Chapter 73: Disorders Presenting Primarily With Diarrhea Flashcards
Amount to tell if acute diarrhea?
10ml/kg/d
What is diarrhea?
An increased frequency of defecation, usually greater than 3 bowel movements per day for a daily stoll weight exceeding 250grams
In normal conditions, how many ml fluids is lost in the stool per day?
<100ml
Intestinal absorption occurs through the ____, and secretion occurs through the ____
Intestinal absorption occurs through the villi, and secretion occurs through the crypts
Two mechanism of fluid absorption and which of this is affected with toxin?
Passively with the transport of sodium which are afffected with toxin and actively with the absorption of glucose
In diarrheal states, enterotoxins, inflammation, or ischemia. Which are more affected, villi or crypt?
Villi so decrease absorption. Cryspts are more resilient after injury
Diarrheal illness is primarily a?
Diarrheal illness is primarily a viral infection (norovirus)
This drug stimulates small bowel motility
Clavulanate
How can you say if it acute or chronic diarrhea?
Acute (<3 weeks) whihc are of greatest concern or chronic (>3 weeks)
Patient with diarrhea had seizure episode. What is your diagnosis?
Shigellosis
Theophylline toxicity
Hyponatremia
After rural hiking, patient had diarrhea. What is your diagnosis?
Giardiasis
Reiter’s syndrome, the triad of arthritis, conjunctivitis, and urethritis or cervicitis
Salmonella, Shigella, Campylobacter, or Yersinia infection
An elderly patient presented at ED with bloody diarrhea and abdominal pain that is out of propoprtion. What will you suspect?
Mesenteric ischemia
The most common cause of antibiotic-associated or nosocomial diarrhea
Clostridium difficile
Patient had diarrhea and cough. Upon xray shows pneumonia. What is the cause?
Legionella
Fluid of choice for diarrhea patient that can tolerate oral feeding
Glucose- containing, caffeine-free beverages are the fluids of choice example is Gatorade
The major bacteria responsible are the toxin- and non–toxin-producing diarrhea is
E. coli
What symptoms need microbiologic studies to rule out bacterial or amoebic infection?
- Severe abdominal pain
- Fever
- Bloody stool
It is recommended treatment for all patients believed to have an infectious diarrhea
Ciprofloxacin
Complication of shiga toxin-producing E.coli in children
Hemolytic uremic syndrome
First choice for use in South and Southeast Asia. Safe for children and pregnant women
Azithromycin 1000mg as single dose
Treatment for E. histolytica diarrhea?
Metronidazole 750 milligrams PO three times a day for 10 days AND paromomycin 10 milligrams/kg three times a day PO for 7 days
Implicated in reducing the inci- dence of C. difficile infection if taken concomitantly with antibiotics but have no role in treating active or recurrent disease
Probiotics
Treatment for Salmonella non-typhi diarrhea?
Ciprofloxacin 750 milligrams PO twice a day for 5 days
Azithromycin 500 milligrams PO once a day for 7 days
Treatment for Shigella diarrhea?
Ciprofloxacin 750 milligrams PO twice a day for 3 days
Azithromycin 500 milligrams PO once a day for 3 days
How many days after start of antibiotic will diarrhea start in C. difficile infection?
7 to 10 days
Gold standard in diagnosis of C. difficile infection?
Cell culture cytotoxicity using selective growth medium
It is diagnostic procedure use if patient cannot produce a stool specimen due to ileus or negative assay
Colonoscopy
Primary treatment for C. difficile infection
Fidaxomicin (macrolide antibiotic) 200 milligrams PO twice a day for 10 days
Mild C.difficile (WBC <15,000mm3) diarrhea can be treated with
Vancomycin 125 milligrams PO four times a day for 10 days
What part of the GI is most commonly involved in crohn’s disease?
Ileum
The peak incidence of crohn’s disease occurs at what age group?
15-22 y/o
It worsens the crohn’s disease
- Smoking
- Oral contraceptive use
- NSAIDs
The most important pathologic feature of Crohn’s disease is?
The involvement of all the layers of the bowel and extension into mesenteric lymph nodes
What are the 3 general types of Crohn’s presentation?
- Inflammatory
- Stricture
- Penetrating
Crohn’s disease should also be considered in the differential diagnosis of patients with ____
Crohn’s disease should also be considered in the differential diagnosis of patients with fever of unknown etiology
This laboratory use to monitor disease activity
CRP and ESR
The best modality for imaging perianal fistulae in crohns disease
pelvic MRI
The diagnostic modality of choice for biliary complications in crohns disease
Ultrasound
How to confirm diagnosis of crohns disease?
Colonoscopy
Treatment for mild to moderate crohn’s disease
Sulfasalazine 3-5gm/day
If patient with crohns disease is medically resistant. What to give?
Anti-tumor necrosis factor antibodies
- infliximab
- adalimumab
- certolizumab gel
Complications of biologics drug for crohns disease?
Tuberculosis and hepatitis B
The most common reason for emergent surgery in Crohn’s disease
Obstruction. The distal small bowel is the most common site
The characteristic symptom of ulcerative colitis is ____
Bloody diarrhea
Part of GI that involved in the vast majority of ulcerative colitis patient
Rectosigmoid area
Can be effective in fulminant colitis nonresponsive to IV corticosteroids
IV cyclosporine (4 milligrams/kg per day) Infliximab (5 to 10 milligrams/kg per dose)
The only biologic indicated for ulcerative colitis
Infliximab (5 milligrams/kg per dose)
Most common complication of ulcerative colitis?
Blood loss from sustained hemorrhage
Plain radiograph of abdomen in toxic megecolon. You can see what?
- Air-filled colon greater than 6 cm in diameter
- Loss of colonic haustra and thumb printing
