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Clin Med GI > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

define tenesmus

A

painful rectal spasms with a strong urge to fefecate but little passage of stool

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2
Q

define dysentery

A

abdonimal pain, tenesmus and passage of bloody diarrhea

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3
Q

define hematochezia

A

passage of bright red bloody stools

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4
Q

what is acute diarrhea

A

diarrhea

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5
Q

most common cause of acute diarrhea

A

infectious

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6
Q

acute diarrhea can be divided into what two groups

A
  1. acute non inflammatory

2. acute inflammatory

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7
Q

what is non inflammatory diarrhea

A

watery, non bloody

associated with periumbilical cramps and bloating

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8
Q

severity of non inflammatory diarrhea

A

> 90% of cases are mild and self limiting

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9
Q

if N/V is associated with non inflammatory diarrhea - what does it suggest

A

small bowl source - disrupts normal absorption and secretory process in the small intestine

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10
Q

positive or negative fecal leukocytes in noninflammatory diarrhea

A

negative

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11
Q

causes of non inflammatory diarrhea

A
  1. viral: norovirus, rotabvirus
  2. protozoal: giardia, cryptosporidium, cyclospora
  3. bacterial: performed enterotoxin production: staph aureus, clostridium perfrigens
  4. bacterial: enterotoxin production: E.coli, vibrio cholerae
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12
Q

inflammatory diarrhea colonic tissue damage occurs why?

A

d/t bacterial invasion or toxin

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13
Q

other s/s of inflammatory diarrhea

A

fever, bloody/pus diarrhea d/t tissue damage

LLQ cramps, urgency, tenesmus

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14
Q

volume of stool in inflammatory diarrhea

A

small b/c these organisms involve the colon

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15
Q

positive or negative for fecal leukocytes in inflammatory diarrhea

A

positive

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16
Q

what other substance will be found in inflammatory diarrhea for testing

A

lactoferrin

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17
Q

causes of inflammatory diarrhea

A
  1. viral: CMV
  2. protozoal: entamoeba histolytica
  3. bacterial: cytotoxin: EHEC, Cdiff
  4. bacterial: mucosal invasion: shigella, campy, salmonella, Chlamydia, N. gonorrhoeae, listeria
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18
Q

non infectious causes of acute diarrhea

A 
IBD
IBS
celiac
lactose intolerance
colorectal cancer
diverticulitis
med side effect
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19
Q

mild dehydration

A

indicated by thirst, dry mouth, decreased sweat, decreased urine output, slight weight loss

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20
Q

moderate dehydration

A

orthostatic BP changes, skin tenting, sunken eyes

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21
Q

severe dehydration

A

lethargy, confusion, weak pulse, hypotension, shock

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22
Q

HR of dehydrated pt

A

increased

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23
Q

TEMP of dehydrated pt

A

high

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24
Q

BP of dehydrated pt

A

low

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25
Q

weight of dehydrated pt

A

less than last visit

26
Q

tx options of acute diarrhea

A
  1. diet
  2. rehydration** MAINSTAY
  3. probiotics
  4. antidiarrheal agents
  5. antibiotics
27
Q

diet tx for acute diarrhea

A

avoid high fiber, fats, milk products, caffeine and alcohol

BRAT diet

28
Q

rehydration tx of acute diarrhea

A

fluid and electrolyte replacement

  • oral sugar-electrolyte solutions (sports drinks or designed formulations, pedialyte)
  • IV rehydration
29
Q

antidiarrheal agents for tx of acute diarrhea

A
  • used in mild to moderate diarrheal illnesses for symptomatic relief
  • do not use in pts with bloody diarrhea, high fever, or systemic toxicity
  • opioid agents (Loperamide - imodium) initially then 2mg after each loose stoll
  • bismuth subsalicylate (peptobismol)
30
Q

antibiotic tx of acute diarrhea

A
  • empiric tx NOT indicated for all pts
    1. fluoroquinolones - oral drugs of choice
    2. alternatives: TMP-SMX or doxycycline
31
Q

when would you treat with specific antimicrobial treatment based on culture results

A

-recommended for shigellosis, cholera, extraintestinal salmonellosis, traveler’s diarrhea, Cdiff, giardia and amebiasis

