Diarrhea Flashcards by Zahra Kalifa

Q

What are the types of diarrhea

A

Osmotic
Secretary
motility
surface area

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Q

Differentiate between osmotic and secretary diarrhea breifly

A

Osmotic is nutrient stay in the lumen and water follows

Secretory is enterocyte secretes electrolyte instead of absorbing it and water follows

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Q

Name the reasons for osmotic diarrhea

A

Nutrients that cannot be absorbed
damage to the mucosa
malabsorption of salutes
motility disorders

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Q

Examples of Malabsorption of specific solutes that causes osmotic diarrhea

A

Abnormality at the cellular level

Disaccharide deficiency, glucose-galactose mal-absorption

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Q

Examples of Damage to the absorptive area of the mucosa that causes osmotic diarrhea

A

Celiac disease
Crohn’s disease
Acute gastroenteritis
cows milk allergy

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Q

Examples of Ingestion of solutes that cannot be absorbed that causes osmotic diarrhea

A

Osmotic laxative
Candies
Fruits

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Q

Examples of motility disorders that causes osmotic diarrhea

A

Hyperthyroidism

IBs

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Q

Name the causes for secretory diarrhea

A

activation of pathway by toxin

- inherent abnormality of enterocyte

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Q

How does cholerra toxin cause diarrhea

A

toxin attached to the receptor, then changes the intracellular chemistry ( produce cyclicGMP and this enhances kinases. Kinases enhance the secretion, and inhibit Na, Cl absorption)

= inhibition of electrolytes absorption + ENHANCING RECEPTORS TO SECRETE ABNORMALLY.

“Secretory diarrhea”

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Q

Name inherent abnormalities in the enterocytes that causes secretory diarrhea

A

congenital microvillus atrophy)

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Q

Diff Between Osmotic diarrhea and secretary diarrhea

In volume of stool

A

Osmotic: <200ml
Secretory: >200ml

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Q

Diff Between Osmotic diarrhea and secretary diarrhea

In Response to fasting

A

Osmotic: stops
Secretory: continues

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Q

Diff Between Osmotic diarrhea and secretary diarrhea

In Stool sodium

A

Osmotic: <70
Secretory: >70

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Q

Diff Between Osmotic diarrhea and secretary diarrhea

In Reducing substances

A

Osmotic: positive
Secretory: negative

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Q

Diff Between Osmotic diarrhea and secretary diarrhea

In Stool PH

A

Osmotic: <5
Secretory: >5

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Q

Diff Between Osmotic diarrhea and secretary diarrhea

In anion gap

A

Osmotic: >100
Secretory: <100

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Q

Name a mixed pathology of osmotic and secretory diarrhea

A

Bacterial gastritis

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Q

What is the most common cause of acute diarrhea in all age groups?

A

Gastroentritis

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Q

What is the 2nd most common cause of acute diarrhea in all age groups?

A

Infant: systemic infection > ab > overfeeding

Child and adolescent: food poisoning

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Q

What is the most common cause of chronic diarrhea in all age groups?

A

infant and child: Post-infectious secondary lactase deficiency
adolescent: IBS

Q

First cause of diarrhea is:

A

Viral > bacteria

Q

How does rotavirus cause diarrhea?

A

By damaging the mucosa

Q

Name common viruses to cause diarrhea:

A

Rotavirus
Norwalk virus
Norovirus
CMV
Calicivirus

Q

Acute vs chronic diarrhea duration is

A

14d

In patient with bloody diarrhea, it can be either viral or bacterial, how to differentiate from the clinical scenario?

In bacterial, he’ll have high grade fever, lethargy, extraintestinal mainfestaitons Wheras viral more beingin and started with vomitting > diarrrhea

Name an extraintestinal mainfestation of sheigella?

Seizures

Name common bacteria to diarrhears

Campylobacter jujeni, salmonella, sheigella, ecoli, yersenia, clostredium.

If it’s a prolonged diarrhea, the causative organism is most likely:

Parsitice

What is the pathophysiology of autoimmune enteropathy?

Anti-enterocyte antibodies (IgG) damage mucosa

What is the pathophysiology of micovillus inclusion

Reduction of surface area and massive excretion of electrolyte

In electrolyte transport defect, what indicates the severity of diarrhea

The strenght of the salute and wither it’s eaten or not (fructose tranport defect, if child is eating fructose or not)

In cystic fibrosis, what is the associated diarrhea?

Osmotic (due to pancreatic insuffecency > protein and fat malabsorption)

What liver disease may cause osmotic diarrhea?

Cholestasis: reduced bile salt > insufficicent fat malabsorption

How are disorders of motility like (hyperthyroidism) and (psudointestinal obstruction) cause dirrhae

- increased motility: no time to absorp electrolyte | - decreased motility: increased time causing fermentation & changing osmolality

Define toddler diarrhea

High sugar content diarrhea

General history for diarrhea what will you ask?

- stool description - course of complain (infancy\affected by fasting) - type of diarrhea - organic\functional

Risk factors in history of dirrhea:

- contact\travel: infectious - nutritional\water: toddler\poisoining - prev surgery - pancreatic disease - systemic disease - drugs: laxatice, AB - family hx of IBD or Celiac

What will you do in the physical examination of dirrhea?

- hydration status - growth parameters\nourishment - intestinal\extraintestinal Complete systemic examination

What will you do in stool examination:

``` 1- analysis 2- culture 3- virology 4- ova\parasite 5- PH 6- osmotic\secretory 7- occult blood 8- calprotectin ```

What investigations would be suitable in pancreatic insufficiency leading to fat and protein malabsorption?

- fecal elastase - A1AT - 72 hours stool collection (fat\reducing substance)

What investigations would be suitable in celiac?

- trans-tissue glutaminase - endomysel antibodies (IgA, IgG) - biopsy: “positive serology”

What other investigations will you order for diarrhea

CBC, LFT, RFT, Immunoglobulin, food allergies, abdominal US

What is step 2 in diarrhea disease?

- Endoscopy - barium meal\enema - CT\mri enterography - electron microscopy

What is step 3 in diarrhea investigations

Immunohistochemistry - antienterocyte AB

How to manage diarrhea?

Rehydration and nutirition rehabilitation

What is the role of anti-diarrhea medications

No role

Specific treatment for diarrrhea | For bacterial, celiac, allergic, CF, IBD, Cl & Na losing,

- antibiotic: bacterial - avoid gluten: celiac - avoid trigger: allergies - pancreatic enzyme replacement: CF - steroid\azathioprine: IBD - salt replacement: Na losing

How to treat conginital intractable diarrhea

Insure optimum nutrition TPN + small bowel transplantation