Diarrhea Flashcards
What is the definition of diarrhea?
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 .
How can infectious sources be transmitted?
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.
Where is stool liquid at?
Cecum
Where does stool become well formed?
Rectosigmoid colon
What are very common causes of acute gastroenteritis?
Mucosal invasion, enterotoxin production, cytotoxic production.
Osmotic diarrhea?
Medications
Inflammatory?
When the mucosal lining of the intestine is inflamed such as inflammatory bowel disease or malignancy
Secretory?
When increased secretory activity occurs
Chronic infections?
Parasites like giardia lamblia
Malabsorption syndromes?
Celiac disease, wipples, crohns, and lactose intolerance
Motility disorders?
Irritable bowel syndrome
How do you define acute infectious gastroenteritis?
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
How do you treat acute infectious gastroenteritis?
Usually self limited but may acquire additional work up if a community outbreak occurs.
How do you classify acute infectious diarrhea?
Inflammatory diarrhea sometimes defined as bloody diarrhea.
Non inflammatory referred to as non bloody or watery.
What is the pathophysiology of inflammatory diarrhea?
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.
What causes acute non-inflammatory diarrhea?
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.
Food poisoning results from consuming foods with preformed toxins and toxins created insitu. What are there incubation periods?
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
How soon does acute non inflammatory diarrhea normally resolve itself?
With in 5 days to simple rehydration therapy and anti-diarrheals 90 percent of the time.
If symptoms occur for more than 7 days what should occur?
Stool should be sent for fecal leukocyte, ova and parasite count and bacterial culture.
When is prompt medical evaluation needed?
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
When will peritoneal findings be present?
With C difficile or enterohemorrhagic E Coli
What is the dosage for loperamide?
4mg initially then followed by 2mg after every loose stool up to 16mg a day.
What is the dosage for bismuth subsalicylate?
2 tablets or 30 ml PO q 30-60 min as needed, max 16 tablets or 240 ml/24 hours
What infectious diarrheas for which ABX treatment is recommended?
Shigellosis, cholera, salmonellosis, listeriosis, C.Difficile.
What parasitic infections require treatment?
Amebiasis, giardiasis, cryptosporidiosis.
How do you treat chronic non-infectious diarrheal illnesses?
Treat the underlying causes.
