Cholinesterase inhibitors
Allopurinol
Metformin/Macrolides
PPI

21
Q

Osmotic diarrhea is characterized by?

A

Colonic gas production (bloating, flatulence, distention)
Resolved by fasting

22
Q

Malabsorption syndromes?

A

Osmotically active substances that would be normally absorbed aren’t (ex. Lactose, glucose)= weight loss, nutrition deficiencies, steatorhhea

23
Q

High volume watery diarrhea >1L/day associated with?

A

Secretory diarrhea
(Dehydration and electrolyte imbalance)

24
Q

What are some common ingested osomoles that lead to osmotic diarrhea?

A

Antacids, sorbitol, olestra, lactulose

25
Q

Common malabsorption causes?

A

Small intestinal mucosal diseases, intestinal resections, pancreatic insufficiency, lactase deficiency, lymphatic obstruction, reduced bile salts

26
Q

Causes for reduced bile salts that help ingest fat and fat soluble vitamins?

A

Postcholecystectomy
Ileal resection or Crohn’s Dx
Small intestine bacterial overgrowth (SIBO)

27
Q

Consequence of decreased bile salts?

A

Increase luminal osmoles (fat)
Increased colonic secretions

28
Q

Secretory diarrhea?

A

Increased intestinal secretion (decreased absorption)
Lil’ change in stool output even when fasting

29
Q

Common causes of secretory diarrhea?

A

Infection - travelers diarrhea
Hormonal : carcinoid (VIPoma, Zollinger-Ellison Syndrome) medullary thyroid carcinoma, adrenal insufficiency
Laxative Abuse

30
Q

What are some routine tests to asses etiology of the diarrhea? Especially for chronic patients?

A

CBC, electrolytes, lover function, INR, ESR, C reactive protein, phosphorus, calcium, albumin, TSH, etc.
+ Celiac Dx serology

31
Q

What does stool weight of <300g/day suggest?

A

Not actual diarrhea but a irritable bowel syndrome

32
Q

What does a stool weight of >1000-1500g/24 hours suggest?

A

Secretory diarrhea

33
Q

How do you calculate the osmotic gap for stool sample electrolyte levels?

A

290-2x(Na+K)
Small osmolar gap <50 = secretory diarrhea

34
Q

What are some other things you can test in a stool sample?

A

Electrolytes, ova and parasites, fat (Sudan Stain), occult blood, leukocytes, or lactoferrin

35
Q

If chronic secretory diarrhea suspected check for:

A

Serum - VIP (VIPoma), calcination (medullary thyroid carcinoma), gastrin (zollinger Ellison syndrome)
Urine - 5HIAA carcinoid metabolite

36
Q

Imaging studies for chronic diarrhea?

A

Abdominal CT (pancreatic malfunction or neuroendocrine tumors)
Somatostatin receptor scintigraphy (neuroendocrine tumors)
Small intestine imagining

37
Q

Diagnostic procedures you could do for chronic diarrhea?

A

Sigmoidoscopy or colonoscopy
(IBD or melanosis coli)
Upper endoscopy - celiac
Hydrogen breath test

38
Q

Treatments for chornic diarrhea?

A

Loperamide, diphenoxylate w/ atropine, clonidine (secretory or diabetic), octreotide (secretory), Cholestyramine resin (bile salt)

GEM (28 decks)

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