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Clinical part B > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

complications of diarrhea

A

electrolyte imbalance
dehydration
hemorrhoids

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2
Q

acute vs chronic

A

acute < 14 days

chronic: >14 days or recurring

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3
Q

causes of acute

A

infections
medications
diet/nutrition

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4
Q

how long does diarrhea last

A

2-3 days

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5
Q

most common cause of viral gastroenteritis

A

noroviruses

24 hour stomach flu

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6
Q

rotaviruses causes what? which age is highest incidence

A

acute gastroenteritis and infantile diarrhea

highest incidence between 3-24 months

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7
Q

causes of salmonella and how long it lasts

A

infected poultry, eggs, beef, veges, milk, fruit

1-7 days

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8
Q

campylobacter causes and duration

A

uncooked chicken, unpasteurized milk, contaminated water 1-10 days

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9
Q

ecoli causes and duration

A

contamined food/water, travel

3-5 days, 5-10 days

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10
Q

shiga toxin from ecoli causes what serious syndrome

A

hemolytic uremic

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11
Q

common parasites that cause diarrhea and treatment

A

g.lamblia
e.histolytica
i.belli
cryptosproridium sp.
referral cant self treat

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12
Q

how is giardia spread

A

ingestion of food/water contaminated with animal or human feces containing cysts

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13
Q

when does diarrhea caused by broad spectrum antibiotics start and resolve

A

2-3 days after starting antibiotic

resolved when stop antibiotic

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14
Q

complication of antibiotic induced diarrhea

A

pseudomembranous colitis

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15
Q

medications that cause diarrhea

A 
laxatives
Mg antacids
metoclopramide
orlistat
acarbose
misoprostol 
antineoplastics 
opiate withdrawal
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16
Q

diet that causes acute diarrhea

A

gluten and lactose
sorbitol or mannitol
fatty, spicy, salted
rapid increase in dietary fibre

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17
Q

causes of chronic diarrhea

A 
IBD, chrons, UC, IBS
tumors
chemo 
malabsorption of carbs
diabetes 
diet, meds, infection
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18
Q

risk factors for infectious diarrhea

A 
day care centers
food handler or care giver 
crowded living conditions 
consumption of unsafe food 
certain medical conditions
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19
Q

2 important questions to always ask

A

do you hvae a fever - sign of infection

blood in stool

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20
Q

red flags

A 
fever over 38.5 
excesive ab pain, cramping
blood or mucous in stool 
dehydration, weight loss
vomit >4hrs
under 2 yrs old or frail 
severe: >6stools/day for >48 hours 
chronic medical condition 
laxative abuse
pregnant 
immunocompromised
recent antibiotic use 
worsening or persistent
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21
Q

signs and symptoms of dehydration

A 
dry mouth, tongue 
increased thirst
decreased urination 
weak 
lightheaded 
children: few tears, sunken eyes, grey skin
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22
Q

treatment goals

A 
determine cause 
relieve symptoms 
re-establish normal stools
prevent/correcct fluid and electrolyte loss or imbalance
prevent complications
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23
Q

non pharms

A

handwashing before and after meals, going to bathroom
prevent food poisoning
oral rehydration
early refeeding and maintenance of hydration
follow age appropriate diet
avoid fatty food and simple sugars and spicy foos
avoid caffiene - may promote fluid secretion

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24
Q

how to prevent food poisoning

A 
avoid unpasteurized milk and juice
cook meat, eggs throughly 
keep hot foods hot and cold col 
rinse uncooked foods first 
separate cutting boards for raw meat
reheat food completely
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25
Q

contraindications to oral rehydration therapy

A

protracted vomiting, worsening, unable to keep up wiht losses, stupor, coma, intestinal ileus

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26
Q

are sports drinks recommended

A

no due to high sugar and low amounts of electrolytes

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27
Q

what is contained in oral rehydration therapy and their purpose

A

glucose and electrolytes
glucose provides calories and aids in absorption of sodium and water
osmolality- 1glucose:1sodium

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28
Q

what is in gastrolyte

A

oral rehydration salts - citrate

29
Q

directions and dose of gastrolyte

A

stir in 200ml water and drink freely and frequently while diarrhea continues

30
Q

pedialytle contains what

A

correct balance of electrolytes, sugar, and water

31
Q

loperamide MOA

A

synthetic opioid agonist
slows intestinal motility allowing absorption of electrolytes and water
decrease Gi secretion
reduce of daily fecal volume, increase viscosity and bulk volume, reduce fluid and electrolyte loss

32
Q

indication of loperamide

A

acute diarrhea, travelers (only treatment)
chronic diarrhea associated with IBS
adjunct to rehydration therapy

