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Clin Med II - GI > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

Define diarrhea

A

Passage of abnormally liquid or unformed stools at an increased frequency (3+/day)

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2
Q

Define tenesmus

A

Painful rectal spasms w/a strong urge to defecate but little passage of stool

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3
Q

Define dysentery

A

Abdominal pain, tenesmus, passage of bloody diarrhea

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4
Q

Define hematochezia

A

Passage of bright red bloody stools

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5
Q

What is the MC cause of acute diarrhea?

A

Infectious

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6
Q

Define acute diarrhea

A

Less than 2 weeks of diarrhea

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7
Q

What are the types of acute diarrhea?

A
  • Inflammatory

- Non inflammatory

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8
Q

Characteristics of non-inflammatory diarrhea

A
  • Mild and self limited
  • Watery
  • NOT bloody
  • A/w periumbilical cramps and bloating
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9
Q

What does N/V with non-inflammatory diarrhea suggest?

A

Small intestine source (disrupts normal absorption and secretory process)

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10
Q

Are fecal leukocytes present or absent in non-inflammatory diarrhea?

A

NOT present (tissue invasion does not occur)

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11
Q

Etiologies of non-inflammatory diarrhea

A
  • Viral (noro, rota)
  • Protozoal (giardia, cyclospora)
  • Bacterial (preformed enterotoxin production, enterotoxin production)
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12
Q

What are common bacterial sources of non-inflammatory diarrhea?

A
  • S. aureus, B. cereus, C. perfringens (preformed enterotoxin production)
  • ETEC, vibrio cholerae (enterotoxin production)
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13
Q

Define inflammatory diarrhea

A
  • Colonic tissue damage occurs d/t bacterial or toxin invasion
  • Fever and bloody/pus diarrhea
  • A/w LLQ cramps, urgency, tenesmus
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14
Q

What is the volume of inflammatory diarrhea?

A

Usually SMALL in volume b/c the organisms involve the colon

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15
Q

What components are present in inflammatory diarrhea?

A

Fecal leukocytes or lactoferrin (d/t tissue invasion)

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16
Q

Are fecal leukocytes present or absent in inflammatory diarrhea?

A

YES present, d/t tissue invasion

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17
Q

Etiologies of inflammatory diarrhea

A
  • Cytomegalovirus
  • Entamoeba histolytica
  • EHEC, V. parahaemolyticus, C. diff (cytotoxin production)
  • Shigella, C. jejuni, Salmonella (mucosal invasion)
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18
Q

What are some non-infectious causes of acute diarrhea?

A
  • IBD/IBS
  • Celiac
  • Lactose intolerance
  • Colorectal cancer
  • Malabsorption
  • Meds side effects
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19
Q

How is mild dehydration characterized?

A
  • Thirst, dry mouth
  • Decreased sweat, urine
  • Slight weight loss
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20
Q

How is moderate dehydration characterized?

A
  • Orthostatic BP changes
  • Skin tenting
  • Sunken eyes
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21
Q

How is severe dehydration characterized?

A
  • Lethargy
  • Confusion
  • Weak pulse
  • Hypotension
  • Shock
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22
Q

What items should be avoided in the diet of someone with acute diarrhea?

A
  • High fiber foods
  • Fats
  • Milk products
  • Caffeine
  • Alcohol
23
Q

What diet is encouraged as treatment of acute diarrhea?

A

BRAT (bananas , rice, applesauce, toast) diet

24
Q

What is the mainstay of treatment for acute diarrhea?

A

Rehydration (oral sugar-electrolyte solutions, IV fluids)

25
Q

How do probiotics treat acute diarrhea?

A

Currently being debated

26
Q

Which pharmacologic agents are given for comfort only in acute diarrhea?

A

Anti-diarrheal agents

27
Q

When are anti-diarrheal agents used to treat acute diarrhea?

A
  • Mild to moderate
  • Symptomatic relief only
  • Opioid agents (like Imodium)
  • Bismuth subsalicylate (Pepto-Bismol)
28
Q

When should anti-diarrheal agents NOT be used in acute diarrhea?

