Diarrhea Flashcards
What is Increased stool frequency
a) (more than 3 BM’s QD
(b) Liquidity of feces
Diarrhea
Diarrhea acute in onset and persisting for less than 2 weeks is most commonly caused by ___________, ___________
(either preformed or produced in the gut).
infectious agents, bacterial toxins
Infectious sources can be transmitted by __________, _______ and __________. Also usually has incubation periods between ________ hours.
fecal- oral contact, food and water
12 and 72 Hours
Pertinent Anatomy for diarrhea
(1) Small intestine
(2) Large intestine (colon)
(a) Cecum
(b) Rectosigmoid Colon
Pertinent Physiology
the ______ is the prime absorptive surface of the gastrointestinal tract.
Small intestine
Pertinent Physiology
>90% of all water absorbed in the GI tract takes place where
Small intestine
What part of the small intestine is the major site of water resorption
Jejunum
Disorders of the small intestine result in increased amounts of diarrheal fluid with a concomitantly greater loss of ______, ________ and ____
water, electrolytes, and nutrients
_______ are the most common causes of acute gastroenteritis
Infectious agents
Acute Infectious gastroenteritis is a common diarrheal illness seen in the _____ setting
Operational
What is the definition of diarrheal disease
three or more times per day or at least 200 g of stool per day
______ is defined as diarrheal disease of rapid onset that lasts less than two weeks and may be accompanied by nausea, vomiting, fever, or abdominal pain.
Acute gastroenteritis
Acute gastroenteritis involves the inflammation of the ____ and _____
stomach and portions of the small intestine
True/False
in acute Gastroenteritis both vomiting and diarrhea are usually present; however, either can occur alone.
True
Gastritis vs gastroenteritis
Gastritis involves ONLY the stomach
The two most common causes of gastritis are
- Chronic NSAID use
- Chronic alcohol use and/or large amounts of alcohol consumption
- Other etiologies for gastritis include trauma and critically ill patients that are admitted to the ICU.
Gastritis is typically self limited but patients may benefit from what treatment?
PPI and removal of the offending agent
If gastritis does not resolve with conservative management, consider referral for what testing?
endoscopy and H. Pylori testing
Chronic Diarrheal illnesses may be classified as
Secretory Inflammatory Chronic Infections Malabsorption syndromes Osmotic Motility disorders
What chronic diarrheal illness? due to an increase in the osmotic load presented to the intestinal lumen, either through excessive intake or diminished absorption Such as: 1) Medications 2) Zollinger- Ellison Syndrome
Osmotic
What chronic diarrheal illness?
when the mucosal lining of the intestine is inflamed
Inflammatory (or mucosal),
What chronic diarrheal illness?
when increased secretory activity occurs
Secretory
What is a parasite that can cause a chronic diarrheal illness
Giardia Lamblia
Chronic Diarrheal illnesses
These are examples of what?
Celiac disease, Whipple, Crohn disease, Lactose
Intolerance
Malabsorption syndromes
Irritable bowel syndrome is what type of disorder?
Motility disorder
From a diagnostic and therapeutic standpoint, it is helpful to classify infectious
diarrhea into syndromes that
1) produce inflammatory or bloody diarrhea
2) non- inflammatory, non-bloody, or watery
The term _________ suggests colonic involvement by invasive bacteria or parasites or by toxin production
“inflammatory diarrhea”
What classification of Acute Infectious Diarrhea
Patients complain of frequent bloody, small-volume stools, often associated with fever, abdominal cramps, tenesmus, and fecal urgency.
“inflammatory diarrhea”
Common organisms that cause “inflammatory diarrhea” are
Shigella,
Salmonella,
Escherichia coli,
E coli O157:H7
What is a common protozoal cause of Inflammatory diarrhea?
Entamoeba histolytica
Community outbreaks (including nursing homes, schools, cruise ships) suggest a ………
viral etiology or a common food source
Similar recent illnesses in family members suggest
an infectious origin
Ingestion of improperly stored or prepared food implicates
food poisoning
What type of diarrhea is generally milder and is caused by viruses or toxins that affect the small intestine.
Acute Non-inflammatory diarrhea
What type of diarrhea interferes with salt and water balance, resulting in large-volume watery diarrhea, often with nausea, vomiting, and cramps
Acute Non-inflammatory diarrhea
Acute Non-inflammatory diarrhea
Common causes
-rotavirus
-Norwalk virus
Vibrio cholerae virus
Vibrio parahaemolyticus
-enterotoxin- producing E coli
-other agents that can cause food-borne gastroenteritis
Common Protozoal causes of acute Non- inflammatory diarrhea
Giardia Lamblia,
cryptosporidium
cyclospora
What term denotes diseases caused by toxins present in consumed foods
“food poisoning”
When should a stool sample should be sent for fecal leukocyte, ovum and parasite evaluation, and bacterial culture
If diarrhea worsens or persists for more than 7 days
What is indicated for these
(a) Signs of inflammatory diarrhea manifested by any of the following: fever (> 38.5 degree Celcius), bloody diarrhea, or abdominal pain.
(b) The passage of six or more unformed stools in 24 hours.
(c) Profuse watery diarrhea and signs or symptoms of dehydration.
Prompt medical evaluation
What labs would you get for Diarrhea
(1) CBC/DIFF
(2) Fecal leukocyte
(3) Fecal O/P
(4) Stool culture
(5) C difficile assay, if recent hospitalization or antibiotics
(6) Stool examination for Giardia Lamblia if Giardias is suspected
What is an important cause of waterborne and foodborne disease, daycare center outbreaks, and illness in international travelers?
Giardia Lamblia (Giardiasis)
The goal of treatment for diarrhea is what
to allow for symptoms to subside
Stopping the diarrhea abruptly with antidiarrheal could do what?
prolong symptom relief if causes are ingested bacteria, parasites, etc.
True/ False
Most mild diarrhea will not lead to dehydration provided the patient takes adequate oral fluids containing carbohydrates and electrolytes.
True
_______may be used safely in patients with mild to moderate diarrheal illnesses to improve patient comfort.
Antidiarrheal agents
True/False
Empiric Antibiotic therapy is normally indicated in patients with acute, community-acquired diarrhea
False
normally not indicated
The infectious bacterial diarrheas for which for which antibiotic treatment is recommended are:
shigellosis cholera salmonellosis listeriosis C. difficile
The parasitic infection treatment is required for……
amebiasis
giardiasis
cryptosporidiosis
how do you treat Chronic Non-Infectious Diarrheal illnesses
Treat the underlying causes…..
What is preferred in patients with severe dehydration or those that cannot drink enough orally?
Intravenous fluids (lactated Ringer injection)
What diet would you recommend to your patient?
BRAT diet; avoid irritating foods
Antidiarrheal Agents used
- Loperamide (Imodium)
- Bismuth subsalicylate (Pepto- Bismol) - anti-diarrhea
Bismuth subsalicylate (Pepto- Bismol) - anti-diarrheal dose
Dose: 2 tablets or 30 mL PO q 30-60 min as needed,
Max 16 tablets or 240 mL/24 hours
Loperamide (Imodium) - anti- diarrheal, Dose
4mg initially, then followed by 2mg after each loose stool
maximum dose of 16mg/day
