Diarrhea

Question 1

What is the definition of diarrhea?

Answer 1

More than 3 bowel movements a day, liquidity of feces, and may vary from one individual to another.

Diarrhea can be acute or chronic.

Acute diarrhea lasting less than two weeks is often infectious agents and bacterial toxins.

Most often caused by infectious agents or bacterial preformed or formed in the gut toxins .

Question 2

How can infectious sources be transmitted?

Answer 2

Fecal oral contact
Food and water

Usually have incubation periods between 12 and 72 hours again.

The incubation period is the amount of time between when you’re infected and when you might see symptoms.

Question 3

Where is stool liquid at?

Answer 3

Cecum

Question 4

Where does stool become well formed?

Answer 4

Rectosigmoid colon

Question 5

What are very common causes of acute gastroenteritis?

Answer 5

Mucosal invasion, enterotoxin production, cytotoxic production.

Question 6

Osmotic diarrhea?

Answer 6

Medications

Question 7

Inflammatory?

Answer 7

When the mucosal lining of the intestine is inflamed such as inflammatory bowel disease or malignancy

Question 8

Secretory?

Answer 8

When increased secretory activity occurs

Question 9

Chronic infections?

Answer 9

Parasites like giardia lamblia

Question 10

Malabsorption syndromes?

Answer 10

Celiac disease, wipples, crohns, and lactose intolerance

Question 11

Motility disorders?

Answer 11

Irritable bowel syndrome

Question 12

How do you define acute infectious gastroenteritis?

Answer 12

Diarrheal disease is defined as three or more times per day or at least 200 g of stool a day.
Rapid onset
Nausea
Vomiting
Fever
Abdominal pain
Vomiting and diarrhea are both typically present, but may be there in isolation

Question 13

How do you treat acute infectious gastroenteritis?

Answer 13

Usually self limited but may acquire additional work up if a community outbreak occurs.

Question 14

How do you classify acute infectious diarrhea?

Answer 14

Inflammatory diarrhea sometimes defined as bloody diarrhea.

Non inflammatory referred to as non bloody or watery.

Question 15

What is the pathophysiology of inflammatory diarrhea?

Answer 15

Suggests colonic involvement by bacteria parasites or toxin production. Typically not caused by a virus. Pt has frequent bloody, small volume stools with fever and cramping.
Teens mud and fecal urgency are common.
Common bacteria causes include shigella, salmonella, E.Coli, or E.Coli 0157:H7.
Parasitic cause: entamoeba histolytica.

Question 16

What causes acute non-inflammatory diarrhea?

Answer 16

Viruses or toxins that affect the small intestine by interfering with salt and water balance.

Major cause of acute non inflammatory diarrhea is viral.

Causes include rotavirus, Norwalk virus, vibriones, enterotoxin producing E.Coli, cholera.

Protozoan causes giardia lamblia, cryptosporidium, and cyclospora.

Question 17

Food poisoning results from consuming foods with preformed toxins and toxins created insitu. What are there incubation periods?

Answer 17

1-6 hours for preformed toxins where vomiting is the main complaint, fever is usually absent.

8-16 hrs toxin is not preformed-vomiting is less prominent,abdominal cramping is frequent with or without fever

Question 18

How soon does acute non inflammatory diarrhea normally resolve itself?

Answer 18

With in 5 days to simple rehydration therapy and anti-diarrheals 90 percent of the time.

Question 19

If symptoms occur for more than 7 days what should occur?

Answer 19

Stool should be sent for fecal leukocyte, ova and parasite count and bacterial culture.

Question 20

When is prompt medical evaluation needed?

Answer 20

Inflammatory diarrhea manifests into a fever, bloody diarrhea or worsening abdominal pain
Six or more uniformed stills in 24 hrs
Profuse watery diarrhea and marked dehydration

Question 21

When will peritoneal findings be present?

Answer 21

With C difficile or enterohemorrhagic E Coli

Question 22

What is the dosage for loperamide?

Answer 22

4mg initially then followed by 2mg after every loose stool up to 16mg a day.

Question 23

What is the dosage for bismuth subsalicylate?

Answer 23

2 tablets or 30 ml PO q 30-60 min as needed, max 16 tablets or 240 ml/24 hours

Question 24

What infectious diarrheas for which ABX treatment is recommended?

Answer 24

Shigellosis, cholera, salmonellosis, listeriosis, C.Difficile.

Question 25

What parasitic infections require treatment?

Answer 25

Amebiasis, giardiasis, cryptosporidiosis.

Question 26

How do you treat chronic non-infectious diarrheal illnesses?

Answer 26

Treat the underlying causes.