Diarrhea Flashcards
What are the types of diarrhea
Osmotic
Secretary
motility
surface area
Differentiate between osmotic and secretary diarrhea breifly
Osmotic is nutrient stay in the lumen and water follows
Secretory is enterocyte secretes electrolyte instead of absorbing it and water follows
Name the reasons for osmotic diarrhea
- Nutrients that cannot be absorbed
- damage to the mucosa
- malabsorption of salutes
- motility disorders
Examples of Malabsorption of specific solutes that causes osmotic diarrhea
Abnormality at the cellular level
Disaccharide deficiency, glucose-galactose mal-absorption
Examples of Damage to the absorptive area of the mucosa that causes osmotic diarrhea
Celiac disease
Crohn’s disease
Acute gastroenteritis
cows milk allergy
Examples of Ingestion of solutes that cannot be absorbed that causes osmotic diarrhea
Osmotic laxative
Candies
Fruits
Examples of motility disorders that causes osmotic diarrhea
Hyperthyroidism
IBs
Name the causes for secretory diarrhea
- activation of pathway by toxin
- inherent abnormality of enterocyte
How does cholerra toxin cause diarrhea
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”
Name inherent abnormalities in the enterocytes that causes secretory diarrhea
congenital microvillus atrophy)
Diff Between Osmotic diarrhea and secretary diarrhea
In volume of stool
Osmotic: <200ml
Secretory: >200ml
Diff Between Osmotic diarrhea and secretary diarrhea
In Response to fasting
Osmotic: stops
Secretory: continues
Diff Between Osmotic diarrhea and secretary diarrhea
In Stool sodium
Osmotic: <70
Secretory: >70
Diff Between Osmotic diarrhea and secretary diarrhea
In Reducing substances
Osmotic: positive
Secretory: negative
Diff Between Osmotic diarrhea and secretary diarrhea
In Stool PH
Osmotic: <5
Secretory: >5
Diff Between Osmotic diarrhea and secretary diarrhea
In anion gap
Osmotic: >100
Secretory: <100
Name a mixed pathology of osmotic and secretory diarrhea
Bacterial gastritis
What is the most common cause of acute diarrhea in all age groups?
Gastroentritis
What is the 2nd most common cause of acute diarrhea in all age groups?
Infant: systemic infection > ab > overfeeding
Child and adolescent: food poisoning
What is the most common cause of chronic diarrhea in all age groups?
- infant and child: Post-infectious secondary lactase deficiency
- adolescent: IBS
First cause of diarrhea is:
Viral > bacteria
How does rotavirus cause diarrhea?
By damaging the mucosa
Name common viruses to cause diarrhea:
- Rotavirus
- Norwalk virus
- Norovirus
- CMV
- Calicivirus
Acute vs chronic diarrhea duration is
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
