diarrhea Flashcards
clin med
differentiate between inflammatory and noninflammatory diarrhea
noninflammatory= watery, only eval if have severe diarrhea for longer than 7 days, no need a work up
inflammatory= blood/pus in stool, get a routine stool bacterial culture
acute diarrhea, defined as having diarrhea _____, is most often _____
< 2 weeks
infectious
most common cause of noninfectious dairrhea
meds
abx NSAIDs antidepressants chemo antacids, laxatives
differentiate between the organisms found in abx associated diarrhea vs abx associated colitis
abx associated coliits is mostly due to C Dfi where most cases of abx associated diarrhea are NOT C dif
give an example of an abx that causes abx associated diarrhea
augmentin (amaoxicillin-clavulanate)
in the case of chronic diarrhea, we can rule out med associated, IBS, and lactose intolerance when?
in the presence of nocturnal diarrhea
weight loss
anemia
(+) fecal occult blood test (FOBT)
normal osmotic gap of stool
<50
describe sx, trx, and causes of osmotic diarrhea
stool volume DECREASES w fasting, have increased osmotic gap
sx= distension, bloating, flatulence,
trx= stop lactose, fructose and sorbitol, and alc
causes= meds (antacids, lactulose), lactose intolerance
laxative abuse, malabsorptive syndromes
+ hydrogen breath test = ?
lactose intolerance
describe sx and causes of secretory diarrhea
stool volume NO change with fasting, normal osmotic gap of stool, high volume of watery diarrhea, NAGMA
causes
=endocrine tumors- zollinger ellison syndrome, carcinoid tumor, medullay thyroid carcinoma
= bile salt malabsorption= ileal resection, crohn, post-chole
= factitious diarrhea- laxative abuse
=villous adenoma
most common causes of chronic diarrhea
medications
IBS
lactose intolerance
what tests should you order for chronic diarrhea
CBC serum electrolytes liver enzymes albumin Vit A+D TSH ESR+CRP tTG stool studies
what can a modified acid stain be used to detect
cryptosporidium
cyclospora
what can a wet mount or a fecal Ag by used to detect
giardia
E. hystolytica
what test can be done to rule out IBD, microscopic colitis, colonic neoplasia
colonoscopy with mucosal biopsy
what test can be done when celiac ds or whipple ds is suspected
upper endoscopy w small bowel biopsy
what tests should be performed when malabsorption is suspected
fecal elastase <100 –> pancreatic insufficiency
abd radiograph with calcifications –> chronic pancreatitis
hydrogen breath test –> lactose intolerance
small intestine imagint –> crohn, tumor, diverticula
serologic test
VIP to look for VIPoma
calcitonin, look for medullary thyroid carcinoma
gastrin to look for zollinger-ellison syndrome
F-HIAA to look for carcinoid
what meds can lead to diarrhea
cholinesterase inhibitors SSRIs angiotensin II-receptor blocker PPI NSAID metformin allopurinol
describe the three types of clinical presentation with IBS
spastic colon
alternative constipation and diarrhea
chronic, painless diarrhea
what are the alarm sx with IBS and what do they indicate
they indicate the dx isn’t actually IBS, warrants further investigation
acute onset of sx nocturnal diarrhea severe constipation / diarrhea hematochezia weight loss fever family hx
clinical manifestations of IBS
age < 30, female
crampy abd w irregular bowel habirs
distension, relief of pain w bowel movement, increased frequency of stools with pain, loose stools w pain, mucus in stools, sense of incomplete evacuation,
pasty pencil-thin stools
diagnostics for IBS
chronic, at least 3 months
utilize ROMA IV clinical diagnostic criterion
= at least 3 months, improve w defecation, change in frequency or appearance of stool
consider sigmoidoscopy, barium radiograph
trx for IBS
meds for the bowel habits and pain
low FODMAPS diet
risk with lactose intolerant patients who choose to restrict milk products
osteoporosis
-Ca supplementation is recommended
most common abx associated with C dif infection
ampicillin
clindamycin
3rd gen cephalosporin
flouroquinolone
yellow adherent plaques and volcano exudate seen on flexible sigmoidoscopy
C dif= psuedomembranous colitis
trx and complications of C df
PO/IV metronidazole
PO only vancomycin
complications= toxic megacolon, hemodynamic instability
lymphocytic colitis/collagenous colitis
population,
hx
dx
trx
population= females, 50s-60s hx= NSAIDs, ASA, SSRI, ACE inhibitors, B blockers dx= normal appearing, with chronic infl trx= antidiarrhea therapy= loperamide stop offending agent
sx of malabsorption syndromes
weight loss osmotic diarrhea steatorrhea nutritional deficiency must wasting growth retardation
gene mutations associated celiac ds
HLA-DQ2
HLA-DQ8
tTG A
sx, hx, dx, trx of celiac
sx= weight loss, chronic diarrhea, dyspepsia, flatulence, bloating, growth retardation, fatigue
dermatitis herpetiformis, osteoporosis
dx= IgA tTG Ab, anti-DGP, endoscopy= atrophy or scalloping of the duodenal folds may be observed histology= complete loss of intestinal villi labs= cbc, Ca, Vit A+D, CMP w GGT, PT/INR
trx= removal of all gluten
sx of pancreatic insufficiency
steatorrhea
weight loss
gaseous distension
large, greasy, foul smelling stools
sx of bile salt malaborpsion
terminal ileum, crohn ds
mild steatorrhea, impaired Vit ADEK, watery secretary diarrhea
whipple ds
sx, dx, trx, prognosis
tropheryma whipplei, white men in their 40s-60s
-weight loss, malabsorption, chronic diarrhea, HF, dementia
-endoscopy w duodenal biopsy= PAS+
-trx= abx, need prolonged trx
ceftriazone, TMP/SMX
repeat bipsies every 6 months
prognosis= fatal if not trx, neuro signs may be permanent
define pseudodiarrhea
frequent passage of small volumes of stool
happens with IBS or proctitis
define fecal incontinence
involuntary discharge, NMSK disorders or structural anorectal problems
define overflow diarrhea
only contents that get by are liquid
elderly/nursing home pts
fecal impaction is detectable by rectal exam
chronic use of laxatives can cause
melanosis coli
benign hyperpigmentation of the colon
