Diarrhea Flashcards
Definition of acute Diarrhea
> 3 stools per day for <2 weeks
Stools are looser and more frequent than baseline
Definition of Chronic Diarrhea
Frequent and looser stools >4 weeks
DDX. acute diarrhea in the general population
Infectious Early chronic -IBS -IBD -Thyroid -Maldigestion -Neoplastic
DDx for the infectious acute diarrheas
Parasites -Amoebiasis -Giardia Bacterial -C. Diff -Listeria -Shigella -Salmonella -Campylobacter Viral -Rotavirus -Norovirus -Hep A
DDX for infectious diarrhea in children
Campylobacter
Parvum
Cryptosporidia
Rotavirus
DDX for diarrhea in travelers
Norovirus Shigella Salmonella Campylobacter Giardia
DDX in the elderly
LESS LIKELY TO BE INFECTIOUS Ischemic bowel Diverticulitis Appendicitis Neoplasm Obstruction C. Diff if infectious
Risks for C. Diff
Healthcare Immunocompromised Older Previous C. Diff Recent antibiotics
Which antibiotics are most likely to give you c diff
Fluoroquinolones
Treatment for C. Diff
Vancomycin
2nd line=Metronidazole
Fidaxomycin
3rd line=Fecal transplant, monoclonal, or rifazamin
Physical exam for diarrhea
Vitals (orthostatic) JVP Cap refill Abdo exam DRE
Investigations for acute diarrhea
Maybe nothing Hb WBC Lytes Creat CRP Albumin FIT AXR
Red flags for diarrhea
Age >50 B symptoms Hematochezia Fever Arthritis Anorexia Nocturnal symptoms
When to hospitalize in the setting of diarrhea
Unrelenting fever Bloody diarrhea Dehydration Prgnant Immunocompromised Severe pain
Treatment Shigella, salmonella and E. coli
Cipro
Whats the difference between Secretory and osmotic
Secretory does not decrease with fasting but osmotic does
DDX. for Chronic diarrhea (10)
IBD Overflow Laxatives IBS Hyperthyroid CF Celiac SIBO Neoplasm Alcohol Caffeine Radiation
Sx of IBD
Nocturnal symptoms Weight loss Pus and hematochezia Arthitis Rash
Treatment for IBD (Non pharm)
Colon cancer screening
Vaccines
Smoking cessation
Diet
Medication treatment for IBD
Start with Sufasalzines or steroids
Can add in Thiopurines
Methotrexate
Anti TNF therapy (Vedolizumab, ustekinumab)
List three things that should be avoided in Chrons
Oral 5 AHA Antibiotics Probiotics Omega 3 Naltrexone Marijuana
What tests should you do for IBS
Celiac serology
Colonoscopy if ?50
What tests should you avoid for IBS
CRP, Fecal calprotectin, food allergy tests
What treatment options non pharm for IBS
FODMAPS
CBT
Peppermint oi
Pharm treatment of IBS
Psyllium Antispasmodics Antidepressants (SSRI if constipation and TCA if diarrhea ) Lubiprostone (FOr constipation) Eluxadoline (diarrhea)
List three medications and one non medication treatment to avoid in IBS
Loperamide Osmotic lazative Cholestyramine Acupuncture Herbal tea Gluten free diet
