Diarrhea

Question 1

Definition of acute Diarrhea

Answer 1

> 3 stools per day for <2 weeks

Stools are looser and more frequent than baseline

Question 2

Definition of Chronic Diarrhea

Answer 2

Frequent and looser stools >4 weeks

Question 3

DDX. acute diarrhea in the general population

Answer 3

Infectious 
Early chronic
-IBS
-IBD
-Thyroid
-Maldigestion
-Neoplastic

Question 4

DDx for the infectious acute diarrheas

Answer 4

Parasites
-Amoebiasis
-Giardia 
Bacterial
-C. Diff
-Listeria
-Shigella
-Salmonella
-Campylobacter
Viral
-Rotavirus
-Norovirus
-Hep A

Question 5

DDX for infectious diarrhea in children

Answer 5

Campylobacter
Parvum
Cryptosporidia
Rotavirus

Question 6

DDX for diarrhea in travelers

Answer 6

Norovirus
Shigella
Salmonella
Campylobacter
Giardia

Question 7

DDX in the elderly

Answer 7

LESS LIKELY TO BE INFECTIOUS 
Ischemic bowel
Diverticulitis
Appendicitis
Neoplasm
Obstruction 
C. Diff if infectious

Question 8

Risks for C. Diff

Answer 8

Healthcare 
Immunocompromised
Older
Previous C. Diff
Recent antibiotics

Question 9

Which antibiotics are most likely to give you c diff

Answer 9

Fluoroquinolones

Question 10

Treatment for C. Diff

Answer 10

Vancomycin
2nd line=Metronidazole
Fidaxomycin
3rd line=Fecal transplant, monoclonal, or rifazamin

Question 11

Physical exam for diarrhea

Answer 11

Vitals (orthostatic)
JVP
Cap refill 
Abdo exam 
DRE

Question 12

Investigations for acute diarrhea

Answer 12

Maybe nothing 
Hb
WBC
Lytes
Creat
CRP
Albumin 
FIT
AXR

Question 13

Red flags for diarrhea

Answer 13

Age >50 
B symptoms 
Hematochezia 
Fever 
Arthritis
Anorexia 
Nocturnal symptoms

Question 14

When to hospitalize in the setting of diarrhea

Answer 14

Unrelenting fever
Bloody diarrhea 
Dehydration 
Prgnant 
Immunocompromised 
Severe pain

Question 15

Treatment Shigella, salmonella and E. coli

Answer 15

Cipro

Question 16

Whats the difference between Secretory and osmotic

Answer 16

Secretory does not decrease with fasting but osmotic does

Question 17

DDX. for Chronic diarrhea (10)

Answer 17

IBD
Overflow
Laxatives
IBS
Hyperthyroid
CF
Celiac
SIBO
Neoplasm 
Alcohol 
Caffeine 
Radiation

Question 18

Sx of IBD

Answer 18

Nocturnal symptoms 
Weight loss
Pus and hematochezia 
Arthitis 
Rash

Question 19

Treatment for IBD (Non pharm)

Answer 19

Colon cancer screening
Vaccines
Smoking cessation
Diet

Question 20

Medication treatment for IBD

Answer 20

Start with Sufasalzines or steroids
Can add in Thiopurines
Methotrexate
Anti TNF therapy (Vedolizumab, ustekinumab)

Question 21

List three things that should be avoided in Chrons

Answer 21

Oral 5 AHA
Antibiotics
Probiotics
Omega 3
Naltrexone 
Marijuana

Question 22

What tests should you do for IBS

Answer 22

Celiac serology

Colonoscopy if ?50

Question 23

What tests should you avoid for IBS

Answer 23

CRP, Fecal calprotectin, food allergy tests

Question 24

What treatment options non pharm for IBS

Answer 24

FODMAPS
CBT
Peppermint oi

Question 25

Pharm treatment of IBS

Answer 25

Psyllium 
Antispasmodics
Antidepressants (SSRI if constipation and TCA if diarrhea ) 
Lubiprostone (FOr constipation) 
Eluxadoline (diarrhea)

Question 26

List three medications and one non medication treatment to avoid in IBS

Answer 26

Loperamide
Osmotic lazative
Cholestyramine 
Acupuncture 
Herbal tea
Gluten free diet