Abdomen Trans Part 2 Flashcards by joseph dizon

Diarrhea for adults,

3 or more bowel movements

>200 g/day stool weight

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Frequent passage of small volumes of stool
Associated with rectal urgency
Seen in IBS, anorectal disorder (procititis)

Pseudo diarrhea

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Involuntary discharge of rectal contents

Caused by neuromuscular disorder and structural anorectal problems

Fecal in continence

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Intense urge with straining but little or no result

Tenesmus

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Acute diarrhea

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Persistent diarrhea

2-4 weeks

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Chronic diarrhea

> 4 weeks

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Diarrhea

Motility disorders involving the left colon

Frequent small volume movements

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Diarrhea

Right colon or small bowel and if recto sigmoid reservoir is intact

Stool fewer but large volume

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Diarrhea

Painless large volume stools

Right colon or small bowel source

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Diarrhea

With dehydration in absence of vomiting or limited oral intake typically have stool weights

> 1,000 grams

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Diarrhea

Ingestion of poorly absorbed cations and anions: mannitol, sorbitol, magnesium, sulfate and phosphate.

Osmotic diarrhea

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Diarrhea

Osmotic diarrhea transported by

Saturated at low Ingraluminal ion

Low capacity

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Essential characteristic of osmotic diarrhea are

Disappear with fasting

Electrolyte absorption is not impaired

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Diarrhea

Diving force of this type of diarrhea is always either.
Net secretion of chloride or HCO3
Inhibition of net sodium absorption

Secretory diarrhea

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Diarrhea

It severely affect the messenger system that regulates ion transport pathways.

Secretory diarrhea

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Diarrhea

Diarrhea being produced by several pathophysiologic mechanism.

Complex diarrhea

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Complex diarrhea involves regulatory systems including

Paracrine
Immune
Neural endocrine

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Often cited as pure secretory diarrhea.

Cholera

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Cholera toxins targets the ________ , ________, ________, which opens apical chloride channels to estimate choride secretion and results in diarrhea

Epithelial cells
Increase second messenger
cAMP

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However, cholera toxin stimulates both _________________ that reinforced the direct secretory effect on electrolyte

Endocrine cells and neural elements

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Intact enterocytes are barraged by multiple secretagogues released by immune cells in the intestine and by bacterial toxins that may influence enterocyte function

Inflammatory bowel disease

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IBD

Bacteria proteins may stimulate the production of cytokines, suchas

Interleukin 8

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IBD

Aggravated by

Altered motility

Compromised rectal reservoir

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Failure to absorb CHO may lead to osmotic diarrhea, but failure to absorb long chain fatty acids may complicate matters by impairing electrolytes absorption bythe colon

Malabsorptive Syndrome

Bacterial infection Protozoan infection Tropical sprue

Travelers diarrhea

Diarrhea Bacterial Viral(rotavirus) Protozoal

Epidemics/ outbreaks

Diarrhea Altered motility Drugs (acarbose, metformin)

Diabetic patients

Diarrhea ``` Opportunistic infections (CMV, herpes,M.avium) Drug side effects ```

AIDS patients

Diarrhea Drug side effects Clostridium difficile Fecal impaction with overflow diarrhea Tube feeding

Institutionalize/ hospitalized patient

Diarrhea Implies a defect primarily in H2O absorption due to increase electrolyte secretion or reduced electrolyte absorption or ingestion of poorly absorbed substance

Watery diarrhea

Diarrhea Implies presence of one of a limited number of inflammatory or neoplastic diseases involving the gut.

Inflammatory diarrhea

Diarrhea Implies defective absorption of fat in the small intestine

Fatty diarrhea

Diarrhea Acute

Infection Food poisoning Food allergies Medication

Diarrhea Acute diarrhea Associated with systemic manifestations in infectious diarrhea Arthritis, urethritis, conjuctivitis, Related: salmonella, shigella, campylobacter, yersinia

Relter's syndrome

Diarrhea Acute diarrhea Associated with systemic manifestations in infectious diarrhea Related to yersiniosis

Autoimmune Thyroiditis, pericarditis

Diarrhea Acute diarrhea Associated with systemic manifestations in infectious diarrhea Related to E, coli and shigella

HUS

Diarrhea Acute diarrhea Associated with systemic manifestations in infectious diarrhea Complication of infectious diarrhea

