Diarrhea (Quiz 2) Flashcards
acute diarrhea is defined as lasting how long
- less than 2 weeks
common etiology of acute diarrhea
- infectious
chronic diarrhea is defined as lasting how long
- more than 4 weeks
etiology of chronic diarrhea
- multiple etiologies
- often non-infectious
pathophysiology of osmotic/malabsorption diarrhea
- increased osmotic load in intestine
- retains fluid in lumen of bowel
treatment of osmotic diarrhea
- resolves or decreases with fasting
pathophysiology of secretory diarrhea
- excess secretion of electrolytes and water into intestinal lumen
secretory diarrhea characterized by
- elevated stool volumes
- hypokalemia
result of fasting with secretory diarrhea
- continues despite fasting
how to calculate stool osmotic gap
290 - (2 x (Stool Na + Stool K)
stool osmotic gap > 100 suggests
osmotic gap < 50 suggests
- osmotic diarrhea
- secretory diarrhea
pathophysiology of inflammatory diarrhea
- mucosal destruction leads to increased permeability
- inflammatory mediators stimulate secretion and inhibit reabsorption
clinical features of inflammatory diarrhea
- WBC and blood in stool
- fever
- tenesmus
what is tenesmus
- urgency to have a bowel movement
two divisions of microscopic colitis
- lymphocytic colitis
- collagenous collitis
which microscopic colitis affects women more
which one affects both equally
- collagenous - women
- lymphocytic - men and women affected equally
what does the colon look like with endoscopy and radiographically in microscopic colitis
- normal appearing colon
how to diagnose microscopic colitis
- colonic mucosal biopsies
biopsy of lymphocytic colitis shows
- infiltration of colonic epithelium with lymphocytes
biopsy of collagenous colitis shows
- thickening of sub epithelial collagen band
- some increase in intraepithelial lymphocytes
treatment of microscopic colitis
- Budesonide
genetics of celiac disease
importance of this test
- lack of HLADQ2/8 forms autoantibodies (TTG, EMA)
- patient’s don’t necessarily have celiac if they are negative for these HLAs but they could have it
presentations of celiac disease
- ADEK deficiencies
- iron deficiency anemia
- dermatitis herpetiformis
histologic findings for celiac disease
- blunting of villi (crypt:villus ratio 3:1 instead of 1:3)
- increased lymphocytes and plasma cells in lamina propria of epithelium
- fusion of microvilli
pancreatic exocrine insufficiency - malabsorption does not occur until exocrine secretions are decreased by
- 90%
pancreatic exocrine insufficiency what you see in clinical studies
- fat in stool
- decrease in ADEK vitamins
pathophysiology of bacterial overgrowth
- decreased transit resulting in overgrowth of bacteria in the small bowel
how to diagnose bacterial overgrowth
- small bowel X-rays
- hydrogen breath test
- empiric antibiotic trial
exogenous agents that can cause osmotic diarrhea
- sorbitol
- lactose in those deficiency in lactase
- fructose in those deficient in GLUT5
pathophysiology of motility diarrhea
- rapid transit through colon
what is IBS
- functional bowel disorder
- abdominal pain associated with defecation or change in bowel habit
4 IBS subtypes
- IBS constipation
- IBS diarrhea
- IBS mixed
- IBS unspecified
pathophys of IBS
- heightened visceral hypersensitivity
- altered gut-brain axis
- abnormal CNS processing of visceral stimuli
- due to infection
red flags for IBS
- onset after age 50
- worsening symptoms
- weight loss
- nocturnal diarrhea
- family history of colon cancer, celiac, IBD
- rectal bleeding or melena
- iron deficiency anemia
treatment of motility diarrhea
- improves with fasting
what are the criteria for IBS
- Rome IV criteria
