Acute and Chronic Diarrhea Flashcards
What is the definition of acute diarrhea?
Loose or watery stools lasting < 14 days.
What is the definition of chronic diarrhea?
Loose or watery stools occurring at least 3x/day for > 14 days.
What is the most common cause of diarrhea in children?
Almost all diarrhea in children is due to an infectious agent, most commonly rotavirus.
If a patient presents with diarrhea, what six findings would prompt a more thorough evaluation for the underlying cause (since most diarrhea is self-limited and doesn’t require extensive evaluation)?
Infants < 2 months of age, gross blood in the stool, WBCs on microscopic exam of the stool, toxic-appearing child, immunocompromised child, or diarrhea that develops during hospitalization or after a course of antibiotics.
What additional laboratory testing should be performed in patients who present with diarrhea and concerning laboratory or physical exam findings?
Stool studies should be performed to look for invasive bacterial infection.
Why are C. difficile toxin assays unreliable in children < 1 year of age?
Enterocytes in infants have not yet developed the receptor for c. difficile toxin.
What should be on the differential for a child who presents with acute diarrhea and recent travel?
Toxigenic E. coli (Montezuma’s revenge) and giardia.
What should be on the differential for a child who presents with acute diarrhea and exposure to pet reptiles?
Salmonella
What should be on the differential for a child who presents with acute diarrhea, fever, and elevated WBCs?
Shigella
What should be on the differential for a child who presents with acute diarrhea and hemolytic uremic syndrome?
E. coli O157:H7
What should be on the differential for a child who presents with acute diarrhea and a history of swimming in lakes or drinking well water?
Giardia
What should be on the differential for a child who presents with acute diarrhea and consumption of pork intestines?
Yersinia
What are the indications for IV therapy in a child with diarrhea?
Shock, stool output > 10 ml/kg/hour, ileus, and monosaccharide intolerance.
What is the recommended treatment for acute diarrhea in an otherwise stable patient?
Oral rehydration therapy
Do children with resolving diarrhea require special diets?
No. After achieving rehydration, resume the child’s age-appropriate normal diet. The traditional bland diet results in a longer recovery time and has never been validated in a clinical trial.
List 5 categories of antidiarrheal agents.
Adsorbents, antimotility agents, probiotics, antisecretory agents, and bismuth subsalicylate.
How do adsorbents function in the setting of an acute diarrheal illness?
They mainly alter stool consistency (make it seem more solid) and do not affect absolute fecal water loss or shorten the length of the infection.
How do antimotility drugs function in the setting of an acute diarrheal infection?
These agents are generally opiates. They reduce gut motility but do not shorten the course of illness and can be dangerous in children since they may induce ileus and can worsen the underlying bacterial infection.
How do probiotics function in the setting of an acute diarrheal infection?
They are microorganisms that can be taken to modulate diarrhea which is due to bacterial or viral etiologies. Saccharomyces boulardii is a nonpathogenic yeast that is helpful in reducing the recurrence rate of C. difficile, and Lactobacillus rhamnosus GG lessens the severity of rotavirus infection.
How do antisecretory agents function in the setting of an acute diarrheal infection?
They act by stimulating sodium and chloride absorption and inhibiting chloride secretion.
List two examples of antisecretory agents for treating diarrhea.
Somatostatin and octreotide.
How does bismuth subsalicylate function as an antidiarrheal agent?
It has antimicrobial, antisecretory, and adsorbent properties.
In which situations would the use of bismuth subsalicylate be contraindicated?
Children and adolescents who are recovering from varicella or a flu-like illness should not use bismuth subsalicylate due to its association with Reye syndrome.
What side effect should parents be cautioned to expect with the use of bismuth subsalicylate?
This agent results in the formation of dark black stools.
