Diarrhea Flashcards
what does greasy/malodorous diarrhea indicate?
malabsorption disorder
what does diarrhea containing blood or pus indicate?
inflammatory disorder
what does watery diarrhea indicate?
a secretory process
what does abdominal pain along with diarrhea suggest?
IBS or IBD
what is diarrhea clinically?
- 3 or more loose/watery stools/day or decrease in consistency and increase in BM
- pt loses bicarbonate and potassium
acute diarrhea
- less than 2 weeks duration
- non-inflammatory (watery, no blood, self limited, no work up)
- inflammatory (blood/pus, fever, caused by invasive/toxin producing bacteria),**needs stool bacterial culture
causes of acute diarrhea
90% is infectious (viral gastroenteritis, bacterial/protozoal)
10% caused by meds (antibiotics), ischemia, food, artificial sweeteners (sorbitol) etc
Antibiotic associated diarrhea
- most cases are NOT due to c.diff (which is antibiotic associated colitis)
- usually mild and self limited, gets better once you stop taking it, no work up usually needed
chronic diarrhea
- more than 4 weeks
- meds
- IBS
- lactose intolerance
- chronic infections
- microscopic colitis
- malabsorptive conditions
- overflow incontinence from fecal impaction
- systemic issues (thyroid, diabetes)
- *warning signs=nocturnal diarrhea, weightloss, anemia, fecal occult blood, indicate likely not top 3, need more workup
osmotic diarrhea
-gets better with fasting, has increased stool osmotic gap
Sx: abd distention, bloating, flatulence, due to increased colonic gas production (ask about their dairy, artificial sweetener and alcohol use)
MC causes: meds,discaccharide deficiency.carbohydrate malabsorption, lactose intolerance, laxative abuse, malabsorption syndromes
secretory diarrhea
- does NOT get better with fasting, normal stool osmotic gap
- increased intestinal secretions (high volume watery diarrhea), can lead to dehydration and electrolyte issues
- MC causes: endocrine tumor, bile salt malabsorption, factitious diarrhea/laxative abuse, villous adenoma
MC causes of chronic diarrhea
- meds
- IBS
- lactose intolerance
initial lab workup for pt with chronic diarrhea
- CBC
- serum electrolytes
- liver enzymes, albumin
- vit A and D
- TSH
- CRP
- IgA tissue transglutaminase (tTG)
stool studies for workup
- determine osmotic vs secretory via osmotic gap
- malabsorptive via staining for fat
- inflammatory by looking for fecal occult blood, leukocytes, etc (IBD)
- infections (ova and parasites), fecal antigen/wet mount for giardia, E histolytica
- modified acid fast staining: cryptosporidium, cyclospora
more workup for chronic diarrhea
endoscopy with mucosal biopsy
- can exclude IBD, microscopic colitis, colonic neoplasia
- upper endoscopy w/ small bowel biopsy if SI inflammatory malabsorptive disease is suspected
