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Gastroenterology > Approach To Diarrhoea > Flashcards

Approach To Diarrhoea Flashcards

1
Q

What is diarrhea

A

More than 200g per day
More than 3 times per day

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2
Q

Bristol stool chart

A
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3
Q

Acute diarree vs persistent vs chronic time frame

A

Acute 2 weeks
Persistent 2-4weeks
Chronic more than 4 weeks

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4
Q

What happens in acute diarrhea

A

The causing factor bypasses host mucosal immune and non-immune defense

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5
Q

What are the 4 agents of acute diarrhea?

A

Ingested bacterial toxin
Cytotoxic invasive organism
Systemic manifestation
Severe systemic infection

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6
Q

Ingested toxins symptoms

A

Profuse(watery) diarrhea
Not really vomiting or fever

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7
Q

Cytotoxic invasive organisms symptoms (abdo)

A

High fever
Abdo pain
Dysentery (bloody stool)

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8
Q

Systemic diarrhea causes

A

Arthritis
Urethritis
Conjunctivitis
Shigella
Salmonella
Compylobacter
Yersina

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9
Q

Systemic infections causing diarrhea

A

Hep
Legionella
Toxic shock syndrome

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10
Q

Travelers diarree causative organisms

A

E coli
Campylobacter
Giardia
Shigella
Aeromonas
Norovirus
Coronavirus
Salmonella

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11
Q

Food poisoning organisms

A

Salmonella(eggs,cream,seafood)
Shigella
Enterohemorrhagic E coli
Bacillus cereus (rice)
Staph aureus (mayonnaise and cream)
Vibrio species (contaminated water)

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12
Q

Diarree in immunocompromised population

A

Mycobacteria species
Cmv
Adenovirus
Herpes simplex
Cryptosporidium
Isospora belli
Microsporidia

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13
Q

Daycare attendees organisms

A

Giardia
Shigella
Cryptosporidium

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14
Q

Institutionalized patients diarrhea organism

A

Clostridium difficile (generally if patient had previous antibiotic use)

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15
Q

Non-infectious causes of diarrhea

A

Meds
Antibiotics
Cardiac arrhytmia
NSAIDS
PPI
Bronchodilator

Ischemic colitis

Diverticulosis

GVHD(after stem cell transplant)

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16
Q

When to investigate diarrhea

A

Dehydration
Bloody stool
Fever
More than 48 hours
Older than 70
Recent antibiotics
Community outbreaks
Severe abdominal pain
Immunocompromised patient

17
Q

Stool analysis

A

Microscopy
Antigen detection
Immunoassay(bacterial toxins,viral toxins,protozoal antigen)
Sigmoidoscopy

18
Q

Acute diarree treatment

A
19
Q

Chronic diarrhea classification

A

Secretory
Osmotic
Steatorrheal
Inflammatory
Dysmotility
Factitial

20
Q

Secretory diarrhea characterized and cause

A

Derangement in fluid and electrolytes
Characteristics:
Watery
Large vol
Painless
Persist with fasting
No osmolar gap

21
Q

Causes of secretory diarrhea

A

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

22
Q

Hormonal causes of secretory diarrhea

A

 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)

23
Q

What is osmotic diarrhea

A

 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

24
Q

What is Inflammatory diarrhea

A

 Generally pain, fever, bleeding, protein loss (anasarca)
 Inflammatory type stool
 Leukocytes
 Fecal calprotectin
 Multifactorial pathology

25
Q

Inflammatory diarrhea types

A

 IBD (UC/CD/Microscopic colitis)
 Eosinophilic gastroenteritis
 Radiation
 GVHD
 Behcets syndrome

26
Q

What is dysmotility diarrhea

A

 Rapid transit diarrhea
 Follows a ‘secretory’ type of diarrhea
 Types
Hyperthyroidism
Carcinoid syndromes
Drugs (prostaglandins)
Diabetic diarrhea (neuropathies)
IBS

27
Q

Factious diarrhea

A

 Munchausens disease (deception or self injury for
secondary gain)
 Eating disorders with laxative abuse

28
Q

Chronic diarrhea

A

Gastroenterology (1 decks)

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