Diarrheal Diseases

Question 1

Antibiotics used in severe diarrhea or immunocompromised diarrhea patients

Answer 1

Bactrim

Fluoroquinolones

Question 2

Which infections cause secretory and inflammatory chronic diarrheas

Answer 2

Secretory = E. coli

Inflammatory = C. diff

Question 3

Very low pH in stool analysis in a patient with chronic diarrhea suggests this

Answer 3

Carbohydrate malabsorption

(bacteria digest carbs and produce acid)

Question 4

Which of the three chronic diarrheas is most likely to have blood and/or pus in the stool?

Answer 4

Inflammatory (UC)

Question 5

Labs to assess for dehydration in diarrhea

Answer 5

CBC - Hematocrit

Electrolytes

BUN/Cr

Question 6

Two causes of accelerated GI transit leading to diarrhea

Answer 6

Hyperthyroidism

Carcinoid syndrome

Question 7

True or false. Sports drinks lack the sodium needed to rehydrate a patient with acute diarrhea

Answer 7

True

Question 8

Differentiate between IBD and IBS

Answer 8

IBD = autoimmune (Crohn’s and UC)

IBS = not autoimmune (IBS-C and IBS-D)

Question 9

Two main pathophysiologic causes of diarrhea

Answer 9

Increased water in colon/stool

Accelerated transit

Question 10

Which is more common, acute or chronic diarrhea?

Answer 10

Acute diarrhea

Question 11

Two hallmark signs of osmotic diarrhea

Answer 11

Stops with fasting

Presence of stool osmotic gap (very dilute stool)

Question 12

Which form of chronic diarrhea is most common?

Answer 12

Secretory

Question 13

Cause of osmotic chronic diarrhea

Answer 13

Ingestion of poorly absorbable substances (laxatives, sugar alcohols) leads to water accumulation in gut

Question 14

Differentiate osmotic from secretory chronic diarrhea

Answer 14

Osmotic: Water drawn into gut without electrolytes, large osmotic gap

Secretory: Electrolytes secreted into gut drawing water with them, no big osmotic gap

Question 15

WBCs in stool sample of chronic diarrhea suggest this cause

Answer 15

Bacterial

Question 16

Chronic diarrhea diagnostic criteria

Answer 16

> 3 loose stools daily for >4 weeks

Question 17

Signs of dehydration in diarrhea patients

Answer 17

Decreased urine output, decreased skin turgor

Tachycardia with moderate

Hypotension with severe

Question 18

When to use anti-diarrheals in acute diarrhea

Answer 18

When no blood in stool and no fever

Question 19

Chronic diarrhea treatments

Answer 19

Treat underlying cause/eliminate offending agent

Antibiotics if high infection risk (daycare worker)

Antidiarrheals - if nothing else to do (loperamide, diphenoxylate + atropine)

Cholestyramine if gallbladder removed, post-ileal resection, or abdominal radiation

Question 20

Causes of increased water in colon/stool

Answer 20

Osmotic water movement into intestine

Can be due to inflammation, pathogens and their toxins, ingestion of poorly absorbable substances, or a lactase deficiency

Question 21

Diagnosis criteria for acute diarrhea

Answer 21

> 3 loose stools daily for <2 weeks

Question 22

Labs to assess cause of diarrhea

Answer 22

Stool analysis with culture

Sigmoidoscopy with biopsy if severe, persistent diarrhea

Question 23

Acute diarrhea treatment

Answer 23

Most cases resolve on their own in 3-4 days

Rehydration (PO moderate or IV if severe)

Question 24

Principal cause of morbidity/mortality and best thing to check for on physical exam to determine severity in diarrhea

Answer 24

Dehydration

Question 25

True or false. In diarrhea patients, pain often increases with palpation.

Answer 25

False, but must assess for rebound tenderness to rule out other causes

Question 26

Three classifications of chronic diarrhea

Answer 26

Osmotic Secretory Inflammatory

Question 27

Which of the three chronic diarrheas is most likely to have abdominal pain?

Answer 27

Inflammatory (UC and Crohn's)