Diarrhea Flashcards
Antibiotic-Associated Diarrhea Dx
best initial test: stool C. diff toxin test or PCR.***
=”nucleic amplification assay”
Blood and white blood cells may be present in the
stool
Antibiotic-Associated Diarrhea tx
1° Oral vancomycin** OR oral metro +barato
not working? tapered dose of vanco OR fidaxomicin.
not PO possible? EV metronidazol
After multiple recurrences of Antibiotic-Associated Diarrhea, tx
fecal transplantation.
What is fulminant C. diff?
High WBC
Metabolic acidosis
High lactate
High creatinine
onlinemed:”fever+leukocytosis+megacolon+renal fail”
fulminant C. diff Tx
use both vancomycin po and
metronidazole IV
fat Malabsorption Rare causes
tropical sprue and Whipple disease.
Vitamin D Deficiency Manifestation
Hypocalcemia, osteoporosis
Vitamin K Deficiency Manifestation
Bleeding, easy bruising
Vitamin B12 Deficiency Manifestation
Anemia, hypersegmented neutrophils, neuropathy
Celiac disease comes along with this disease _____in 10% of cases.
dermatitis
herpetiformis
Whipple Disease CXFx
also presents with: Cardiac symptoms* Arthralgias* Ocular findings Neurologic abnormalities (dementia, seizures)* Fever Lymphadenopathy Diarrhea* trots "CANT"
Whipple Disease Tx
ceftriaxone followed by TMP/SMX
Malabsorption Diagnostic Tests
iron deficiency: suggest celiac. kinda r/o chronic pancreatitis
Celiac disease: first test
Anti-tissue transglutaminase (TTG). This is the best!!!!!!!.
Then u can use
Antiendomysial antibody
IgA antigliadin antibody
most accurate diagnostic test for celiac disease
small bowel biopsy: flattening of the villi
also important to exclude lymphoma
Whipple disease and tropical sprue dx
most accurately diagnosed with a bowel wall biopsy showing the specific
organism.
Klebsiella, E coli and Enterobacter.
T. whippelii
Chronic Pancreatitis most accurate diagnostic test.
Secretin stimulation testing: pancreas will release a large volume of bicarbonate-rich fluids after the intravenous injection of secretin
Chronic Pancreatitis Dx also
Abdominal x-ray:
Abdominal CT scan:
calcification of the pancreas
D-xylose testing: normal results
Chronic
pancreatitis tx
Enzyme replacement
Celiac disease tx
Avoid gluten-containing foods such as wheat, oats, rye, or barley
Whipple disease tx
Ceftriaxone, trimethoprim/sulfamethoxazole
Tropical sprue tx
Trimethoprim/sulfamethoxazole, tetracycline
Carcinoid Syndrome CxFx
Diarrhea
Flushing
Wheezing
Cardiac abnormalities of the right side of the heart
Carcinoid Syndrome best initial diagnostic test
urinary 5-hydroxyindoleacetic acid (5 HIAA) test
Carcinoid Syndrome tx
octreotide (a synth. somatostatin)
Lactose Intolerance cx fx
No weight loss
no deficiency in calories not vits
>f in asians
Lactose Intolerance dx
stool osmolality is increased, but the usual way to make
the diagnosis is simply to remove all milk-containing products from the diet and
wait a single day for resolution of symptoms.
Lactose Intolerance tx
Avoiding milk products except yogurt
oral lactase replacement
acute and chronic diarrhea diff
<2 w Ac
here is subacute.
>4wk chro
Dx test if it’s not C diff.
Wath in the workup labs can guide you to find out whether it is invasive or enterotoxic, and how would you interpret that?
stool WBC, Reds,}both + in invasive
and Lactoferrin:+ for invasive. - for enterotoxic
if invasive diarrhea suspected, what to do?
culture + colonoscopy
Hemolytic-uremic Sx (HUS) Pathogen + CxFx + source of infection
on the spectrum of thromocytopenic thrombotic purpura. PATH: EHEC O157:H7
Blody diarrhea after eating uncooked meat+ anemia + renal failure
Hemolytic-uremic Sx HUS patho
microangiopatic hemolitic anemia
HUS Dx
blood smear: schistocytes
shiga like toxine assay
HUS Tx
supportive
plasma exchange
Avoid antibiotics and antimotility agents
Dialysis if AKI
Secretory Diarrhea labs
labs are normal! particularly they just have positive nocturnal symp. “even when slept its secreting!”
inflammatory chronic diarrhea labs findings
+RBC +WBC + mucose
Co
what to do if secretory diarrhea is suspected?
get a Endoscopy, C Diff testing, and hormones?
what to do if chronic inflammatory diarrhea is suspected?
colonoscopy + bx
VIPoma Dx
VIP level
VIPoma Tx
Resection
Carcinoid patho
5ht secretor tumor of the intestines. Usually that 5ht in metabolized by the liver and all ok. tho sometimes it can metastize to hepatic vein, right side of the heart. TOTALLY dif, to the carcinoma of the lung who goes to left heart. both fibrose and make valve disease.
Carcinoid Cx Fx
Right sided cardiac fibrosis
diarrhea
flush
Carcinoid Dx
5HIAA urine test
Carcinoid Tx
resection if resectable, if not: somatostatin
Duodenum malabsorption problems lead to missing what nutrients, and diseases
Folate: macrocytic
Iron: mycrocitic
Calcium: osteoporosis
carbohidrates: bolating, flatos.
terminal ileum malabsorption problems lead to missing what nutrients, and diseases
b12 A D E K
Vitamin E Deficiency Manifestation
nystagmus
some important test you could do at first when suspecting malabsorption
-100g fat load 72 hours
-d xylose absorption.
Usually no one does this duh
Tropical sprue dx
endoscopy + bx
Tropical sprue epidem
caribean farmer
biopsy of whipple
tropical sprue
celiac dissease
biopsy of whipple= electron mycrocsope, tons of dots for macrophages.
tropical sprue= Villous atrophy, elongated crypts, presence of inflammatory cells
celiac dissease=+-loss villi
S3 sound
s3, cierre de aortica y pulmonar because of the movement of the blood: increased blood in heart : ICC, hypertyroidism, Insuf Aortica, anemia, pregnancy, ., niños benigno
s4
justo antes de s1, hipertrofia ventricular.
