Evaluation of Diarrhea Lecture Powerpoint Flashcards
2nd leading worldwide cause of death in children under 5, and leading cause of malnutrition in this group
diarrhea
Diarrhea
Passage of frequent (3 or more a day) small volume loose stools
Acute vs chronic diarrhea
Acute is a day up to 2 weeks, usually due to infection and self limiting or drugs, chronic is at least 4 weeks and is more often associated with irritable bowel syndrome, inflammatory bowel disease, intolerances, certain medications
Osmotic diarrhea
Occurs when too many solutes retained in the intestines which inhibits water absorption, often due to sugar malabosrption (lactose, fructose, etc) however electrolyte absorption is NOT impaired, often resolves upon cessation of ingestion of irritating substance
Secretory diarrhea
Diarrhea that occurs when excretion of water in intestine exceeds absorption, frequently involves electrolyte loss, usually does not resolve if fasting, infections are the #1 cause
Functional diarrhea
Diarrhea that is variable but improves with fasting and is most typically associated with irritable bowel disease
Fatty diarrhea
Often steatorrhea, caused by malabsorption (damage or loss of absorptive ability either due to surgery, giardia, mesenteric ischemia, or maldigestion, etc.
Factitious diarrhea
Self induced via laxative use diarrhea seen in patients with munchausen’s or bulimia
Inflammatory/exudative diarrhea
Sees occult or frank blood or pus as well as mucus in the stool, can be due to IBD, infection, etc
Acute diarrhea treatment (2)
- hydration (electrolytes and glucose)
- BRAT diet
Infectious diarrea transmission (2)
- fecal oral route or contamination
- hand contamination
1 cause of parasitic diarrhea in US and how to you test for it? How do you treat it?
-Giardia, stool ova and parasite, metronidazole
Entamoeba histolytica infection and how do you treat it?
- Causes diarrhea, fever, stomach pain, cramping
- treated with metronidazole
Cryptosporidiosis infection, diagnosis, and treatment
Can survive chlorine disinfectants and be a cause of chronic diarrhea in HIV/immunocompromised, diagnosed via stool culture, treated with nitazoxanide
2 most common viral causes of gastroenteritis
- norwalk virus
- rotavirus (foul smelling excessive diarrhea)
Staphylococcus food poisoning characteristics
- often ingesting foods contaminated with toxin
- lasts 24 hours
- lacks fever
- cannot be passed to others
- self limiting
- n/v/d
Clostridium perfringens infection characteristics
- foods kept warm before serving (catering)
- fever absent
- lasts 24 hours
E coli 0157 enterohemorrhagic (shiga toxin producing) infection characteristics
- usually raw foods or contaminated water
- can spread person to person
- mild to severe diarrhea
- may cause hemolytic uremic syndrome (anemia, uremia, thrombocytopenia)
- do NOT use antibiotics
Enterotoxigenic e coli (ETEC) infection characteristics
-Most common cause of travelers diarrhea, food and water contaminated with feces, incubates 1-2 days and resolves in 3-4 days
Salmonella enterica infection characteristics
- contaminated picnic foods
- diarrhea can last several days
- self limiting
Salmonella typhi infection characteristics
- severe form of salmonella
- life threatening, progressive fever, abdominal pain, rose spots
- stool culture/blood culture
- treatment needed with cipro or ceftriaxone otherwise severe complications
- can be asymptomatic carriers
Shigella infection characteristics
- spread thru any contact with stool that has shigella germs
- greatest risk children under 5 in daycare centers
- highly infectious
- usually self limiting
Yersinia enterocolitica infection characteristics
- contaminated meat or dairy products
- may mimic appendicitis
- can cause reactive arthritis
Camplyobacter jejuni infection characteristics
- common bacterial cause of diarrhea in the US from undercooked meats, dairy, freshwater
- very high fever
- sea gull wing rods on gram stain
- reactive arthritis or guillan barre syndrome
Vibrio cholera infection characteristics
- normally uncomplicated
- rice stool, can get from shellfish
- need to keep hydrated
Toxic megacolon and treatment options (2)
Rare but severe complication of colonic inflammation, characterised by distension of total or segment of colon and associated with systemic toxicity, treated with antibiotics or surgery
C diff has to be treated with what type of administration?
PO
Patient presents with acute onset of watery, nonbloody, volumous diarrhea accompnaied by nausea and vomiting, does not have a fever. What organism?
-enterotoxigenic E coli
Patient has had chronic diarrhea. Stool cultures grow out cryptosporidium. What is important to do next?
-test patient for HIV
Treatment of choice for diarrhea caused by giardia?
Metronidazole (flagyl)
What is the most common cause of travelers diarrhea
-e coli