Diarrhea Flashcards
Define diarrhea
A change in stool frequency or or decreased consistency of stool
Variable numbers of stools/day by age
Infants > 10 stools/day
Old kids, teens, adults > 3 stools/day
Name the major causes of acute diarrhea (< 2 weeks duration)
Viral infection - most common: norovirus Bacterial infection Food-borne toxins Parasites Malabsorption (sorbitol or carbohydrate) Food intolerance (soy or milk protein) Extraintestinal infections (AOM, UTI, appendicitis)
DDx of persistent diarrhea (> 2 weeks)
INFANTS Infection Protein intolerance Malnutrition Anatomic anomalies Metabolic disorders (Cystic fibrosis, enzyme and transport defects)
OLDER INFANTS AND TODDLERS Toddler's diarrhea Postinfectious diarrhea Protein intolerance Giardia Celiac Sucrase-isomaltase deficiency Hirschsprung's enterocolitis
SCHOOL-AGE CHILDREN and TEENS Giardiasis Celiac disease Irritable bowel syndrome Lactose intolerance IBD Laxative abuse
Names signs associated with dehydration
Dry MM Reduced tears CR> 2s General appearance Tachycardia Decreased skin elasticity Sunken eyes Weight loss Decreased U/O - early sign
What are classic historical and PEx findings and their matching pathology?
Uncomplicated viral gastroenteritis
- mild diffuse abdominal tenderness, active bowel sounds
Surgical abdomen or bowel obstruction
- localized or rebound tenderness
- absent or high-pitched bowel sounds
Constipation, Intussusception, IBD
- Palpate a discrete mass
IBD
- mass, perianal skin tags, fissures, abscesses
Hirschsprung’s enterocolitis
- increased anal tone, explosive stools
HUS
- pallor, decreased U/O, bloody diarrhea
Celiac, Cystic fibrosis, Giardiasis
- Protuberant abdomens and wasting of the buttocks and lower limbs
Hiking/camping, untreated drinking water –> Giardia
Cruise ship –> Norovirus
Pool exposure –> Crytposporidium
Unpastuerized milk, fruit juice, uncooked meat –> E coli, Salmonella, parasites
Healthy cows –> E coli
Chickens, ducks, cows, pet birds, turtles, frogs, lizards, domestic birds, hamsters and rodents fed to snakes –> Salmonella
Wild and domestic birds, farm animals, young cats and dogs –> Campylobsacter
Watery/explosive vinegary-smelling stools - malabsorption
What foods/ingestants can mimic hematochezia? tarry looking stools? False FOBT positives?
Fruit juices Candies Gelatin Popsicles Kool-aid Tomatoes Beets Plums Watermelon Cranberries Crayons
Tarry-looking stools Pepto-bismol or other bismuth-containing anti-diarrheal products Iron Black licorice Blueberries Spinach Purple grapes Chocolate Grape juice
False FOBT positives Red meat Cherries Tomato skin Iron supplements
Name the common infectious causes of diarrhea
VIRAL Norovirus Rotavirus Enteric Adenovirus Astrovirus Calicvirus
BACTERIAL Salmonella Shigella Campylobacter Yersinia E. coli Clostridium difficile
PREFORMED BACTERIAL TOXINS
Bacillus cereus
Clostridium perfringens
Staph aureus
PARASITIC Giardia Cryptosporidium Entamoeba histolytica Strongyloides Microsporidium
Name some complications of infectious diarrhea
Shigella and E.coli - can induce seizures via high fever or toxins
Salmonella - bacteremia
Salmonella - osteomyelitis in immunocompromised or patients with heme disorders
Giardia, Celiac, IBD - FTT
C diff - pseudomembranous colitis
E coli - HUS or TTP from cytotoxin induced endothelial injury
Name 6 disorders that may be mistaken for infectious diarrhea
Chronic nonspecific (toddler's) diarrhea Encopresis Sorbitol-induced diarrhea Milk protein allergy Lactose intolerance Laxative abuse
Describe the method of ORT (oral rehydration therapy)
Recommended for mild-moderate dehydration
Use low-osmolality ORS
Give frequent, small aliquots vis 5 mL syringe or spoon
Give 50 to 100 ml/kg over 2-4 hours for rehydration
Replace ongoing losses 10 ml/kg/stool, 2 ml/kg/emesis
Consider slow, continuous nasogastric administration or ORS for persistent emesis
List 4 reasons why anti-motility agents are not safe for kids
Limited testing
Salicylate absorption/toxicity from bismuth-containing products
- bismuth encephalopathy in renal insufficient patients
CNS-induced sedation, resp depression and GI ileus - Lomotil (opiate- also contains atropine) and Immodium (synthetic opiates)
All of them can cause gut stasis after and higher risk of infection
When are antibiotics needed for diarrhea
Empiric is rarely ever recommended
Risk of HUS from toxin release after antibiotic administration
Only to children with signs of sepsis, bacteremia, or extraintestinal spread of the infection
If Salmonella positive - antibiotics are indicated for infants, toxic appearing kids, asplenic, immunocompromised or malnourished kids
Empiric therapy and ID consult for kids with typhoid fever, dysentry, or severe colitis, especially among recent travelers
Emergent cases of diarrhea
Severe dehydration Hypernatremic deydration Intussusception Hirschsprung's HUS Appendicitis
Severe dehydration - need IV rehydration, can be in shock
Hypernatremic deydration - need careful rehydration to prevent cerebral edema
Intussusception - surgical emergency, can lead to gut necrosis
Hirschsprung’s - can lead to enterocolitis
HUS - can lead to hypertension, hyperkalemia, anemia, thrombocytopenia
Appendicitis - can lead to perforation, obstruction, shock
When to perform testing in kids with diarrhea
If diarrhea > 2 weeks
Bloody
Infants
FTT
Test for giardia, celiac, IBD, carbohydrate intolerance
What does BRAT stand for?
Bananas
Rice
Applesauve
Toast
