Diarrheal Diseases Flashcards by Katya Angoua

Diarrheal dx definition

Group of disease with diarrhea as main symptoms

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Diarrhea definition

Passing of watery stool more than 3 times / day
Or
Increase stool weight above 300g per day

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Chronic diarrhea definition

Diarrhea more than 30 days

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What is dysentery

Blood and mucoid stool

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What is acute gastroenteritis

Diarrhea with constitutional symptoms

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2 ways to classify diarrhea

Acute or chronic
Infection or non infectious etiology

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What is acute diarrhea

Less than 14 days of diarrhea

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What is persistent diarrhea

More than 14 days of diarrhea but less than 30 days

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What is chronic diarrhea

Diarrhea more than 30 days

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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

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Non infectious causes of diarrhea

Lactose intolerance
Celiac disease
Non celiac gluten sensitive
Irritable bowel syndrome
Inflammatory bowel disease
Hyperthyroidism
Bile acids
Some drugs

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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 )

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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

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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

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In food history , what should you note

Time of Apparition of diarrhea from ingestion of food

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If diarrhea appeared no more than 6h after ingesting food , pathogens suspected

Staph aureus
Bacillus cereus
Clostridium species

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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