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Clin Med 2 > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

Diarrhea

A

Increase in the frequency or decrease in the consistency of bowel movements

Stool mass is the best gauge of diarrhea

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2
Q

What is the best gauge of diarrhea?

A

Stool mass

> 250 grams
70-95% water
2 times per day

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3
Q

Chronic diarrhea

A

> 30 days

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4
Q

Acute diarrhae

A

<14 days

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5
Q

Persistent diarrhea

A

> 14

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6
Q

Osmotic diarrhea

A

Occurs when the intraluminal water load exceeds the absorptive capacity of the GI tract

Ingestion of nonabsorbable or poorly absorbed solutes
Ingestion of selected foods
Failure to transport osmotically active dietary factors

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7
Q

What are the characteristics of osmotic diarrhea?

A

Reduces with fasting
Stool volume is <1L
Osmotic gap: (Na + K) x 2 >50 mOsm

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8
Q

What are exogenous reasons for osmotic diarrhea?

A

Laxatives
Antacids
Artificial sugars
Medications

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9
Q

What are endogenous reasons for osmotic diarrhea?

A

Congenital
Generalized
Acquired

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10
Q

What are acquired reasons for osmotic diarrhea?

A

Post-enteritis disaccharide deficiency

Pancreatic insufficiency

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11
Q

What are congenital reasons for osmotic diarrhea?

A 
Disaccharide deficiency (lactase) 
Glucose-galactose or fructose
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12
Q

Lactose intolerance is an example of which type of diarrhea?

A

Osmotic

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13
Q

What is a classic example of small bowel malabsorption?

A

Celiac sprue

Autoimmune intolerance to gluten

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14
Q

How do you dx celiac sprue?

A

Serology

  • anti-endomysial Ab with normal IgA
  • anti-tissue tansflutaminase Ab

Small bowel biopsy
-blunted or absent small bowel villi (proximal > distal)

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15
Q

What are the sxs of celiac?

A

Based on extent of small bowel involvement

Malabsorption causes diarrhea, steatorrhea, weight loss

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16
Q

What are the complications of celiac sprue?

A

Ulcerative jejunoileitis
Collagenoous sprue
Lymphoma
Oropharyngeal, esophageal and small bowel cancer

17
Q

Whipple’s Disease

A

Infection with the Whipple bacillus - Tropheryma Whippellii

Diarrhea, weight loss, abdominal pain

Migratory, non destructive arthraligia

Fever, lymphadenopathy

Pericarditis, endocarditis

Dementia

18
Q

What is the treatment for Whipple’s disease?

A

Bactrim bid x 1 year

19
Q

Secretory diarrhea

A

Active intestinal secretion or inhibition of ion absorption with concomitant flow of water

  • infectious
  • neoplastic
  • misc.
20
Q

What are the characteristics of secretory diarrhea?

A

No osmotic gap
Small bowel morphology is usually normal

Can come from inside or outside the gastrointestinal tract

Persists during fasting

21
Q

Cholera

A

Secretory diarrhea

Sxs: severe diarrhea —volume depletion, dehydration, acidosis, death

4-7 day course with 50% mortality

It’s not that the infection itself causes sepsis —its the volume depletion that leads to acidosis

22
Q

Epi of IBS

A

1 in 6 people
W > M (2 fold)

Chronic (12 weeks out of the year)

Everything is normal ….normal labs, etc.

Irregular peristalsis

23
Q

Exudative diarrhea

A

Results from disruption of integrity of intestinal mucosa due to inflammation

Loss of proteins, blood, mucus, and pus

Fecal water and electrolytes are high

24
Q

What are causes of exudative diarrhea?

A

Infectious
-salmonella, shigella, campylobacter, entamoeba

Inflammatory bowel disease

  • ulcerative colitis
  • chrons disease

Misc.

  • radiation
  • ischemia
25
Q

Characteristic of exudative diarrhea

A

Frequent bowel movement (>6daily)

Bowel movements can contain mucus and blood

Stool volume is usually <1L daily

26
Q

Crohn’s disease

A

Episodes can awaken you at night

Ulcerations and inability to see vascularization on colonscopy

27
Q

Cruise ship diarrhea

A

Norovirus

28
Q

What is the most common etiology of infectious diarrhea?

A

Viruses

29
Q

Travelers diarrhea?

A

ETEC

30
Q

What is the treatment for Whipples Disease?

A

PCN for 1 year

31
Q

How do you treat Whipples disease?

A

Small bowel biopsy

PAS postive

32
Q

What is the first line treatment for C. Diff?

A

Metronidazole

second line is vancomycin

33
Q

What ABX has been associated with the cause of C. Diff?

A

Clindamycin

Clin Med 2 (13 decks)

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