Diarrhea Flashcards
watery non bloody diarrhea with fecal urgency and incontinence and patient uses naproxen
microscopic colitis
presentation of microscopic colitis
watery non bloody diarrhea and fecal urgency and incontinence and abdominal pain and fatigue and weight loss and arthralgias. See in middle aged women
triggers for microscopic colitis
smoking, medications: NSAIDS, PPIs, SSRI’s, ranitidine
diagnosis of microscopic colitis
colonoscopy biopsy with lymphocytic infiltration and lamina propria
two types:
collagenous: thickened subepithelial collagen band
lymphocytic: high levels of intraepithelial lymphocytes (>20 for every 100 epithelial cells and focal cryptitis may occur)
management of microscopic colitis
removed possible triggers antidiarrheal medications and oral budesonide
if refractory: get cholestyramine, bismuth, subsalicylate and TNF a inhibitors with (infliximab and adalimumab)
lactose intolerance diarrhea
abdominal discomfort and flatulence but rarely diarrhea also no changes on colonic biopsy
Clinical presentation of Giardiasis?
diarrhea, foul smelling due to malabsorption, sometimes described as explosive.
steatorrhea
fatigue and malaise
abdominal cramps,
flatulence, and bloating
significant weight loss despite good oral intake
Treatment of giardia
metronidazole
diagnosis of Giardiasis?
stool microscopy over stool antigen testing because Giardia cysts shed intermittently.
stool microscopy and look for giardia trophozoites and cysts.
who gets giardiasis?
giardia cysts live in cold water (rivers and streams) and water dwelling mammals. They infect hikers who drink water without adequate filtration, treatment or boiling
childcare workers,
men who have sex with men
secondary lactose intolerance
develops after acute infection or inflammation (viral gastroenteritis, Crohn’s dx flaire up)
lactose intolerance clinical features
crampy abdominal pain, bloating, increased flatulence, diarrhea, (happens after ingestion of lactose containing products) on PE only hear borborygmi (bowel sounds)
stool lab findings of lactose intolerance
elevated osmotic gap >125 mOsm/kg and decreased pH<6 of stool.
why does secondary lactose intolerance occur?
happens due to inflammatory destruction of the terminal villi and subsequent loss of lactase enzyme. There can be recovery of enzyme activity but this can take several months after inflammatory insult to cease and healing to begin
management of lactose intolerance
stop eating cheese. lactose restricted diet, enzyme replacement and vitamin D and calcium supplementation
what separates out chronic giardiasis from secondary lactose intolerance
giardiasis has weight loss and steatorrhea and malaise and fatigue. This is just abdominal pain, bloating and flatulence
treatment of irritable bowel syndrome is with
FODMAP diet with low diet of fermentable oligo, di, monosaccharide and polyols
management of acute diarrhea
supportive measures if on antibiotics stop them if possible and observe clinically
what to evaluate for with someone who has acute diarrhea
fever,
hypovolumia,
immunocompromised
or elderly
>6 stools in 24 hrs
symptoms duration >1 week
peritoneal signs
bloody diarrhea
if no to all do supportive measures and stop abx if able
if acute diarrhea and has one or more of the following: fever hypovolumia immunocompromised or elderly or hospitalized >6 stools in 24 hrs symptoms duration >1 week peritoneal signs bloody diarrhea what do you do?
If had any of those symptoms they need a diagnostic evaluation. fecal leukocyte ova and parasites stool culture and check C diff assay if on recent antibiotics.
if patient has inflammatory diarrhea then:
Give empiric abx until pathogen is identified
if pt has non inflammatory diarrhea then
supportive measures.
what is acute diarrhea
diarrhea that is <14 days in duration
acute diarrhea etiology:
can be infectious or non infectious and usually resolves within a few days
most common cause of acute antibiotic diarrhea
clindamycin, cephalosporin or amoxicillin clavulanate (most commonly but can happen with any abx)