Diarrhea And Constipation Flashcards
Electrolyte complications of diarrhea
- Hypokalemia
- Acidosis (loss of HCO3 in stool)
- Hyponatremia (loss of Na in stools and oral intake free of water)
Why does diarrhea lead to hyponatremia?
Loss of sodium and oral replacement with hypotonic fluids like water soda juice in the presence of ADH (volume preservation)
Most common cause of constipation
Medications
Reasons for constipation
Medications, hypothyroid (metabolic), inertia (slow transit), dyssnergia (faulty mechanism)
Drugs that cause constipation
Imodium, mood disorder drugs, Anit-anxiety drugs, hypertensives, CCBs, parkinson’s drugs, peptic ulcer drug sucralfate, opioids, St Johns Wort
Volvulus
Twisting or axial rotation of a portion of bowel about its mesentery. Lack of bowel movement leads to constipation and pain
Intussusception
Part of the intestine telescopes into another often resulting in obstruction. Kids with red currant jelly per recutum
Patient presents with constipation and you send them home on therapeutic trial of fiber plus laxatives. That fails, what do you do now?
Anorectal manometry and balloon expulsion test
Colonic transit
Barium or MR defecography
A 26 year old woman with a history of ulcerative colitis presents for evaluation of diarrhea. She was doing well until 3 months ago when she noted non-bloody diarrhea. She describes intermittent frequent loose stools, averaging 4-6 per day. She denies nocturnal bowel movements.
Which of the following tests would be most helpful in distinguishing the possible causes of this patient’s diarrhea?
A. Stool for fecal leukocytes B. Stool for C. difficile toxin A and B D. Stool for fecal rbc E. Stool for culture and sensitivity
C
A 3 year old boy is brought to the office with three days of watery diarrhea as described by his mother. She states that he has as many as 10 movements a day of foul smelling liquid brown stool. She denies any blood or fevers but notes that her son is less active and with less urine output. He hasn’t been to his day care since the start of these complaints.
What is the most likely cause of this boy’s symptoms?
A. Parasitic disease (giardiasis)
B. Food poisoning
C. Inflammatory bowel disease (Ulcerative colitis)
D. E Coli
A
A 3 year old boy is brought to the office with three days of watery diarrhea as described by his mother. She states that he has as many as 10 movements a day of foul smelling liquid brown stool. She denies any blood or fevers but notes that her son is less active and with less urine output. He hasn’t been to his day care since the start of these complaints.
Where is the most likely site of the diarrhea?
A. Small bowel
B. Stomach
C. Colon
D. Extra-intestinal
A
An 85 year old man with advanced dementia is referred for evaluation of 4 weeks of a small amount of liquid stool up to 5 times a day. His care giver notes that he is “constantly soiled” and she has had to have him wear depends. Review of his medications shows calcium supplement, blood pressure medication, and a daily opiate pain pill (severe arthritis).
What is the most likely cause of his diarrhea?
A. Medication induced diarrhea
B. Infectious diarrhea, such as cdiff
C. Colon cancer
D. Constipation with overflow
D
A colleague of yours stops you in the hallway to get your opinion on his “friend’s” symptoms. For years he has had to use the bathroom 5-6 times a day regardless of diet. He wakes up 1-2x a night to use the bathroom and notes large watery diarrhea. The only time he felt well was when he was on vacation in India for two weeks. He has always had trouble gaining weight and has been making protein milk shakes daily to help with this with some success. What is the most likely source of his symptoms?
A. Inflammatory bowel disease
B. Lactose intolerance
C. Giardiasis
D. It’s all in his…”friend’s” head
A
Causes of enteritis
Bacterial: campylobacter, E. Coli, Salmonella, Shigella, S. Aureus
Radiation induced
Causes of dysentery
Amoeba- entamoeba histolytica
Bacterial- same as enteritis
