DSA Diarrhea

Question 1

The stool appearance may suggest

• Greasy or malodorous –> _______ disorder ?
• Containing blood or pus => ________ disorder ?
• Watery => ________ process ?

The presence of abdominal pain suggests possible

• _________
• ________

Physical examination should assess for signs of: ______, _____, and ____

Answer 1

The stool appearance may suggest

• Greasy or malodorous –> malabsorption disorder ?
• Containing blood or pus => inflamm disorder ?
• Watery => secretory process ?

The presence of abdominal pain suggests possible

• IBS
• IBD

Physical examination should assess for signs of: malnutrition, dehydration, and IBD

Question 2

what do you lose in diarrhea

Answer 2

bicarb

K

Question 3

• Acute ___________ (lasts less than 2 weeks) does not need a workup.
• ALL patiensts with acute ___________ (lasts less than 2 weeks) must be tested for what?

Answer 3

Noninflammatory

inflammatory => all must be tested for EHEC and C.diff/ova and parasites if inidcatd

Question 4

Of acute diarrhea, 90% is infectious and 75% is due to _________.

Answer 4

Viruses

Question 5

Differential Dxconsiderations:

Acute Diarrhea

Answer 5

• Infectious
  
  • viral
  • Bacterial
  • Protzoal
• Noninfectious
  
  • meds: ABX, too much
  • food allergies/intolerances
  • artifical sweetners

Question 6

Diarrhea more than 14 days, but less that 4 weeks is most likely do to what?

Answer 6

• Noninfectious
• 1. Meds (ABX)
• 2. Food sweetners (Sorbital

Question 7

ANTIBIOTIC-ASSOCIATED Diarrhea occurs ________.

It is important to different it from ________.

Answer 7

during the period of abx exposure

C.Diff (is it the c diff cause diarrhea or is ith the ABX

Question 8

Chronic Diarrhea lasts how long

Answer 8

>4 weeks

Question 9

Differential Dx:

Chronic Diarrhea >4weeks

Answer 9

1. Meds
2. IBS
3. Lactase deficiency/Lactose intolerance
4. Chronic infections
5. Microscopic colitis
6. Malabsorptiveconditions
7. Overflow incontinence/fecal impaction
8. Systemic Conditions (To come in ENRP II) Thyroid disease

Diabetes

Question 10

What findings exclude meds, IBS and lactose def as the causes of chronic diarrea and require further eval?

Answer 10

1. Nocturnal diarrhea
2. WL
3. Anemia
4. • fecal occult blood test

Question 11

The osmotic gap is the difference between the measured osmolality of the stool (or serum) and th eestimated stool osmolality and is normally _____________

Answer 11

less than 50 mOsm/kg.

Question 12

OSMOTIC DIARRHEA

• Stool volume ________ with fasting
• _________ stool osmotic gap

Answer 12

1. decreases
2. Increase (>50-75)

Question 13

If patients present with osmotic diarrhea, what should we ask them in PE

Answer 13

Dairy products (lactose), fruits and artificial sweeteners (fructose and sorbitol), and alcohol.

Question 14

MCC of Osmotic Diarrhea

Answer 14

1. MEds (Antacids)
2. Disacch def/carb malabsorption
   
   1. lactose intolerance
3. Laxative abuse could be osmotic or secondary
4. Malabsoprtion syndromes

Question 15

The diagnosis of carbohydrate malabsorption may be established by…

Answer 15

elimination trial for 2-3 weeks

hydrogen breathe test

Question 16

Secretory DIARRHEA (=> high volume watery diarrhea >1L day)

• Stool volume ________ with fasting
• _________ stool osmotic gap

Answer 16

• does not imppove
• NL

Question 17

MCC of Secretory Diarrhea

Answer 17

1. Endocrine tumors (hormonally mediated: stimulating intestinal or pancreatic secretion):
   * Zollinger Ellison syndrome, Carcinoid Syndrome VIPoma, Medullary thyroid carcinoma
2. Bile salt malabsorption (stimulating colonic secretion)
3. Factitious diarrhea
4. Villous adenoma

Question 18

Before examing for Chronic Diarrhea, what should be considered?

Answer 18

MCC causes of chronic diarrea: Meds, IBS and lactose intolerance

Question 19

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