Diarrhea Flashcards
what constitutes diarrhea? (2)
increased stool frequency over 3x per day
OR
loose/watery stools
what is the most common cause of acute diarrhea in adults?
infectious
diarrhea for 14 days or fewer
acute
diarrhea for more than 14 days but less than 30 days
persistent
diarrhea for more than 30 days
chronic
what will be different between inflammatory and noninflammatory diarrhea?
inflammatory diarrhea results in bloody stools, fecal leukocytes, and fevers
what is the most common cause of nausea, vomiting, and diarrhea in the US?
viral gastroenteritis
what is the most common cause of the stomach flu?
norovirus
what virus is most likely found in infants and young kids?
rotaviruses
protozoa found in untreated water while camping with beavers, spreads quickly within families
giardia
protozoa found in untreated water while camping, affecting immune suppressed individuals
cryptosporidium
preformed enterotoxin found in meats eggs, diary products; causes N/V, diarrhea, and cramping
staph aureus
preformed enterotoxin found in starchy foods left at room temperature
bacillus cereus
preformed enterotoxin found in beef, poultry, and gravy; causes diarrhea and cramping
clostridium perfringes
enterotoxin found in undercooked ground beef, unpasteurized milk/juice, and water. causes diarrhea and cramping.
E. coli
enterotoxin found in fecal contamination of food and water; causes profuse watery diarrhea (rice-water stools)
vibrio cholerae
virus that is more common in immunocompromised patients
cytomegalovirus
parasite from untreated water
entamoeba hystolytica
found in contaminated oysters or shellfish with onset of 2-24 hours
vibrio parahaemolyticus
opportunistic infection when normal flora has been reduced, caused by antibiotic usage
C. difficile
found in sandwiches, salads, and raw food that come into contact with infected person
shigella
causes fever, stiff neck, confusion and vomiting
listeria
what 6 labs should be ordered for acute diarrhea?
CBC/CMP
stool leukocytes/culture
stool assay for C. diff
PCRs
what diagnostic should be ordered for acute diarrhea that is present over 10 days?
stool O&P
what 4 S&S indicate dehydration?
tachycardia
hypotension
orthostatic hypotension
dry mucous membranes
what 3 S&S indicate inflammatory disease?
fever
bloody stools
severe abd pain/tenderness
what is the treatment for acute diarrhea? (2)
BRAT diet + hydration
loperamide: only for mild-moderate
probiotics
for acute diarrhea, when should empiric antibiotics be considered? (7)
fever
> 6 stools/day
bloody stools
immunocompromised pts
clinical dehydration
> 70 yo
comorbidities
what are the empiric antibiotics that can be used?
azithromycin x 3 days
ciprofloxacin x 3-5 days
increased stool frequency of more than 3/day, stool weight over 200 g/day, and decreased fecal consistency over a 4-week period
chronic diarrhea
what is the most common cause of osmotic diarrhea (increased stool osmotic gap)?
malabsorption syndromes
characterized by abdominal distention, bloating, and flatulence d/t increased gas production
malabsorption of carbs
how to diagnose malabsorption syndrome? (2)
elimination trial x 2-3 weeks
hydrogen breath test
high volume of stool, with normal stool osmotic gap
secretory diarrhea
what causes secretory diarrhea? (2)
endocrine tumors
bile salt malabsorption
what is the most common cause of chronic diarrhea in young adults?
IBS
abnormal motility and malabsorption without pain or abnormal findings
functional diarrhea
what inflammatory processes cause chronic diarrhea? (2)
what symptoms present? (2)
ulcerative colitis
crohn disease
blood
pus
what lab is recommended for signs of malabsorption?
IgA-tTG
what positive test suggests malabsorption?
fecal fat
what diagnostic is recommended to rule out IBD and cancers?
colonoscopy w/ mucosal biopsy
what diagnostic is recommended for suspected small intestinal malabsorption conditions?
upper endoscopy
what are 4 antidiarrheal options for chronic diarrhea?
loperamide
codeine + opium
clonidine
octreotide
what med can be used for secretory diarrhea?
octreotide
diarrhea beginning 2-10 days into travel; commonly a bacterial infection
traveler’s diarrhea
what are 3 most common etiologies of traveler’s diarrhea?
E. coli
shigella
campylobacter
a patient presents with 7-10 stools/day, abdominal cramping, and nausea +/- vomiting. Dx?
traveler’s diarrhea
what is the treatment for mild traveler’s diarrhea? (3)
hydration
bismuth subsalicylate
loperamide (use caution)
what is the treatment for moderate-severe traveler’s diarrhea? (3)
hydration
+/- antibiotics if fever, bloody stools, or worsening abdominal pain:
azithromycin x 3 days
OR
ciprofloxacin x 3-5 days
