Diarrhea/Gastroenteritis Flashcards
What is the definition of Diarrhea
more than 3 BM’s a day
liquidity of feces
varies from one individual to another
What is the most common cause of acute diarrhea lasting less than 2 weeks?
infectious agents
bacterial toxins (preformed or produced in gut)
infections sources usually have what timeframe for incubation?
12-72 hrs.
where does 90% of all water absorption in the GI tract take place in?
small intestine
what is the major site of resorption?
jejunum
what is the most common cause of acute gastroenteritis?
infectious agents
how is acute gastroenteritis defined?
3 or more times a day/200g of stool
rapid onset
lasts < 2 weeks
May be accompanied by nausea, vomiting, fever, abdominal pain
what is a common finding with acute viral gastroenteritis?
mild diffuse abdominal pain
how is “gastritis” defined and what does it require?
histopathologic evidence of inflammation
involves ONLY the stomach
(do not confuse infectious gastroenteritis with acute gastritis)
two most common causes of gastritis?
Chronic NSAID use
Chronic Alcohol use
Classifications of Chronic Diarrhea
Osmotic
Inflammatory
Secretory
Chronic Infections
Malabsorption Syndrome
Motility
two classifications of acute infectious diarrhea:
inflammatory and bloody
non inflammatory, non bloody, watery
inflammatory diarrhea suggests what involvement?
colonic involvement by invasive bacteria or parasites or by toxic production.
patient complaints with inflammatory diarrhea:
frequent bloody, small volume stools, associated with fever, abdominal cramps, tenesmus, fecal urgency
common causes of inflammatory diarrhea:
Shigella, Salmonella, Escherichia coli, E coly 0157:H7
common protozoal cause of inflammatory diarrhea:
Entamoeba histolytica
Community outbreaks suggests what etiology?
viral or common food source
what is the cause of acute non inflammatory diarrhea?
viruses, toxins that effect the small intestine
common causes acute non inflammatory diarrhea?
VIRAL: rotavirus, norwalk virus
Vibriones: vibrio cholerae, vibrio parahaemolyticus
enterotoxin producing E coli
Protozoal: Giardia Lamblia, Crytosporidium, clyclospora
Incubation period for preformed food borne toxins
1-6 hours
incubation period for food borne pathogens that produce toxins after being ingested?
8-16 hours
actions if diarrhea worsens for more than 7 days:
stool should be sent for fecal leukocyte, ovum and parasite evaluation, and bacterial culture.
situations indicating prompt medical evaluation:
inflammatory diarrhea with:
-fever (38.5 C)
-6 or > unformed stools in 24 hrs
-signs and sx of dehydration
SX of non inflammatory diarrhea:
N/V and decreased appetite
abdominal pain
loose stool
malaise
fatigue
TTP abdomen, diffuse
distention
increased bowel sounds
afebrile
+tilts possibly
DDX of Diarrhea
food poisoning
inflammatory bowel disease
malabsorption
medication effect
laxative abuse
Labs for Diarrhea
CBC with Diff
Fecal leukocyte
Fecal O/P
Stool Culture
C difficile assay, if recent hospitalization or antibiotics
Stool exam of Giardia Lambia if Giradiasis is suspected.
Rehydration for diarrhea is preferred to have what chemicals?
Na+, K+, Cl-, and bicarbonate or citrate.
rate at which to give fluids for rehydration for diarrhea:
50-200mL/kg/24 hr
IV fluid of choice for rehydration in regards to diarrhea
Lactated ringers
Antidiarrheal Agents
Loperamide (imodium)
Bismuth subsalicylate (pepto bismol)
infectious bacterial diarrhea treatment is appropriate with what?
shigellosis, cholera, salmonellosis, listeriosis, and C difficile
parasitic infections requiring treatment:
amebiasis, giardiasis, cryptosporidiosis
categories of gastritis:
erosive and hemorrhagic gastritis
nonerosive and nonspecific gasritis
specific types of gastritis
labs to run for gastritis:
HCT (CBC)
H pylori testing
fecal occult blood