Postinfectious IBS

Acute diarrhea can be a major symptom of systemic infection

``` Viral hepatitis Toxic shock syndrome Leptospirosis Listeriosis Legionellosis Septicimia ```

Chronic diarrhea Osmotic diarrhea Osmotic laxatives Carbohydrate malabsorption

Watery diarrhea

Chronic diarrhea Congenital syndrome Bacterial toxins Ileal bile acid malabsorption

Secretory diarrhea

Selected diarrheal syndrome Chronic diarrhea Abdominal pain is central to diagnosis Output is low

Diarrhea in irritable bowel syndrome

Selected diarrheal syndrome Does not wake the patient from sleep Weight loss is uncommon

Diarrhea in irritable bowel syndrome

More common endocrine disease that causes diarrhea

DM Hypertension Addison's disease

Selected diarrheal syndrome Peptic ulcer was healed surgically by vagotomy with pyloroplasty or antrectomy which causes Postop diarrhea

Diarrhea after gastric surgery

Characterized by flushing, hypotension, diarrhea and hypoglycemia Result from unregulated gastric emptying, osmotic shift, rapid release of peptide hormones from the gut

Dumping syndrome

Selected diarrheal syndrome Loss of surface area promotes malabsorption of fluid, electrolytes or nutrients, depending on the portion of the bowel resected

Diarrhea after bowel resection

Selected diarrheal syndrome Others

Ileostomy diarrhea | Post cholesystectomy diarrhea

Constipation 2 criteria for diagnosis

Straining Lumpy or hard stool Sensation of incomplete evacuation Sensation of anorectal obstruction

Constipation Sex

More frequent in women

Constipation Nationality

1.3x more frequent among non white Americans | Native in Africa and India less frequent

Constipation Recent onset, especilly with colidsuspect colonic CA, stricture Maybe associated with bleeding

Obstructive constipation

Constipation Present for years or even decades May be attributed to diet, lifestyle, and psychological

Functional constipation

Painful or difficult urination or burning sensation

Dysuria

Dysuria accompanied by Voiding at abnormally brief interval with or without increase in urine volume

Urinary frequency (pollakiuria)

Dysuria accompanied by Exaggerated sense of needing to urinate

Urgency

Dysuria accompanied by A delay between attempting to initiate urinationand the actual flow of urine

Hesitancy

Mechanism of dysuria and frequency Pain and initiation of voiding reflex

Bladder and urethral inflammation or irritation

Mechanism of dysuria and frequency Frequency and progresses to overflow incontinence or complete urinary retention

Severe urinary retention and distended bladder

Mechanism of dysuria and frequency Frequency

Contracted bladder

Causes of dysuria and frequency Diseases of urinary tract

``` UTI Bladder abnormalities Prostatic abnormalities Urethral abnormalities Calculus disease Glomerulonephritis ```

Causes of dysuria and frequency Other

Disease of genitalia Pregnancy Psychogenic disorders

Oliguria

Urine output of

Anura

Complete absence of urine | Urine volume

2 mechanism of anuria

Reduction of GFR | Obstruction to urine flow

Consequences of oliguria

Retention of nitrogenous waste products Expansion of ECF volume Disorders on electrolytes and acid-base balance

Oliguria etiology

Pre-renal causes -55% Intrinsic/ Renal causes -40% Post renal causes -5%

Oliguria Pre-renal causes

Hypovolemia Low CC Systemic vasodilation Intra renal vasoconstriction

Oliguria Intravascular volume depletion

``` Bleeding Renal losses GI losses Skin losses 3rd space sequestration ```

Oliguria Decrease CO

``` CHF Acute MI Pericardial effusion with tamponade Myocarditis Cardiomyopathy ```

Oliguria Peripheral vasodilation

Sepsis Anti hypertensive drugs Anesthesia Anaphylaxis

Oliguria Altered renal systemic vascular resistance ration

Hepatorenal syndrome Ace inhibitors Cyclooxygenase inhibitors

Oliguria Hyper viscosity

Multiple myeloma Polycythemia Macroglobulinemia

Refer to significant increase in 24 hours urine volume Exceeding 3L/day May be associated by urinary frequency

Polyuria

Urinary frequency at night | Awakening the patient more than once at night

Nocturnal

Excretion of abnormal quantities of erythrocytes in the urine

Hematuria

Gross of macroscopic Hematuria

Dis colored with blood Brown to brownish red Smoky or coffee or tea-colored or bright red

Covert of microscopic Hematuria

Urine is normal in color but with abnormali quantities of erythrocytes

Hematuria Urethral lesion

Initial Hematuria

Hematuria Any lesion above bladder neck

Total Hematuria

Hematuria Bladder, bladder neck, prostatic urethra

Terminal Hematuria

Passage of abnormally liquid or unformed stools at increased frequency.

Diarrhea