Diarrhea

Question 1

definition

Answer 1

> 3 loose stools daily for 2-3 consecutive days

nocturnal symptoms (ANY nocturnal liquid BM suggests diarrhea)

Question 2

non-inflammatory Diarrhea

Answer 2

non-bloody, copious diarrhea (infectious and non infectious_

Question 3

infectious non inflammatory Diarrhea

Answer 3

acute, watery, non-bloody diarrhea with bloating, nausea, vomiting and periumbilical pain

suggests toxin

Question 4

diagnosis of non inflammatory Diarrhea

Answer 4

stool culture (consideration of C Diff, giardiasis, virus)

fecal fat, stool osmol gap

stool sample = little to no WBC

Question 5

non inflammatory diarrhea management

Answer 5

supportive care, underlying cause

aggressive rehydration

antidiarrheal agents (if not concerned for C DIFF)

Question 6

inflammatory diarrhea

Answer 6

acute watery, bloody diarrhea, fever with bloating, presence of WBC in stool, periumbilical pain

Question 7

common bacterial causes of inflammatory diarrhea

Answer 7

E. coli
Shigella
campylobacter
salmonella
yersinia

Question 8

inflammatory diarrhea management

Answer 8

worse outcome

consider empiric abx while awaiting stool culture (cipro + metronidazole, amoxicillin w.augmentin)

Question 9

acute gastroenteritis symptoms

Answer 9

nausea with vomiting progressive to diarrhea with abdominal cramping

begin within 24 hrs of ingestion

Question 10

diagnosis of acute gastroenteritis

Answer 10

stool culture and ova parasite testing (non resolving symptoms)

Question 11

tx of acute gastroenteritis

Answer 11

supportive

if pt is healthy, no bloody diarrhea, no C Diff concern = supportive only

Question 12

food poisoning

Answer 12

n/v/d accompanied by fever in setting of recent ingestion of food

Question 13

food poisoning with mostly vomiting etiologies

Answer 13

staph aureus
bacillus cerus
norovirus

Question 14

food poising with mostly diarrhea etiologies

Answer 14

clostridium perfringens
enterotoxigenic E. coli
cryptosporidium/cyclospora

Question 15

staph aureus

Answer 15

symptoms begin within hrs

Question 16

bacillus cerus

Answer 16

contaminated rice (I.e. Chinese restaurants)

secretes enterotoxin

Question 17

Rotovirus

Answer 17

infants, young children

fecal-oral

watery, non bloody diarrhea + low grade fever

supportive tx and vaccination

Question 18

norovirus

Answer 18

outbreaks of gastroenteritis type symptoms due to fecal contaminated water or food, contamination of surfaces, person-person contact

diagnosis stool PCR

cruise ships

Question 19

intestinal parasites

Answer 19

diagnosis with stool O and P

transmission thru ingestion of contaminated food or water with feces

protozoa = metronidazole

helminth = mebendazole pr praziquantel

Question 20

first two things to consider when evaluating diarrhea

Answer 20

1. acute (< 2 weeks) or chronic (>4 weeks)
2. inflammatory or non inflammatory

consider stool culture

Question 21

chronic diarrhea etiologies

Answer 21

1. osmotic
2. fatty/steatorrhea
3. secretory
4. inflammatory

Question 22

fecal fat/stool osmol gap

Answer 22

fecal fat measured and suggests malabsorption issue

distinguishes between osmotic and secretory diarrhea

Question 23

secretory diarrhea

Answer 23

occurs at night, large volume

use stool osmol gap

Question 24

melanosis coli

Answer 24

hyper pigmentation of the colon wall

occurs 2/2 to overuse of laxatives

tx is to stop laxatives

Question 25

giardiasis

Answer 25

infectious diarrhea due to GI lambilia

metronidazole

non blood, watery, stomach cramps

“drinks water from a creek”

Question 26

pancreatic insufficiency

Answer 26

hx of pancreatic resection or recurrent pancreatitis,

decreased pancreatic enzyme secretion into gut is decreased resulting in malabsorption and chronic diarrhea

Question 27

tx of pancreatic insufficiency

Answer 27

supplementation with pancreatic enzymes orally

Question 28

inflammatory diarrhea workup

Answer 28

stool culture
stool O/P
consideration of endoscopy

• chronic blood diarrhea in young adult