Approach To Diarrhoea Flashcards
What is diarrhea
More than 200g per day
More than 3 times per day
Bristol stool chart
Acute diarree vs persistent vs chronic time frame
Acute 2 weeks
Persistent 2-4weeks
Chronic more than 4 weeks
What happens in acute diarrhea
The causing factor bypasses host mucosal immune and non-immune defense
What are the 4 agents of acute diarrhea?
Ingested bacterial toxin
Cytotoxic invasive organism
Systemic manifestation
Severe systemic infection
Ingested toxins symptoms
Profuse(watery) diarrhea
Not really vomiting or fever
Cytotoxic invasive organisms symptoms (abdo)
High fever
Abdo pain
Dysentery (bloody stool)
Systemic diarrhea causes
Arthritis
Urethritis
Conjunctivitis
Shigella
Salmonella
Compylobacter
Yersina
Systemic infections causing diarrhea
Hep
Legionella
Toxic shock syndrome
Travelers diarree causative organisms
E coli
Campylobacter
Giardia
Shigella
Aeromonas
Norovirus
Coronavirus
Salmonella
Food poisoning organisms
Salmonella(eggs,cream,seafood)
Shigella
Enterohemorrhagic E coli
Bacillus cereus (rice)
Staph aureus (mayonnaise and cream)
Vibrio species (contaminated water)
Diarree in immunocompromised population
Mycobacteria species
Cmv
Adenovirus
Herpes simplex
Cryptosporidium
Isospora belli
Microsporidia
Daycare attendees organisms
Giardia
Shigella
Cryptosporidium
Institutionalized patients diarrhea organism
Clostridium difficile (generally if patient had previous antibiotic use)
Non-infectious causes of diarrhea
Meds
Antibiotics
Cardiac arrhytmia
NSAIDS
PPI
Bronchodilator
Ischemic colitis
Diverticulosis
GVHD(after stem cell transplant)
When to investigate diarrhea
Dehydration
Bloody stool
Fever
More than 48 hours
Older than 70
Recent antibiotics
Community outbreaks
Severe abdominal pain
Immunocompromised patient
Stool analysis
Microscopy
Antigen detection
Immunoassay(bacterial toxins,viral toxins,protozoal antigen)
Sigmoidoscopy
Acute diarree treatment
Chronic diarrhea classification
Secretory
Osmotic
Steatorrheal
Inflammatory
Dysmotility
Factitial
Secretory diarrhea characterized and cause
Derangement in fluid and electrolytes
Characteristics:
Watery
Large vol
Painless
Persist with fasting
No osmolar gap
Causes of secretory diarrhea
Meds
Laxatives
Chronic ETOH
Toxins
Bowel resection
Mucosal disease
Enterocolic fistula
Bile acid diarrhea(excess bile secretion for ileal reabs)
Partial bowel obstruction,stricture or faecal impaction
Hormonal causes of secretory diarrhea
Hormone induced secretory diarrhea (classic type of
secretory diarrhea)
Carcinoid tumors (metastatic or primary bronchial
Flushing, wheeze, dyspnea, right sided heart disease
Serotonin – histamines – prostaglandins – various kinins
Gastrinomas
PUD
But 10% present with only diarrhea
Due to maldigestion of fat by inactive pancreatic enzymes due to
low luminal pH
VIPoma
Non-B cell pancreatic adenoma
Watery hypo K, achlorhydia syndrome (pancreatic cholera)
Massive stooling (>3L/day)
Life threatening dehydration and effects of electrolyte
abnormalities (K/Mg/Ca)
Hyperthyroidism and medullary thyroid Ca (Calcitonin)
What is osmotic diarrhea
Ingested, poorly absorbed, osmotically active solute
draws fluid back into the lumen
Feacal water output increases in proportion to the
solute load
Ceases with fasting
Stool osmotic gap > 50mosmol/L = 290 - 2× (Naf +Kf)
Limitations: Must be immediate as ongoing CHO
fermentation
What is Inflammatory diarrhea
Generally pain, fever, bleeding, protein loss (anasarca)
Inflammatory type stool
Leukocytes
Fecal calprotectin
Multifactorial pathology
Inflammatory diarrhea types
IBD (UC/CD/Microscopic colitis)
Eosinophilic gastroenteritis
Radiation
GVHD
Behcets syndrome
What is dysmotility diarrhea
Rapid transit diarrhea
Follows a ‘secretory’ type of diarrhea
Types
Hyperthyroidism
Carcinoid syndromes
Drugs (prostaglandins)
Diabetic diarrhea (neuropathies)
IBS
Factious diarrhea
Munchausens disease (deception or self injury for
secondary gain)
Eating disorders with laxative abuse
Chronic diarrhea
