Diarrhea Flashcards
Define diarrhea
Passage of abnormally liquid or unformed stools at an increased frequency (3+/day)
Define tenesmus
Painful rectal spasms w/a strong urge to defecate but little passage of stool
Define dysentery
Abdominal pain, tenesmus, passage of bloody diarrhea
Define hematochezia
Passage of bright red bloody stools
What is the MC cause of acute diarrhea?
Infectious
Define acute diarrhea
Less than 2 weeks of diarrhea
What are the types of acute diarrhea?
- Inflammatory
- Non inflammatory
Characteristics of non-inflammatory diarrhea
- Mild and self limited
- Watery
- NOT bloody
- A/w periumbilical cramps and bloating
What does N/V with non-inflammatory diarrhea suggest?
Small intestine source (disrupts normal absorption and secretory process)
Are fecal leukocytes present or absent in non-inflammatory diarrhea?
NOT present (tissue invasion does not occur)
Etiologies of non-inflammatory diarrhea
- Viral (noro, rota)
- Protozoal (giardia, cyclospora)
- Bacterial (preformed enterotoxin production, enterotoxin production)
What are common bacterial sources of non-inflammatory diarrhea?
- S. aureus, B. cereus, C. perfringens (preformed enterotoxin production)
- ETEC, vibrio cholerae (enterotoxin production)
Define inflammatory diarrhea
- Colonic tissue damage occurs d/t bacterial or toxin invasion
- Fever and bloody/pus diarrhea
- A/w LLQ cramps, urgency, tenesmus
What is the volume of inflammatory diarrhea?
Usually SMALL in volume b/c the organisms involve the colon
What components are present in inflammatory diarrhea?
Fecal leukocytes or lactoferrin (d/t tissue invasion)
Are fecal leukocytes present or absent in inflammatory diarrhea?
YES present, d/t tissue invasion
Etiologies of inflammatory diarrhea
- Cytomegalovirus
- Entamoeba histolytica
- EHEC, V. parahaemolyticus, C. diff (cytotoxin production)
- Shigella, C. jejuni, Salmonella (mucosal invasion)
What are some non-infectious causes of acute diarrhea?
- IBD/IBS
- Celiac
- Lactose intolerance
- Colorectal cancer
- Malabsorption
- Meds side effects
How is mild dehydration characterized?
- Thirst, dry mouth
- Decreased sweat, urine
- Slight weight loss
How is moderate dehydration characterized?
- Orthostatic BP changes
- Skin tenting
- Sunken eyes
How is severe dehydration characterized?
- Lethargy
- Confusion
- Weak pulse
- Hypotension
- Shock
What items should be avoided in the diet of someone with acute diarrhea?
- High fiber foods
- Fats
- Milk products
- Caffeine
- Alcohol
What diet is encouraged as treatment of acute diarrhea?
BRAT (bananas , rice, applesauce, toast) diet
What is the mainstay of treatment for acute diarrhea?
Rehydration (oral sugar-electrolyte solutions, IV fluids)
How do probiotics treat acute diarrhea?
Currently being debated
Which pharmacologic agents are given for comfort only in acute diarrhea?
Anti-diarrheal agents
When are anti-diarrheal agents used to treat acute diarrhea?
- Mild to moderate
- Symptomatic relief only
- Opioid agents (like Imodium)
- Bismuth subsalicylate (Pepto-Bismol)
When should anti-diarrheal agents NOT be used in acute diarrhea?
Do NOT use in pts w/bloody diarrhea, high fever or systemic toxicity
Describe antibiotic treatment of acute diarrhea
- Empiric NOT indicated for all pts
- Quinolones are PO drugs of choice
Antibiotic treatment of acute diarrhea is recommended for which conditions?
- Shigellosis
- Cholera
- Extraintestinal salmonellosis
- Traveler’s diarrhea
- C. diff
- Giardia
- Amebiasis
Antibiotic treatment of acute diarrhea is NOT recommended for which conditions?
- Campylobacter
- Shig-toxin-producing E. coli
- Aeromonas
- Yersinia
- Except in severe disease
What are prophylactic measures of infectious diarrhea?
- Hand hygiene
- Travelers eat only hot/fresh food, boiled or treated water
- Bismuth subsalicylate
- Probiotic (MAY be effective)
- Proph abx (not recommended unless at high risk)
- Vaccines (rotavirus, S. typhi, V. cholerae)
When are prophylactic antibiotics recommended for infectious diarrhea?
NOT recommended unless at high risk
Define chronic diarrhea
- Diarrhea that is present for 4+ weeks
- Most are non-infectious
Are most chronic diarrhea cases infectious or non-infectious?
Non-infectious
Classifications of chronic diarrhea
- Secretory conditions
- Osmotic diarrheas
- Inflamm conditions
- Malabsorptive conditions
- Motility disorders
- Factitious
- Iatrogenic
Define secretory chronic diarrhea
- Decreased fluid and electrolyte transport across enterocolonic mucosa
- Watery, LARGE volume stools
- NO change in symptoms w/fasting
What can cause secretory chronic diarrhea?
- Persistent bacterial infections like C. diff, Giardia
- Hormone producing tumors
- Laxative abuse
Define osmotic chronic diarrhea
- Ingestion or malabsorption of an osmotically active substance
- Stool volume will DECREASE w/fasting
- Osmotic gap present in stool
What is the MC cause of chronic diarrhea in adults?
Lactase deficiency
What are the MC causes of osmotic chronic diarrhea?
- Carb malabsorption (lactose, fructose)
- Mg containing antacids or laxatives
What type of chronic diarrhea presents with large volume of watery stools? No changes in symptoms with fasting?
Secretory
What type of chronic diarrhea results in a decrease of stool volume with fasting?
Osmotic
Define inflammatory chronic diarrhea
- S/S of inflammation
- Positive fecal leukocytes/lactoferrin
- Caused by IBD, meds, immunodeficiency, malignancies
Define malabsorption chronic diarrhea
- Weight loss, steatorrhea (greasy, foul smelling), and nutritional deficiencies
- Osmotic gap present in stool
- Positive fecal fat stain
What type of chronic diarrhea shows osmotic gap in stool and positive fecal fat stain?
Malabsorption causes
What is the MC cause of chronic diarrhea in young adults?
IBS
What type of chronic diarrhea would be caused by an underlying systemic disease or prior abdominal surgery?
Motility disorders
Define factitious causes of chronic diarrhea
- 15% of unexplained diarrheas
- Munchausen’s syndrome
- Eating disorders
What type of chronic diarrhea presents with really greasy, foul-smelling stool?
Malabsorption causes
What warrants further evaluation when diagnosis chronic diarrhea?
- Nocturnal diarrhea
- Weight loss
- Anemia
- Positive FOBT
What diagnostic test is required in patients with bloody stool?
Colonoscopy with biopsy
Treatment of chronic diarrhea
- Depends on underlying disorder
- Fluids and electrolytes for all
Meds used for empirical therapy of chronic diarrhea
- Loperamide
- Diphenoxylate w/atropine
- Codeine and deodorized tincture of opium
- Clonidine
- Cholestyramine
