Block 1: Diarrhea Flashcards
On Bristol stool chart what is diarrhea?
5-7
What is diarrhea?
Decreased frequency and decreased consistency of fecal discharge
What is acute diarrhea?
Less than 14 day duration
What is chronic diarrhea?
Greater than 14 day duration
Usually secondary
RF of diarrhea?
- Day care
- Food handlers or caregivers
- Congregate living conditions
- Consumption of unsafe foods
- Diverticulitis, immunocompromised
What is viral GEitis?
Norovirus: transmitted by contaminated water or food, people, surfaces
Rotavirus: common in infants and children (seasonal Nov-Fev) - PO vaccines
What is bacterial GEitis?
Food borne trasmission
Campylobacter, E.coli, Salmonella
Water diarreha or bloody
Foodbourne GEitis?
Norovirus
Linked to poor sanitation and manufacturing practices in food facilities
What is traveler’s diarrhea?
- Acquired mainly by ingestion of contaminated food or water
- Fruits, vegetables, raw meat, seafood, water, ice cubes
What is food induced diarrhea?
Provoked by food intolerance or foods that are excessively spicy, fatty, or high fiber
What is protozoal diarrhea?
Cryptosporidium, Entamoeba histolytica
When would diarrhea become fatal?
- Lack of access to clean water in natural disasters
- prolonged or voluminous diarrhea
- Dehydration and electrolyte imbalances
- Develoiping countries
How can you prevent diarrhea?
- Food handling
- Handwashing
- Water santitation
- Environmental cleaning
Meidcation that induce diarrhea?
- Mag
- Laxatives
- Antibiotics
- Metformin
- PPI/H2RA
How do you prevetn traveler’s diarrhea?
- Bottled water or treatment of tap water
- Caution with consumption of fresh fruits/vegetables
- Prophylactic antibitoics not recommended
What are tx of Traveler’s diarrhea?
- Antibiotics or Bismuth subsalicylate
- Azithromycin 1g po x 1 dose
What are the tx goals of diarrhea?
- Mild easy digestible diet
- Oral Rehydration Solutions (ORS)
- Provide symptomatic relief: EXCEPTIONS: Toxic/warning signs (blood, severity, excessive fever, dehydration)
Opioids, Bismuth subsalicylate - Reverse/Treat curable causes
How do you treat toxic patients?
require hospitalization, IV fluids and electrolyte administration, and empiric antibiotic therapy waiting for culture and sensitivity results
What are the exclusions for diarrhea self-treatment?
- Young age
- Persistent fever
- Visible blood, pus, or mucus in stool
- Vomiting
- High output
- Dehydration
- Mental changes
- Abdominal distress
- Pregnancy
- Chronic
- Nonresponsive to ORS
How do you treat acute diarrhea?
What is ORS?
Rehydration using ORS is preferred for mild-moderate diarrhea
What are the pahses of ORS?
- Rehydration-over 3-4 hours quickly replaces water and electrolytes to restore normal body composition
- Maintenance-given to maintain normal body composition until adequate dietary intake is reestablished
What is loperamide? MOA?
Synthetic opioid agonist that lacks central nervous system effects
Slows intestinal motility and allows absorption of electrolytes and water
Helps reduce daily fecal volume, increased viscosity and bulk volume, and reduced fluid and electrolyte loss
Use in 6+
ADR for loperamide? CI?
DZ and constipation
CI: invasive bacterial diarrhea
Concerns for abuse at high doses (euphoria)
