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Medicina forense > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

what is diarrhea

A

decreased consistency and/or frequency increased
>200 g/day

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2
Q

which is the group of population that gets diarrhea the most?

A
  1. 31-40
  2. 21-30
  3. 0-10
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3
Q

Evolution time of an acute diarrhea

A
  1. 25-48 h
  2. <24 h
  3. 49-72 h
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4
Q

as a doctor, which one should you stop first, diarrhea or dehydration?

A

Dehydration

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5
Q

In your body daily secretions, describe which secretions are endogenous and exogenous

A

Endogenous (7 liters)
1. saliva
2. gastric acid
3. intestinal secretion
4. pancreatic
5. biliary

Exogenous (2 liters)
1. food
2. beverage

because you have 7 L of liquid you can get diarrhea without eating

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6
Q

duration of the acute d

A

up to 14 days

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7
Q

duration of the persistent d

A

> > 15 days

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8
Q

duration of the chronic d

A

> > 30 days

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9
Q

which types of e. coli produces dysentery

(bloody diarrhea)

A

EIEC (enteroinvaisve): enters the Intestinal Epithelium, cell destruction
EHEC (enterohemorragic): releases toxin similar to shiga

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10
Q

important questions to ask to the patient:

A
  1. how many times he goes to the bathroom normally and with the diarrhea
  2. consistency
  3. presence of blood
  4. presence of mucous
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11
Q

different types of physiopathology

A
  1. osmotic: solute is pulling water out
  2. secretory: secretory stimuli to the enterocyte leads to opening Cl channels and then H2O secretion into the lumen with absorption inhibition
  3. inflammatory or exudative: enterocyte damage causes a inflammatory response
  4. motor: increased motility (non-sufficient time in epithelium) and decreased motility (bacterial overgrowth causes constipation) related to diabetes because of neuropathy (enteric plexus)
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12
Q

clinical features of osmotic diarrhea and treatment

A
  • vomit
  • distention
  • abdominal pain
  • flatulence
  • liquid diarrhea
  • fasting
  • NO FEVER

Tx: astringent diet, electrolytes, probiotics

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13
Q

exogenous and endogenous causes of osmotic diarrhea

5 & 3

q

A

exogenous
1. laxatives
2. Food (sorbytol, mannytol, xylitol)
3. Virus (rotavirus, adenovirus)
4. Parasites (Giardia, ryptosporidium)
5. Bacteria (EAEC, EPEC)

endogenous
1. Disacharidase deficit (lactase, sacarasa)
2. Malabsorption syndrome (Celiac disease)
3. Pancreatic exocrin insufficiency

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14
Q

exogenous and endogenous causes of secretory diarrhea

5 & 3

A
  • Exogenous
    Laxatives
    Medications (quinidine, theophylline, PG)
    Bacteria (V. cholerae, ETEC, Shigella, EPEC)
    Toxic (arsenic, OH, seashell (osteons), coffee, fungi)
    Toxins (S. aureus)
  • EndogenousBile salt malabsorption
    Hormone secretory tumors
    Neuropathy
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15
Q

most frequent type of diarrhea

clinical features of secretory diarrhea

A
  • Liquid abundant diarrhea
  • fever
  • Mild abdominal pain
  • Dehydration
  • fasting might stop it.
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16
Q

clinical features of inflammatory or exudative diarrhea

A
  • Frequent, small-volume diarrhea
  • Fever
  • Fatigue
  • Abdominal pain and cramping
  • Acute abdomen
  • Blood in your stool
  • Mouth sores
17
Q

how does a person can get inflammatory diarrhea

A

when the patient goes from doctor to doctor taking a lot of different antibiotics, brushing out the probiotics, therefore the epithelium is susceptible to grow an opportunistic bacteria named Clostridium difficile, we don’t get rid of it easily, so there is a lot of damage.

18
Q

causes of inflammatory diarrhea

A

Infectious
1. Invasive
- shigella
- EIEC
- Salmonella no typhi
- Campylobacter
2. Noninvasive (grows but do not evaginate)
EHEC
C. difficile
3. other
- ischemic colitis
- radiation
- autoinmune
- cancer

Noninfectious
Intestinal inflammatory disease (Crohn’s disease or Kusi)
Arrive to hospital because they have acute abdomen.

19
Q

clinical features of motor diarrhea

A

the most important is that when there is decreased motility the diarrhea is chronic, so px do not seek medical attention as it’s intermittent.
happens the most in diabetic patients
Treatment: loperamide (almost exclusive for motor)
procinetcs

20
Q

in which three scenarios should we give antibiotic

A
  1. watery moderate to severe diarrhea after a trip
  2. watery moderate to severe diarrhea with fever (even if no trip)
  3. bloody diarrhea and px with fever
21
Q

microorganism that causes Non bloody diarrhea

A

Virus
E. coli (ETEC, EPEC)
S. aureus
Difícil - C. difficile

22
Q

microorganism that causes bloody diarrhea

esha casa vy

A

E. coli (EH, EI)
SHigella
Amiba (E. Histolytica)
Campylobacter
Salmonella
Vibrio cholerae
Yersinia enterolítica

23
Q

with foods can cause non bloody

A

unrefrigerated meat, dairy (mayonese, cream), eggs, rice, seafood, shellfish

24
Q

foods that can cause bloody diarrhea

A

eggs and undercook pork

25
Q

pharmacologycal treatment for bacterial and parasitic diarrheas

A
  1. bacterial
    - fluoroquinolones
    - macrolides
  2. parasitic
    - metronidazole

parasitic diarrhea have mucous in it and isnt liquid

Medicina forense (5 decks)

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