32
Q

when is specific antimicrobial tx not recommended

A

Campylobacter, shigatoxin producing Ecoli, aeromonas, or yersinia

-can increase toxin production

33
Q

when to admit pt with acute diarrhea

A
  1. severe dehydration for IV
  2. bloody diarrhea that is severe or worsening
  3. severe abdominal pain, worrisome for toxic colitis, IBD, intestinal ischemia, or surgical abdomen
  4. signs of severe infection/sepsis
  5. severe or worsening diarrhea in pts >70 or immunocompromised
  6. signs of hemolytic uremic syndrome
34
Q

infectious diarrhea prophylaxis

A
  1. hand hygiene
  2. travelers: eat only hot, freshly cooked food, avoid raw veggies/fruit
  3. bismuth subsalicylate - prophylaxis
  4. probiotic
  5. prophylactic ABX - not recommended unless at high risk
  6. vaccinations: rotavirus, S.typhi, and V cholerae
35
Q

definition of chronic diarrhea

A

diarrhea that is present for >4weeks

36
Q

cause of chronic diarrhea

A

most are non infectious

37
Q

classifications of chronic diarrhea

A
  1. secretory
  2. osmotic
  3. inflammatory
  4. malabsorptive
  5. motility
  6. factitious
  7. iatrogenic
38
Q

what is secretory chronic diarrhea d/t?

A

d/t decreased fluid and electrolyte transport across the enterocolonic mucosa

39
Q

s/s of secretory chronic diarrhea

A

watery, large volume stools that re painless, no change in symptoms with fasting

40
Q

ex of secretory chronic diarrhea

A
  1. microbial: giardia, Cdiff
  2. s/p bowel resection, cholecystecomty, Crohn’s (decreased mucosal surface for reabsorption - worsens with eating)
  3. hormone producing tumors (carcinoid, gastrinomas, VIPoma, ZES)
  4. laxative abuse
41
Q

define diarrhea

A

passage of abnormally liquid or unformed stools at an increased frequency (>3/day)

42
Q

osmotic causes of chronic diarrhea

A

d/t ingestion or malabsorption of an osmotically active substance

43
Q

what will happen to stool volume during fasting in osmotic chronic diarrhea

A

decreases

44
Q

when is an osmotic gap present in stool

A

osmotic chronic diarrhea - with fasting

45
Q

most common causes of osmotic chronic diarrhea

A

carbohydrate malabsorption (lactose, fuctose), Mg containing antacids, or laxatives

46
Q

what is the most common cause of chronic diarrhea in adults

A

lactase deficiency - leading to malabsorption of lactose

47
Q

inflammatory chronic diarrhea s/s

A

presents with s/s of inflammation (abdominal pain, fever, weight loss, hematochezia

48
Q

fecal leukocytes/lactoferrin in inflammatory chronic diarrhea

A

positive

49
Q

ex. of inflammatory chronic diarrhea

A
  1. IBD
  2. microscopic colitis (secondary to meds) - statins, SSRI’s, ARBs, PPIs, NSAIDS, metformin, allopurinol, stimulant laxatives, chronic ETOH
  3. immunodeficiency
  4. malignancy
50
Q

malabsorption causes of chronic diearrhea

A
  1. small mucosal intestinal dz (celiac, tropical sprue, Whipple dz, small bowel resection, Crohn’s)
  2. intestinal resections
  3. lymphatic obstructions
  4. pancreatic dz
51
Q

s/s of malabsorption chronic diarrhea

A

weight loss, steatorrhea (greasy, foul smelling), and nutritional deficiencies

52
Q

stool labs for malabsorption chronic diarrhea

A

positive fecal fat

osmotic gap present in stool

53
Q

what is the most common cause of chronic diarrhea in young adults

A

IBS

54
Q

what conditions cause rapid transit of bowels for motility disorders

A

hyperthyroidism
carcinoid syndrome
certain drugs

55
Q

what surgeries can cause post surgical motility disorders of GI

A

vagotomy, partial gastrectomy, partial colectomy

56
Q

factitious causes of chronic diarrhea

A
  1. 15% unexplained
  2. Munchausen’s syndrome (deception or self injury for secondary gain)
  3. eating disorders - laxative abuse
57
Q

what symptoms warrant further evaluation when working up a patient for chronic diarrhea

A
  1. noctural diarrhea
  2. weight loss
  3. anemia
  4. positive FOBT
58
Q

meds for chronic diarrhea: loperamide

A

mild opiate, used in mild to moderate diarrhea

59
Q

meds for chronic diarrhea: diphenoxylate with atropine

A

mild opiate, used in mild to moderate diarrhea

60
Q

meds for chronic diarrhea: codeine and deodorized tincture of opium

A

used in severe diarrhea

61
Q

meds for chronic diarrhea: clonidine

A

alpha-2-adrenergic agonist that inhibits intestinal electrolyte secretion

62
Q

meds for chronic diarrhea: cholestyramine

A

bile salt binding resin used in pts with bile salt induced diarrhea (s/p resection)

Clin Med GI (3 decks)

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