Diarrhea Flashcards
Do most patients with diarrhea present for care?
No
Do most cases of diarrhea need tx?
No
What are most cases of diarrhea?
Infectious
Most cases of infectious diarrhea are what?
Viral
Most cases of viral diarrhea are what?
Norovirus
Most cases of severe diarrhea are what?
Bacterial
Most cases of bacterial diarrhea are what?
Campylobacter
Diarrheal diseases represent what?
One of 5 leading causes of death world wide
Approach to patients with diarrhea focuses on what?
Distinguishing infectious etiologies from non infectious etiologies
Definition of diarrhea
Decreased absorption or increased secretion (or both) causing >200 grams of stool a day - in dry weight
3x in a 24hr period
Diarrhea reflects what?
Impaired water absorption or increased water secretion by the bowel
What is acute diarrhea? Likely what?
Acute is 14 days or less, likely infectious
What is persistent/subacute diarrhea? Could be what?
More than 14 days but <30 days
Could be inflammatory or infectious
What is chronic diarrhea? What are the 3 types?
> 30 days
3 types: osmotic, secretory and inflammatory vs non-inflammatory
Small bowel vs large bowel functions
Small bowel - functions as a fluid and enzyme secreting/regulating organ
-ABSORBS NUTRIENTS
Large bowel - absorbs fluid and salt
-EXCRETES K
Dysregulation of what 2 processes leads to watery diarrhea?
Dysregulation of small bowel and large bowel processes leads to watery diarrhea
What are the major causes of acute infectious diarrhea?
Viruses - norovirus, rotavirus, adenovirus, astrovirus
Bacteria - Salmonella, Campylobacter, Shigella, entertoxigenic, E. Coli, C. Dif
Protozoa - cryptosporidium, guardia, cyclospora
When do non-infectious etiologies of diarrhea become more likely?
As the course of diarrhea becomes more persistent and chronic
When is Acute Evaluation of diarrhea warranted?
- persistent fever
- bloody diarrhea
- severe abdominal pain (they look like toxic megacolon)
- sx’s of volume depletion (hypotension, scant urine)
- hx of inflammatory bowel disease
- possible widespread food-borne outbreak
What is the most common etiology of diarrhea?
Viruses
Evaluation of diarrhea
- good hx
- character of sx’s, duration
- food hx
- exposure, pets
- travel
- meds/medical hx
- volume status
What determines whether diarrhea originates from small or large bowel?
Frequency and nature of stool
Different pathogens depending on if small or large bowel diarrhea
Diarrhea of small bowel sx’s
- watery
- large volume
- abd cramping
- bloating
- gas
- weight loss w/ persistent diarrhea
- rarely occurs with fever, occult blood or inflammatory cells in stool
Diarrhea of large bowel sx’s
- frequent, regular
- small volume
- painful bowel movements
- fever
- bloody or mucoid stools common
- inflammatory and red blood cells seen on microscopy