Diarrhea DSA Flashcards by Zach Visinoni

Clinical Dx of diarrhea

How long is acute diarrhea? Chronic?

3 or more loose/watery stools a day
OR
Decrease in consistency and increased frequency of BMs

<2 wks for acute
>4 wks for chronic

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All inflammatory diarrheas (blood, pus, fever, etc.) require:

Stool bacterial cultures

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Most common non-infectious cause of diarrhea

Meds - Abx, NSAIDs, anti-depressants, chemo, etc.

Sweeteners - Sorbitol

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What features of diarrhea will warrant further workup?

Nocturnal diarrhea
Wt loss
Anemia
+ fecal occult blood test

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Normal stool osmolality =

<50 mOsm/kg

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Osmotic diarrhea

What happens to stool volume when fasting?

What is the stool osmotic gap?

Symptoms include:

Most common causes (4)

Stool volume decreases w/ fasting

Stool Osm gap: > 50-75 mOsm/kg

Abdominal distention, bloating, flatulence

Meds
Lactose intolerance
Laxative abuse
Malabsorptive syndromes

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Secretory diarrhea

What happens to stool volume when fasting?

What is the stool osmotic gap?

Symptoms include:

Most common causes (4)

Stool volume does not improve w/ fasting

Normal Osm gap

High-volume watery diarrhea, dehydration (hyponatremia, NAGMA)

Endocrine tumors
Bile salt malabsorption
Factitious diarrhea (laxative abuse)
Villous adenoma

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Which 2 parasites should be detected by fecal antigen?

Giardia

E. histolytica

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Which 2 parasites should be detected by modified acid-fast staining?

Cryptosporidium

Cyclospora

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Which patients should have an endoscopic exam and mucosal Bx?

Pts. w/ chronic persistent diarrhea

-IBD, microscopic colitis, clonic neoplasia, etc.

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What signs/findings are consistent with pancreatic insufficiency vs. chronic pancreatitis?

Pancreatic insufficiency: fecal elastase < 100 mcg/g

Chronic pancreatitis: calcification on abdominal XR

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How is small bowel bacterial overgrowth diagnosed? (2)

Non-invasive breath test (glucose or lactulose)

dConfirmed by obtaining an aspirate of SI contents for aerobic/anaerobic cultures

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What does a H+ breath test help diagnose?

Lactase deficiency

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Reported abnormalities in IBS (3)

Altered colonic motility at rest and response to stress, drugs, CCK
Altered SI motility
Enhanced visceral sensation - lower pain threshold

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Patients with what unique symptomology may present with IBS?

Psychological disturbances

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3 types of clinical presentation of IBS

Spastic colon: chronic abdominal pain and constipation
Alternating constipation and diarrhea
Chronic, painless diarrhea

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Pencil thin stools are common in:

IBS

At what point should IBS be in the differential?

In patients with diarrhea, bloating and flatulence, what should be excluded?

At least 3 mo. IBS usually diagnosed at 6 mo.

Lactose intolerance

What is used to diagnose IBS?

ROME IV clinical diagnostic criteria

What diet is used to treat/manage IBS?

Low FODMAPS diet

Fermentable oligosaccharides
Oligosaccharides
Disaccharides
Monosaccharides
Polyols

3 protists associated with chronic diarrhea

Giardia
E. histolytica
Cyclospora

What intestinal nematode is associated with chronic diarrhea?

Strongyloides

What bacteria is associated with chronic diarrhea?

C Diff

Diagnostics for C Diff (3)

Stool assay (toxins A and B)
WBC > 15K
Pseudomembranous colitis on sigmoidoscopy w/ volcano eruptions (not needed in most pts.)

Diarrheal type in C Diff

Mild to moderate geenish, foul-smelling watery diarrhea 5-15x a day

2 major complications with a C Diff infection

Toxic megacolon and hemodynamic instability

Microscopic colitis include which 2 variants? Which patients are at the greatest risk? What med is most often implicated? Tx?

Lymphocytic and collagenous colitis F>M; >50 y/o; idiopathic NSAIDs Tx anti-diarrheal w/ loperamide and stop offending agent

Symptoms of malabsorption syndromes (4)

Weight loss Osmotic diarrhea Steatorrhea Nutritional deficiency

What damage occurs in Celiac disease? What alleles are associated w/ Celiac? Abs involved:

Diffuse damage to the proximal SI mucosa w/ malabsorption HLA-DQ2 and HLA-DQ8 tTG abtibodies

3 atypical symptoms of Celiac disease

Dermatitis herpetiformis Iron deficiency anemia Osteoporosis

Major histological change in Celiacs

Complete loss of intestinal villi

What test is done to screen for osteoporosis in patients with sprues?

DEXA

Where are bile salts reabsorbed? What causes destruction or loss of bile salts? Steatorrhea? Weight loss? Absorption of what is impaired? What kind of diarrhea?

Terminal ileum Bacterial overgrowth, acid hypersecretion, meds that bind bile salts Mild steatorrhea, with minimal wt loss Impaired absorption of fat-soluble vitamins (ADEK) Watery diarrhea

Symptoms of Whipple disease What is used to diagnose? If untreated, it is...

Wt. loss, malabsorption, chronic diarrhea Endoscopy w/ duodenal Bx with PAS stain (+ for Mo w/ characteristic bacillus) Fatal

Pseudo-diarrhea = Accompanies which pathologies?

Frequent passage of small volumes of stool IBS and prostitis

Fecal incontinence = What causes it?

Involuntary discharge of rectal contents NM disorders pr structural problems

Overflow diarrhea = Where is it seen? What is readily found by rectal exam?

Severe constipation, only contents that get by is liquid Elderly/nursing homes Fecal impaction

What is melanosis coli? What causes it?

A benign hyperpigmentation of the colon caused by chronic laxative use

What is paradoxical diarrhea?

Diarrhea from stool leaking around impacted feces - "overflow incontinence"

In what case should you not do a DRE?

If pt. has leukopenia

What kind of diarrhea accompanies bile salt malabsorption?

Osmotic diarrhea