Diarrhea Flashcards
What are the 2 concerning things lost in a patient’s Diarrhea?
Potassium and Bicarb
When is acute diarrhea concerning and need a workup?
Bloody or pus (Dysentery)
Fever
Risk of E. Coli
Risk of C. Diff
3 big causes of Non-infectious Diarrhea
- Meds
- Food allergies/intolerances
- Artificial Sweeteners
What is the difference between ABX-associated diarrhea and ABX-associated colitis?
Colitis is attributable to the C. Diff infection that follows ABX use
Diarrhea is caused by the drug itself
Osmotic Diarrhea
Caused by stuff staying in the GI tract and pulling water in.
Gets better with fasting.
Lactose intolerance, artificial sweeteners, and alcohol
Laxative abuse
Secretory Diarrhea
Does NOT improve with Fasting
Dehydration/hyponatremia can develop
Causes: Zollinger Ellison, Crohns, Laxative abuse
3 most common causes of chronic diarrhea
- Meds
- IBS
- Lactose Intolerance
What findings are red flags for chronic diarrhea?
Nocturnal diarrhea
weight loss
anemia
Positive fecal occult blood test
Examples of Routine lab work for Diarrhea
CBC
CMP
anti tTG test (celiac’s)
Albumin
Common causes of diarrhea due to malabsorption
Pancreatic insufficiency/pancreatitis
A high Gastrin level (>1000) is a sign of what?
Zollinger-Ellison Syndrome
Meds that can cause Diarrhea
AcHe Inhibitors SSRIs PPI NSAIDs Metformin
3 clinical presentations of IBS
- Spastic colon (abd pain)
- Alternating diarrhea/constipation
- Chronic, painless diarrhea
Lactase Deficiency
No Lactase in brush border
Diarrhea, cramping, flatulence post lactose ingestion
Can diagnose with Hydrogen breath test or by improvement of symptoms when lactose is removed from diet
What is the most common cause of antibiotic-associated colitis?
C. Diff- can cause pseudomembranous colitis as well
3 risk groups of C. Diff
- Hospitalized
- Elderly
- Immunocompromised
C. Diff caused colitis
Usually after ABX that alters normal gut flora.
Foul-smelling watery diarrhea many times a day
Pseudomembranous Colitis characterized by Volcano exudate
Symptoms that lead you to a malabsorption syndrome
Weight loss
Vitamin Def
Steatorrhea
Nutritional def
Examples of malabsorption disorders
Pancreatitis Whipple disease Crohns Celiac CF
Celiac Dz
Caused by gluten (gliadin) allergy damages small intestine and shows villous atrophy HLA-DQ2 and HLA-DQ-8 associated Dermatitis Herpatiformis Fe-Def Anemia Test for anti-tTG ab
Where are Bile salts resorbed?
distal Ileum
resection or disease (Crohns) can cause malabsorption and lead to steatorrhea/watery diarrhea and malabsorption of fat-soluble vitamins
Whipple Disease
Caused by the gram + Tropheryma Whipplei
White men (farmers)
Causes weight loss, malabsorption, and can lead to heart failure of untreated.
Diagnose using PAS staining for foamy macrophages
Upon colonoscopy, your patient’s colon is brown/black and you freak out. Should you?
No, it is most likely melanosis coli, a benign hyperpigmentation of the colon due to chronic laxative use