Diarrhea Flashcards
what is diarrhea
decreased consistency and/or frequency increased
>200 g/day
which is the group of population that gets diarrhea the most?
- 31-40
- 21-30
- 0-10
Evolution time of an acute diarrhea
- 25-48 h
- <24 h
- 49-72 h
as a doctor, which one should you stop first, diarrhea or dehydration?
Dehydration
In your body daily secretions, describe which secretions are endogenous and exogenous
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
duration of the acute d
up to 14 days
duration of the persistent d
> > 15 days
duration of the chronic d
> > 30 days
which types of e. coli produces dysentery
(bloody diarrhea)
EIEC (enteroinvaisve): enters the Intestinal Epithelium, cell destruction
EHEC (enterohemorragic): releases toxin similar to shiga
important questions to ask to the patient:
- how many times he goes to the bathroom normally and with the diarrhea
- consistency
- presence of blood
- presence of mucous
different types of physiopathology
- osmotic: solute is pulling water out
- secretory: secretory stimuli to the enterocyte leads to opening Cl channels and then H2O secretion into the lumen with absorption inhibition
- inflammatory or exudative: enterocyte damage causes a inflammatory response
- motor: increased motility (non-sufficient time in epithelium) and decreased motility (bacterial overgrowth causes constipation) related to diabetes because of neuropathy (enteric plexus)
clinical features of osmotic diarrhea and treatment
- vomit
- distention
- abdominal pain
- flatulence
- liquid diarrhea
- fasting
- NO FEVER
Tx: astringent diet, electrolytes, probiotics
exogenous and endogenous causes of osmotic diarrhea
5 & 3
q
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
exogenous and endogenous causes of secretory diarrhea
5 & 3
- 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
most frequent type of diarrhea
clinical features of secretory diarrhea
- Liquid abundant diarrhea
- fever
- Mild abdominal pain
- Dehydration
- fasting might stop it.
clinical features of inflammatory or exudative diarrhea
- Frequent, small-volume diarrhea
- Fever
- Fatigue
- Abdominal pain and cramping
- Acute abdomen
- Blood in your stool
- Mouth sores
how does a person can get inflammatory diarrhea
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.
causes of inflammatory diarrhea
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.
clinical features of motor diarrhea
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
in which three scenarios should we give antibiotic
- watery moderate to severe diarrhea after a trip
- watery moderate to severe diarrhea with fever (even if no trip)
- bloody diarrhea and px with fever
microorganism that causes Non bloody diarrhea
Virus
E. coli (ETEC, EPEC)
S. aureus
Difícil - C. difficile
microorganism that causes bloody diarrhea
esha casa vy
E. coli (EH, EI)
SHigella
Amiba (E. Histolytica)
Campylobacter
Salmonella
Vibrio cholerae
Yersinia enterolítica
with foods can cause non bloody
unrefrigerated meat, dairy (mayonese, cream), eggs, rice, seafood, shellfish
foods that can cause bloody diarrhea
eggs and undercook pork
pharmacologycal treatment for bacterial and parasitic diarrheas
- bacterial
- fluoroquinolones
- macrolides - parasitic
- metronidazole
parasitic diarrhea have mucous in it and isnt liquid
