Diarrhea & constipation Flashcards
Constipation:
-definition
def: passage of stool infrequently or with difficulty, stool frequency of less than 3/wl.
- straining, hard stool, incomplete evacuation
Causes of Constipation
Etiologies:
- MC lifestyle*
- inadequate fiber in diet
- inadequate hydration
- inactivity
- meds:
- -opiates/narcotics
- -anticholinergics (xanax, cetirizine, benadryl, codiene)
- -calcium channel blockers
- -antiparkinsonians
- -antidepressants
- carcinoma
- ischemia
- volvulus
- megacolon (hirschsprungs)
- anorectal disorders:
- -prolapse
- -rectocele(tissue between rectum and vagina weakens)
- -pelvic flood dysfunction (MC in pregnancy, MS, and autonomic neuropathy; DM)
- Hypokalemia
- hypothyroidism*
- hyperparathyroidism
- addisons dz
- hypercalcemia
- MS
- Parkinsons
- Hirschprung
- Chagas
- spinal cord lesions
- amyloidosis
- scleroderma (Hardening of CT)
- pregnancy
- surgical (abd, pelvic, colonic, anorectal)
- depression
- eating disorder
Constipation:
- examination
- Tx In pts less than 50YO with no alarming sx
- further tx should be performed on pts with any of the following risk factors?
- what are alarming sx?
Examination: full history, PE (DRE**)
Tx in pts less than 50YO with no alarming sx may be started with empiric tx.
Further tx should be performed on pts with any of the following:
- over 50YO
- severe constipation
- signs of an organic disorders
- hematochezia
- weight loss
- positive FOBT (fecal occult blood test)
Alarming sx:
-weight loss, hematochezia, hematemasis, FHx of colon CA, anemia
Constipation:
-labs and procedures you should order
Labs:
- KUB, barium enema, colonoscopy**
- colonic transit study
- Glucose
- CBC (anemia)
- Thyroid
- Calcium
- Magnesium
- Phosphorus
Constipation:
- management
- tx
management:
* first & foremost is prevention!!!!
- educate pts:
- -exercise (stimulates peristalsis and defication)
- -fluid intake
- -fiber intake (unless already constipated)
Tx:
- Stool softeners:
- -colace, ducosate calcium
- Laxative:
- -bulking agents: Psyllium (metamucil) benefiber, fibercon, methylcellulose (citrucel)
- -Osmotics: lactulose, polyethylene glycol (miralax), sorbitol
- Stimulant Laxative: bisacodyl (ducolax), senna (xlax)
- Opiod receptor antagonist: methylnaltrexone
- digital disimpaction
Diarrhea
- definition
- what frequency of stool is considered abnormal?
- pathophysiology
Def:
increase in daily stool weight above 200-300g/24hr OR increase in stool liquidity and/or frequency
-more than 3 stools/day is considered abnormal.
Pathophysiology:
-osmotic: non-absorbable substance draws out excess water into the intestine & increases stool weight and volume.
- secretory: mucosal secretion of fluid and electrolytes 2ndry to bacterial enterotoxins, neoplasms, or exotoxins.
- Motility: food is not mixed properly, digestion is impaired and motility is increased.
Diarrhea :
-classification of acute, persistent, and chronic
Acute: less than 14 days in duration
Persistent: more than 14 days duration
Chronic: more than 30 days duration
Acute Diarrhea
- causes
- sx
Acute Causes:
- infections with viruses and bacteria and are self limited; usually not lasting beyond 7 days.
- Viral:
- -norovirus; nursing home/cruise ship
- -rotavirus; daycare
- -adenoviruses
- -astrovirus
Bacterial:
- salmonella; pet ducklings, rattle snake meat, sprouts, meat
- campylobacter; poultry, raw milk, cheese. Think guillian barre.
- shigella; daycare, veggies
- enterotoxigenic E. coli, C. Diff; travelers to developing world, hospitilization.
Protozoa:
- cryptosporidium
- giardia
- cyclospora
- entamoeba
Noninfectious:
-drugs, food allergies, dz such as thyrotoxicosis & carcinoid syndrome.
Sx: fever, cramping pain, dehdration in elderly/children
Acute Diarrhea
–indications for diagnostic evaluation
perfuse watery diarrhea with signs of hypovolumeia
- bloody diarrhea
- temp greater than/= 38.5C.
- sever abd pain
- hospitalized pts or use of recurrent abx
- diarrhea in elderly or in immunocompromised
- systemic illness with diarrhea esp in pregos.
Chronic Diarrhea;
- causes
- types
cause:
-medications: Cholinesterase inhibitors( Aricept), metformin, SSRI, ARBS, PPI, NSAIDS
- Osmotic
- Secretory
- inflammatory
- malabsorptive
- motility disorders
- chronic infections
Osmotic diarrhea:
- clues to dx
- medications that cause this
- other cause
Clues: diarrhea occurs with eating and goes away when they fast, increased stool osmotic gap
medications: antacids, lactulose, sorbitol
Disaccharide deficiency = lactose intolerance
Secretory Diarrhea
- clues to dx
- causes
clues:
- large volumes of stool (greater than 1L/d), little change with fasting, normal stool osmotic gap.
Causes:
-hormonally mediated: carcinoid, medullary carcinoma of thryoid, zollinger-ellision syndrome
- villous adenoma
- bile salt malabsorption
- meds
Inflammatory Conditions causing diarrhea
- clues to dx
- causes
Clues:
-fever, hematochezia, abd pain
Cause:
- IBD**
- Ulcerative colitis
- Crohns Dz
- Malignancy: lymphoma, adenocarcinoma
- radiation enteritis
Malabsorption syndromes causing diarrhea;
- clues to dx
- cause
Clues:
-weight loss, abnormal lab values, fecal fat greater than 10g/24hrs
Cause:
-Small bowel disorders: Celiac sprue, whipple dz, eosinophilic gastroenteritis, small bowel resection, Crohns dz
Lymphatic obstruction:
-lymphoma, carcinoid, infectious, kaposi sarcoma
Pancreatic Dz: chronic pancreatitis, pancreatic carcinoma
Bacterial overgrowth: motility disorders, scleroderma, fistulas, small intestinal diverticula
Motility Disorders causing diarrhea
- clues
- causes
Clues: systemic dz or prior abd surgery
Cause:
- post-surgical
- systemic disorders: IBS