A

Do NOT use in pts w/bloody diarrhea, high fever or systemic toxicity

29
Q

Describe antibiotic treatment of acute diarrhea

A
  • Empiric NOT indicated for all pts

- Quinolones are PO drugs of choice

30
Q

Antibiotic treatment of acute diarrhea is recommended for which conditions?

A
  • Shigellosis
  • Cholera
  • Extraintestinal salmonellosis
  • Traveler’s diarrhea
  • C. diff
  • Giardia
  • Amebiasis
31
Q

Antibiotic treatment of acute diarrhea is NOT recommended for which conditions?

A
  • Campylobacter
  • Shig-toxin-producing E. coli
  • Aeromonas
  • Yersinia
  • Except in severe disease
32
Q

What are prophylactic measures of infectious diarrhea?

A
  • 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)
33
Q

When are prophylactic antibiotics recommended for infectious diarrhea?

A

NOT recommended unless at high risk

34
Q

Define chronic diarrhea

A
  • Diarrhea that is present for 4+ weeks

- Most are non-infectious

35
Q

Are most chronic diarrhea cases infectious or non-infectious?

A

Non-infectious

36
Q

Classifications of chronic diarrhea

A
  • Secretory conditions
  • Osmotic diarrheas
  • Inflamm conditions
  • Malabsorptive conditions
  • Motility disorders
  • Factitious
  • Iatrogenic
37
Q

Define secretory chronic diarrhea

A
  • Decreased fluid and electrolyte transport across enterocolonic mucosa
  • Watery, LARGE volume stools
  • NO change in symptoms w/fasting
38
Q

What can cause secretory chronic diarrhea?

A
  • Persistent bacterial infections like C. diff, Giardia
  • Hormone producing tumors
  • Laxative abuse
39
Q

Define osmotic chronic diarrhea

A
  • Ingestion or malabsorption of an osmotically active substance
  • Stool volume will DECREASE w/fasting
  • Osmotic gap present in stool
40
Q

What is the MC cause of chronic diarrhea in adults?

A

Lactase deficiency

41
Q

What are the MC causes of osmotic chronic diarrhea?

A
  • Carb malabsorption (lactose, fructose)

- Mg containing antacids or laxatives

42
Q

What type of chronic diarrhea presents with large volume of watery stools? No changes in symptoms with fasting?

A

Secretory

43
Q

What type of chronic diarrhea results in a decrease of stool volume with fasting?

A

Osmotic

44
Q

Define inflammatory chronic diarrhea

A
  • S/S of inflammation
  • Positive fecal leukocytes/lactoferrin
  • Caused by IBD, meds, immunodeficiency, malignancies
45
Q

Define malabsorption chronic diarrhea

A
  • Weight loss, steatorrhea (greasy, foul smelling), and nutritional deficiencies
  • Osmotic gap present in stool
  • Positive fecal fat stain
46
Q

What type of chronic diarrhea shows osmotic gap in stool and positive fecal fat stain?

A

Malabsorption causes

47
Q

What is the MC cause of chronic diarrhea in young adults?

A

IBS

48
Q

What type of chronic diarrhea would be caused by an underlying systemic disease or prior abdominal surgery?

A

Motility disorders

49
Q

Define factitious causes of chronic diarrhea

A
  • 15% of unexplained diarrheas
  • Munchausen’s syndrome
  • Eating disorders
50
Q

What type of chronic diarrhea presents with really greasy, foul-smelling stool?

A

Malabsorption causes

51
Q

What warrants further evaluation when diagnosis chronic diarrhea?

A
  • Nocturnal diarrhea
  • Weight loss
  • Anemia
  • Positive FOBT
52
Q

What diagnostic test is required in patients with bloody stool?

A

Colonoscopy with biopsy

53
Q

Treatment of chronic diarrhea

A
  • Depends on underlying disorder

- Fluids and electrolytes for all

54
Q

Meds used for empirical therapy of chronic diarrhea

A
  • Loperamide
  • Diphenoxylate w/atropine
  • Codeine and deodorized tincture of opium
  • Clonidine
  • Cholestyramine

Clin Med II - GI (17 decks)

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