Clinical Care of the Gastrointestinal System Flashcards
Diarrhea in an acute onset typically lasts less than ____ weeks and is most commonly caused by what?
2 weeks.
Infectious agents, bacterial toxins
How can infectious sources be transmitted, and what is their typical incubation period?
Fecal-oral contact, food and water
12-72 hours
Where does liquid feces move from to turn into well-formed solid stool?
> 90% of water is absorbed in the small intestine. The remaining water reaches the colon, transforms into liquid feces in the CECUM, and then turns into solid stool in the RECTOSIGMOID.
Disorders of what part of the intestines result in increased amounts of diarrheal fluid, and greater loss of water, electrolytes and nutrients?
Small intestine
This is a form of gastroenteritis caused by infectious agents and commonly seen in an operational setting. How is it defined?
Acute gastroenteritis
-Defined as three or more episodes a day or at least 200g per day.
-Rapid onset that lasts <2 weeks.
-May be accompanied by N/V, fever, and/or abdominal pain.
What is a common physical finding of a patient with acute viral gastroenteritis?
Mild diffuse abdominal tenderness
Soft abdomen with voluntary guarding
What are common infectious agents seen in acute infectious gastroenteritis?
Adherence, mucosal invasion, enterotoxin production, cytotoxic production
What are two common causes of gastritis?
Chronic NSAID use and chronic/large amounts of alcohol consumption
What is required to diagnose gastritis?
Histopathologic evidence of inflammation
What are the classifications of chronic diarrhea?
Osmotic
-Increased osmotic load, seen in medication use and Zollinger-Ellison syndrome
Inflammatory
-Inflammation of the mucosal lining of the intestine, like with IBD or malignancy
Secretory
-When secretions be secreting
Chronic infections
-Giardia Lamblia
Malabsorption syndromes
-Celiac, Whipple, Crohn’s, Lactose Intolerance
Motility disorders
-IBS
Inflammatory diarrhea suggests involvement of what organ by invasive bacteria, parasites, or toxins?
Colonic involvement
What do patients complain of in acute infectious diarrhea?
Bloody stool! Frequent, small volume bloody stool associated with fever, abdomen cramps, tenesmus, and fecal urgency.
What are common causes of acute infectious diarrhea?
Shigella, Salmonella, E. coli, E. coli O157:H7, Entamoeba histolytica
Community outbreaks suggest viral etiology or common food source
Recent illness in family suggests infectious origin
Ingestion of improperly stored/prepared food suggests food poisoning.
This type of diarrhea is generally milder and is caused by viruses or toxins that affect the small intestine.
Acute non-inflammatory diarrhea
Non-bloody in nature.
They interfere with salt and water balance, resulting in large volume watery diarrhea, often with N/V and cramps.
What are common causes of acute non-inflammatory diarrhea?
Viruses, enterotoxin-producing E. coli, Giardia Lamblia, crytosporidium, cyclospora
In food poisoning caused by a preformed toxin, the incubation period will be how long, and what will the major complaints be?
Short (1-6 hours after consumption)
Vomiting, fever is usually absent
In food poisoning where the organism is already present but the toxin hasn’t been produced in the food at time of consumption, what will your typical incubation period be? What will your complaints be?
Longer (8-16 hours)
Vomiting is less prominent. Abdominal cramping is frequent. Fever is absent.
Over 90% of patients with acute non-inflammatory diarrhea responds within __ days to what type of treatment?
5 days
Rehydration therapy or antidiarrheal agents (it is a self-limiting condition)
If diarrhea worsens or persists for __ days or more, what should be done?
7
Send stool sample for fecal leukocyte, ovum and parasite evaluation, and bacterial culture.
Prompt medical evaluation is indicated in what situations (diarrhea)?
Signs of inflammatory diarrhea
-Fever >38.5 C)
-Bloody diarrhea
-Abdominal pain
Six or more unformed stools in 24 hours
Profuse watery diarrhea or s/s of dehydration
For patients with diarrhea, hospitalization is required in what situations?
Severe dehydration, toxicity, marked abdominal pain
Send fecal sample for bacterial culture
Symptoms of diarrhea with a sudden onset
N/V and decreased appetite
Crampy abdominal pain
Loose stool
Malaise
Fatigue
Stool examination for Giardia Lamblia is important for what situations?
Waterborne and food borne disease outbreaks, daycare center outbreaks, illness in international travelers
Oral rehydration of a patient with diarrhea can be accomplished with what liquids?
Fluids containing glucose, Na+, K+, Cl-, and bicarbonate or citrate
A convenient mixture of 1/2 tsp salt, 1 tsp baking soda, 8 tsp sugar, and 8 tsp OJ diluted to 1L with water can be used.
Avoid high fiber foods, fats, dairy, caffeine and alcohol.
Oral electrolytes can be used alternatively, given at a rate of 50-200 mL/kg/24h.