Diarrheal Diseases Flashcards
Antibiotics used in severe diarrhea or immunocompromised diarrhea patients
Bactrim
Fluoroquinolones
Which infections cause secretory and inflammatory chronic diarrheas
Secretory = E. coli
Inflammatory = C. diff
Very low pH in stool analysis in a patient with chronic diarrhea suggests this
Carbohydrate malabsorption
(bacteria digest carbs and produce acid)
Which of the three chronic diarrheas is most likely to have blood and/or pus in the stool?
Inflammatory (UC)
Labs to assess for dehydration in diarrhea
CBC - Hematocrit
Electrolytes
BUN/Cr
Two causes of accelerated GI transit leading to diarrhea
Hyperthyroidism
Carcinoid syndrome
True or false. Sports drinks lack the sodium needed to rehydrate a patient with acute diarrhea
True
Differentiate between IBD and IBS
IBD = autoimmune (Crohn’s and UC)
IBS = not autoimmune (IBS-C and IBS-D)
Two main pathophysiologic causes of diarrhea
Increased water in colon/stool
Accelerated transit
Which is more common, acute or chronic diarrhea?
Acute diarrhea
Two hallmark signs of osmotic diarrhea
Stops with fasting
Presence of stool osmotic gap (very dilute stool)
Which form of chronic diarrhea is most common?
Secretory
Cause of osmotic chronic diarrhea
Ingestion of poorly absorbable substances (laxatives, sugar alcohols) leads to water accumulation in gut
Differentiate osmotic from secretory chronic diarrhea
Osmotic: Water drawn into gut without electrolytes, large osmotic gap
Secretory: Electrolytes secreted into gut drawing water with them, no big osmotic gap
WBCs in stool sample of chronic diarrhea suggest this cause
Bacterial
Chronic diarrhea diagnostic criteria
> 3 loose stools daily for >4 weeks
Signs of dehydration in diarrhea patients
Decreased urine output, decreased skin turgor
Tachycardia with moderate
Hypotension with severe
When to use anti-diarrheals in acute diarrhea
When no blood in stool and no fever
Chronic diarrhea treatments
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
Causes of increased water in colon/stool
Osmotic water movement into intestine
Can be due to inflammation, pathogens and their toxins, ingestion of poorly absorbable substances, or a lactase deficiency
Diagnosis criteria for acute diarrhea
> 3 loose stools daily for <2 weeks
Labs to assess cause of diarrhea
Stool analysis with culture
Sigmoidoscopy with biopsy if severe, persistent diarrhea
Acute diarrhea treatment
Most cases resolve on their own in 3-4 days
Rehydration (PO moderate or IV if severe)
Principal cause of morbidity/mortality and best thing to check for on physical exam to determine severity in diarrhea
Dehydration
True or false. In diarrhea patients, pain often increases with palpation.
False, but must assess for rebound tenderness to rule out other causes
Three classifications of chronic diarrhea
Osmotic
Secretory
Inflammatory
Which of the three chronic diarrheas is most likely to have abdominal pain?
Inflammatory (UC and Crohn’s)
