Approach to Diarrhea Flashcards
56 yr/old female with HTN and fibromyalgia. • Previously “normal” BMs until 3 months ago. • Over past 3 months has 3 loose stools daily with urgency, preceded by crampy abdominal pain that his relieved with the BM. • Weight is up 20 lbs over the past 6 months. • No blood, mucus, fevers or chills.
Not diarrhea
• 21 yr/old college student who recently returned from spring break in Cancun. • Having crampy, watery, non-bloody BMs up to 6-8 times a day for the past 3 days. • Poor appetite and feels “run down”.
Yes diarrhea
• 83 yr/old female with osteoporsis who is otherwise healthy. • Complains of diarrhea over the past 3 years. • Having a single loose BM after a formed BM every morning, fine for the remainder of the day. • Denies incontinence, urgency or blood in her stool. • Weight and appetite are stable.
no she doesn’t
• 30 yr/old male with his of liver transplant for Primary Sclerosing Cholangitis who developed progressively worsening diarrhea over the past 3 months. • Started with 4-5 watery stool, but now up to 10-15 BMs per day with blood in >50%. • Having nocturnal BMs and episodes of fecal incontinence about once a week.
yes
Diarrhea_____ grams or____ mL per 24 hour period.
– Difficult to accurately measure • Patient has to be eating • High fiber diet can easily get over 300 gm/d • Does not factor in consistency or frequency
> 200 or 200 mL
Inadequate nutrient absorption
– Associated with steatorrhea
– Relieved by fasting.
Malabsorptive diarrhea
– Due to inflammatory disease
– Purulent, bloody stools
– Continue during fasting
Exudative diarrhea
To have malabsorptive diarrhea, need to have disturance in at least one of four phases
- Intraluminal digestion – Break down of proteins, carbohydrates, and fats into absorbable forms
- Terminal digestion – Hydrolysis of carbohydrates and peptides by disaccharidases and peptidases in the brush border
- Transepithelial transport – Defects in transport of nutrients, fluid, and electrolytes across the small intestinal epithelium
- Lymphatic transport – Defects in of lipid absorption.
Practical definition of normal bowel movemnts
of diarrhea
Normal Bowel Movement: – One BM every three days to 3 BMs every day
• Diarrhea – More than three lose/watery stools per day – Or a clear increase in frequency and decrease in consistency over baseline.
Clues for ‘Real’ Diarrhea
Consistency, urgency, incontience, nocturnal BMs, Flatuphobia
Where is water absorbed in the intestines
10L come out of stomach
6 L from JJ
- 5L from Ileum
- 4 from large intestine
Where do we absorb fat sobule vitamins?
lipids?
bile salts?
duodenum/jj
lipids in both duodenum and jj
bile salts in the ilium
what is abosorbed in the large intestine
water
vit k and biotin
Sodium, Chloride, potassium
Functions to absorb most water, nutrients, minerals, sugars and protein.
small bowel
Issues here causes:
Watery diarrhea, large volume and less frequent.
• Abdominal cramping, bloating, gas and weight loss.
Small bowel
Evidence of malabsorption, vitamin or nutrient deficiencies.
- Fever is rare
- Rare stool WBCs or occult blood
small bowel issues
Functions as storage and some fluid/electrolyte absorption
large bowel
Frequent, small, regular stools • Tenesmus (rectal “dry heaves”) • Painful BM
large bowel
what do we see in stool in large bowel issues?
Fever, bloody, mucoid stools • RBCs and WBC on stool smear.
Neither the small intestine nor the colon can maintain an____ gradient again serum
osmotic
Unabsorbed ions that remain in the lumen – Osmotically active ions act to pull water into the lumen of the bowel – Maintain an intraluminal osmolality =
290 mOsm/kg
Ingestion of what can cause osmotic diarrhea?
Ingestion of poorly absorbed ions or sugars or sugar alcohols – Mannitol, sorbitol – Magnesium, sulfate, and phosphate