33
Q

age restriciton and use in pregnancy of loperamide

A

not under 12 or in pregnancy without doctor recommendation

CI in under 2

34
Q

side effects of loperamide

A 
abdominal pain 
distention 
cramps 
NV
dry mouth 
constipation 
drowsy 
fatigue 
skin rash 
worsens effects of invasive bacteria
35
Q

dose of loperamide***

A

4mg initially

followed by 2mg after each loose stool

36
Q

max use for loperamide

A

16mg/day

2 days

37
Q

CI of loperamide

A 
blood/mucus in stool 
fever
infectious diarrhea
acute ulcerative colotis 
pseudomembranous colitis
under 2
38
Q

onset of loperamide

A

.5-1 hour

39
Q

severe drug interaction with loperamide

A

saquinavir

40
Q

why is there abuse with loperamide

A

high doses can cross BB and reach central opioid receptors leading to euphoria

41
Q

effects of loperamide at high doses

A

CNS toxicity and cardiac toxicity

dizziness, urinary retention, syncope, SOB, palpitations, dytonia

42
Q

bismuth MOA in pepto

A

antimicrobial effect against diarrhea causing pathogens

43
Q

salicylates MOA in pepto

A

antisecretory effects that rescues fluid and electrolyte losses

44
Q

bismuth subsalicylate MOA

A

decrease frequency of unformed stools
increase stool consistency
relieve ab cramping
decreased NV

45
Q

indication of bismuth subsalicylate

A

symptom releif of diarrhea
travellers (px or Tx)
adjuvant to antibiotic treatment of h pylori

46
Q

age restrictions for pepto

A

children =/>3

not for children under 18 with febrile viral illness due to risk of reyes

47
Q

adverse effects of pepto

A

impaction- infants and dehibilitated pts
grey/black stools and tongues
tinnitus
headache, confusion

48
Q

cautions with pepto

A

children recovering from chicken pox/flu
sensitive to aspirin
taking anticoagulants or other salicylates
AIDS (neurotoxicity)
Gi bleeds

49
Q

onset of action for pepto

A

none so prob doesnt work

50
Q

drug interactions with pepto

A

take 3 hours apart from other meds
anticoagulants, salicylates,- has antiplatelet effects
probenedic and methotrexate

51
Q

MOA of attapulgite

A

absorbs 8x its weight in water - absorption not selective ex.toxins, drugs
reduces number of BM, relieves cramps, improve stool consistency

52
Q

age resriction of attapulgite

A

over 3-6

53
Q

side effects of attapulgite

A

mild constipation
dyspepsia
flatulence
nausea

54
Q

onset of attapulgite

A

12-19.5 hours

55
Q

drug interactions with attapulgite

A

no known drug interactions

wait 2-3 hours of other drugs

56
Q

fibre MOA

A

adjusts the consistency of stool by absorbing water in the intestinal tract

57
Q

side effects of fibre

A

cramping

flatulence

58
Q

onset for fibre

A

12-24 hours

peak in 2-3 days

59
Q

monitoring for acute diarrhea

A

signs and symptoms of dehydration such as dry mouth, thirst
doesnt resolve in 48 hours, worsens, high fever, blood/mucus in stool - refer
should see improvement in 1-2 days

60
Q

definition of travellers diarrhea

A

3 or more loose unformed stools per day along with one symptom of enteric infection (fever, ab cramps, nausea, fecal urgency or dysentery)

61
Q

mild categorization of travellers diarrhea

A

mild: 1/2 unformed stools in 24 hours with no other symptoms

62
Q

moderate categorization of diarrhea

A

1/2 unfromed stools in 24 hours with one of the other symptoms or more than 2 unformed in 24 hours with no other symptoms

63
Q

classic categorization of travellers diarrhea

A

3 or more unformed stools in 24 hours with at least one other symptoms

64
Q

types of traveller bacteria

A

ecoli
clostridium
shigella
salmonella

65
Q

is travellers diarrhea contagious

hows it spread

A

no

fecal-oral

66
Q

risk factors for developing TD or complications

A 
region has poor hygiene/sanitation 
remote area with no medical amenities 
reduced stomach acidity 
children or young adults are more advernturous 
elderly or frail 
immunocomprmised
IBD
severe cardiac or renal disease
67
Q

who is at high risk of TD and should be referred for prescription prophylaxis

A

high risk areas where its critical not to fall ill
underlying health problems that make them more susceptible to TD or complication
taking PPIs, h2blockers, or antacids
repeated history of severe TD
if dehydration could cause sever complications
underlying disease -immunocompromised

68
Q

non pharms for TD

A 
boil it cook it peel it or forget it 
purified or hot water to brush teeth 
drink water from sealed bottle 
avoid consuming water while swimming 
wash hands before and after eating 
eat fully cooked food thats hot when served
ice from purified water
carbonated drinks safe
avoid food from street vendors
avoid unpasteurized dairy products

Clinical part B (15 decks)

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