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Gastrointestinal > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

What is Increased stool frequency
(a) (more than 3 BM’s QD)
(b) Liquidity of feces

A

Diarrhea

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2
Q

Diarrhea acute in onset and persisting for less than 2 weeks is most commonly caused by ___________, ___________
(either preformed or produced in the gut).

A

infectious agents, bacterial toxins

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3
Q

Infectious sources can be transmitted by __________, _______ and __________. Also usually has incubation periods between ________ hours.

A

fecal- oral contact, food and water
12 and 72 Hours

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4
Q

Pertinent Anatomy for diarrhea

A

(1) Small intestine
(2) Large intestine (colon)
(a) Cecum
(b) Rectosigmoid Colon

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5
Q

Pertinent Physiology
the ______ is the prime absorptive surface of the gastrointestinal tract.

A

Small intestine

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6
Q

Pertinent Physiology
>90% of all water absorbed in the GI tract takes place where

A

Small intestine

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7
Q

What part of the small intestine is the major site of water resorption

A

Jejunum

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8
Q

Disorders of the small intestine result in increased amounts of diarrheal fluid with a concomitantly greater loss of ______, ________ and ____

A

water, electrolytes, and nutrients

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9
Q

_______ are the most common causes of acute gastroenteritis

A

Infectious agents

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10
Q

Acute Infectious gastroenteritis is a common diarrheal illness seen in the _____ setting

A

Operational

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11
Q

What is the definition of diarrheal disease

A

three or more times per day or at least 200 g of stool per day

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12
Q

______ 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.

A

Acute gastroenteritis

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13
Q

Acute gastroenteritis involves the inflammation of the ____ and _____

A

stomach and portions of the small intestine

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14
Q

True/False
in acute Gastroenteritis both vomiting and diarrhea are usually present; however, either can occur alone.

A

True

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15
Q

Gastritis vs gastroenteritis

A

Gastritis involves ONLY the stomach

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16
Q

The two most common causes of gastritis are

A

-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.

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17
Q

Gastritis is typically self limited but patients may benefit from what treatment?

A

PPI and removal of the offending agent

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18
Q

If gastritis does not resolve with conservative management, consider referral for what testing?

A

endoscopy and H. Pylori testing

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19
Q

Chronic Diarrheal illnesses may be classified as

A

Secretory
Inflammatory
Chronic Infections
Malabsorption syndromes
Osmotic
Motility disorders

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20
Q

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

A

Osmotic

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21
Q

What chronic diarrheal illness?
when the mucosal lining of the intestine is inflamed

A

Inflammatory (or mucosal),

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22
Q

What chronic diarrheal illness?
when increased secretory activity occurs

A

Secretory

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23
Q

What is a parasite that can cause a chronic diarrheal illness

A

Giardia Lamblia

24
Q

Chronic Diarrheal illnesses
These are examples of what?
Celiac disease, Whipple, Crohn disease, Lactose
Intolerance

A

Malabsorption syndromes

25
Q

Irritable bowel syndrome is what type of disorder?

A

Motility disorder

26
Q

From a diagnostic and therapeutic standpoint, it is helpful to classify infectious
diarrhea into syndromes that

A

1) produce inflammatory or bloody diarrhea
2) non- inflammatory, non-bloody, or watery

27
Q

The term _________ suggests colonic involvement by invasive bacteria or parasites or by toxin production

A

“inflammatory diarrhea”

28
Q

What classification of Acute Infectious Diarrhea
Patients complain of frequent bloody, small-volume stools, often associated with fever, abdominal cramps, tenesmus, and fecal urgency.

A

“inflammatory diarrhea”

29
Q

Common organisms that cause “inflammatory diarrhea” are

A

Shigella,
Salmonella,
Escherichia coli,
E coli O157:H7

30
Q

What is a common protozoal cause of Inflammatory diarrhea?

A

Entamoeba histolytica

31
Q

Community outbreaks (including nursing homes, schools, cruise ships) suggest a ………

A

viral etiology or a common food source

32
Q

Similar recent illnesses in family members suggest

A

an infectious origin

33
Q

Ingestion of improperly stored or prepared food implicates

A

food poisoning

34
Q

What type of diarrhea is generally milder and is caused by viruses or toxins that affect the small intestine.

A

Acute Non-inflammatory diarrhea

35
Q

What type of diarrhea interferes with salt and water balance, resulting in large-volume watery diarrhea, often with nausea, vomiting, and cramps

A

Acute Non-inflammatory diarrhea

36
Q

Acute Non-inflammatory diarrhea
Common causes

A

-rotavirus
-Norwalk virus
Vibrio cholerae virus
Vibrio parahaemolyticus
-enterotoxin- producing E coli
-other agents that can cause food-borne gastroenteritis

37
Q

Common Protozoal causes of acute Non- inflammatory diarrhea

A

Giardia Lamblia,
cryptosporidium
cyclospora

38
Q

What term denotes diseases caused by toxins present in consumed foods

A

“food poisoning”

39
Q

When should a stool sample should be sent for fecal leukocyte, ovum and parasite evaluation, and bacterial culture

A

If diarrhea worsens or persists for more than 7 days

40
Q

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.

A

Prompt medical evaluation

41
Q

What labs would you get for Diarrhea

A

(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

42
Q

What is an important cause of waterborne and foodborne disease, daycare center outbreaks, and illness in international travelers?

A

Giardia Lamblia (Giardiasis)

43
Q

The goal of treatment for diarrhea is what

A

to allow for symptoms to subside

44
Q

Stopping the diarrhea abruptly with antidiarrheal could do what?

A

prolong symptom relief if causes are ingested bacteria, parasites, etc.

45
Q

True/ False
Most mild diarrhea will not lead to dehydration provided the patient takes adequate oral fluids containing carbohydrates and electrolytes.

A

True

46
Q

_______may be used safely in patients with mild to moderate diarrheal illnesses to improve patient comfort.

A

Antidiarrheal agents

47
Q

True/False
Empiric Antibiotic therapy is normally indicated in patients with acute, community-acquired diarrhea

A

False
normally not indicated

48
Q

The infectious bacterial diarrheas for which for which antibiotic treatment is recommended are:

A

shigellosis
cholera
salmonellosis
listeriosis
C. difficile

49
Q

The parasitic infection treatment is required for……

A

amebiasis
giardiasis
cryptosporidiosis

50
Q

how do you treat Chronic Non-Infectious Diarrheal illnesses

A

Treat the underlying causes…..

51
Q

What is preferred in patients with severe dehydration or those that cannot drink enough orally?

A

Intravenous fluids (lactated Ringer injection)

52
Q

What diet would you recommend to your patient?

A

BRAT diet; avoid irritating foods

53
Q

Antidiarrheal Agents used

A

-Loperamide (Imodium)
-Bismuth subsalicylate (Pepto- Bismol) - anti-diarrhea

54
Q

Bismuth subsalicylate (Pepto- Bismol) - anti-diarrheal dose

A

Dose: 2 tablets or 30 mL PO q 30-60 min as needed,
Max 16 tablets or 240 mL/24 hours

55
Q

Loperamide (Imodium) - anti- diarrheal, Dose

A

4mg initially, then followed by 2mg after each loose stool
maximum dose of 16mg/day

Gastrointestinal (25 decks)

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