Diarrheal Diseases Flashcards
Diarrheal dx definition
Group of disease with diarrhea as main symptoms
Diarrhea definition
Passing of watery stool more than 3 times / day
Or
Increase stool weight above 300g per day
Chronic diarrhea definition
Diarrhea more than 30 days
What is dysentery
Blood and mucoid stool
What is acute gastroenteritis
Diarrhea with constitutional symptoms
2 ways to classify diarrhea
Acute or chronic
Infection or non infectious etiology
What is acute diarrhea
Less than 14 days of diarrhea
What is persistent diarrhea
More than 14 days of diarrhea but less than 30 days
What is chronic diarrhea
Diarrhea more than 30 days
infectious causes of diarrhea
Viral => norovirus , rotavirus, adenovirus, astrovirus
Bacteria => Salmonella, campylobacter, shigella , E. coli, C. difficile , staph, b. Cereus…
Protozoan => cryptosporidium , entamoeba , giardia , cyclospora
Non infectious causes of diarrhea
Lactose intolerance
Celiac disease
Non celiac gluten sensitive
Irritable bowel syndrome
Inflammatory bowel disease
Hyperthyroidism
Bile acids
Some drugs
Different pathologic mechanism of diarrhea
Inflammatory ( mucosal lining damage)
Secretory ( more water secreted by cells of the intestines than water being absorbed )
Osmotic
Exudative
Dysentery
motility related (rapid motility so less absorption )
Important clinical features to note during history about diarrhea
Frequency
Nature
Severity of diarrhea (use Bristol stool form scale )
Severity of infection
Site of infection
Associated symptoms
Systemic problems
Potential exposure ( food history, residence , occupation, travel, pets, hobbies )
Medical history
Drug history
Sexual history
Bristol stool form scale
Type 1 -> separate hard lumps like nuts
Type 2 -> sausage shaped but lumpy
Type 3 -> sausage but cracks on surface
Type 4 -> sausage but smooth and soft
Type 5 -> soft blobs , clear cut edges
Type 6 -> fluffy pieces , ragged edges , mushy stools
Type 7 -> water , no solid pieces
In food history , what should you note
Time of Apparition of diarrhea from ingestion of food
If diarrhea appeared no more than 6h after ingesting food , pathogens suspected
Staph aureus
Bacillus cereus
Clostridium species
If diarrhea appeared between 8-16h after ingesting food , pathogens suspected
Clostridium perfrigens
If diarrhea appeared between 12-72h after ingesting food , pathogens suspected
Enterotoxigenic E. coli (ETEC)
Shiga toxin
Enteroinvasive E. coli (EIEC)
Vibrio
Salmonella
Shigella
Campylobacter
C. difficile
Pathogens suspected if raw seafood was consumed
Norovirus
Hepatitis A
Vibrios
Pathogens suspected if raw egg was consumed
Salmonella
Pathogens suspected if undercooked or raw meat or poultry was consumed
Salmonella
Campylobacter
EHEC
Yersinia enterolitica
Pathogens suspected if unpasteurized milk or juice was consumed
Salmonella
Campylobacter
EHEC
Yersinia enterolitica
Pathogens suspected if unpasteurized soft cheese was consumed
Salmonella
Campylobacter
ETEC
Yersinia enterolitica
Listeria monocytogenes
Pathogens suspected if canned good was consumed
Clostridium botulinum
Common diarrheal pathogens at day care
Rotavirus
Shigella
Cryptosporidium
Giardia
Pathogen linked with antibiotic use
C. difficile
Pathogens linked with nosocomial infections
C. difficile
Pathogens linked with pregnancy infections
Listeriosis
Pathogens linked with diarrhea in cirrhosis
Vibrio
Pathogens linked with hemochromatosis infections
Yersinia infection
Pathogens linked with homosexuality infections
Shigella
Giardia
Entamoeba
Examination in diarrheal disease
Dehydration status => dry mucous membranes , dark urine, scant urine , decreased skin turgor , Orthostatic hypotension
Volume loss assessment
Abdomen exam => abdominal distension, percussion, tenderness, rebound tenderness , rigidity , signs of peritonitis , signs of ileus
Indications for stool testing
Severe illness
Profuse watery diarrhea and signs of hypovolemia
Pass of more than 6 watery stool in a day
Need hospitalization
Signs of inflammatory diarrhea
Bloody diarrhea
Blood and mucus in diarrhea in small volume
High temper ( more than 38.5)
High risk host
More than 70 yo
Comorbidities
Immunocompromised
IBD
Pregnancy
More than a week symptom
Public health concerns
Species you have to isolate in case of raw sea food ingestion
Vibrio in special conditions
Investigation in case of bloody diarrhea
should suspect EHEC or entamoeba
Shiga toxin
Fecal leukocyte or lactofrrin and if negative should test for amoebiasis
Test to do in case of perisistent diarrhea
Test for parasitic organisms like giardia , cryptosporidium, entamoeba a
Endoscopy or colonoscopy for non infectious cause
Overall test to do in investigation
FBCFor inflammation and dehydration
Serum electrolyte For inflammation and dehydration
Multi pathogen molecular panel
Urine output
Bue + cr
Management of diarrhea
rehydration ( ORS + IV fluid replacement )
Dietary advice
Antibiotic therapy (broad spectrum like azithro or fluoroquinolone or specific when known organisms )
Probiotic
Infectious differentials of acute diarrhea + vomiting
◦ gastroenteritis
◦ C. difficile
◦ Acute diverticulitis
◦ Sepsis
◦ Pelvic inflammatory disease
◦ Meningococcaemia
◦ Pneumonia
◦ Malaria
Non Infectious differentials of acute diarrhea + vomiting
◦ IBD
◦Bowel malignancy
◦ Enteral tube feeding
◦ Constipation overflow
◦ DKA
◦ Thyrotoxicosis
◦ Uremia
◦ NSAIDs
◦ Cytotoxic agents
◦ PPI
◦ Dinoflagellates
◦ Plant toxins
◦ Heavy metals
