Feb19 M3-Diarrhea Acute and Chronic

Question 1

diarrhea def

Answer 1

higher frequency of bowel mvmts every day + stools more watery than usual

Question 2

acute vs chronic diarrhea

Answer 2

acute = last 7 days
chronic = more 4 wks

Question 3

acute diarrhea causes (but are not chronic diarrhea causes)

Answer 3

infections, food poisoning, allergies, medications

Question 4

osmotic diarrhea def

Answer 4

osmoticaly active food poorly absorbed keeps water in GI tract lumen

Question 5

osmotic diarrhea causes

Answer 5

osmotically active salts (Mg, ..), sugars and alcohols sugars (mannitol, sorbitol, lactulose), FODMAP

Question 6

FODMAP diet used in who

Answer 6

in pts with IBS that is diarrhea dominant

Question 7

classical cause of osmotic diarrhea

Answer 7

lactase deficiency

Question 8

causes of secretory diarrhea

Answer 8

• exogenous and endogenous (carcinoid tumor) secretagogues
• ischemia
• lack of ion transporter
• loss of surface area

Question 9

most common cause of acute diarrhea

Answer 9

infections (bacterial = tourista, e.coli, salmonella, shigella, etc., viral = on cruise ships, parasitic = single cell organisms. most common is giardia lamblia, NOT WORMS)

Question 10

diarrhea complications and how to avoid that

Answer 10

dehydration, electrolyte loss, shock (hydrate, correct electrolytes imbalance)

Question 11

diarrhea treatment

Answer 11

Abx sometimes but many diarrheas self limited to 2-3 days

Question 12

important questions in chronic diarrhea

Answer 12

• been travelling?
• diverticulitis (important cause)
• steatorrhea
• how sick pt is (vomitting, pain, nausea)
• medications (and changes in meds recently) (metformin used a lot)
• celiac and IBD (Crohn’s*)

Question 13

ddx of chronic diarrhea

Answer 13

IBD, diverticulitis, ischemic colitis, radiation, neoplastic, endocrine (hyperT), meds, microscopic colitis

Question 14

celiac: charact of the diarrhea

Answer 14

is oily (steatorrhea)

Question 15

treatment of the different infectious diarrheas

Answer 15

treat: shigella, giardia, campylobacter

go away on their own: salmonella, e.coli, viruses.., ..

Question 16

meds causing diarrhea

Answer 16

Abx, antacids (have Mg), HIV meds, NSAIDs, antihypertensives, ..

Question 17

4 tests to do in diarrhea pt

Answer 17

• CBC, electrolytes + Cr and urea for how dehydrated
• T4 and TSH
• stool culture (parasites, c diff, etc.)
• anti-TTG (for gluten sensitivity)
• calprotectine

Question 18

imaging in diarrhea and when

Answer 18

weird cases: can do CT, colonoscopy, capsule endoscopy, ..

Question 19

questions in diarrhea history

Answer 19

surgeries, travelling, radiation, endocrine conditions, meds and if changed, IBS history, food interolerances

Question 20

does gluten problem causing celiac has to be celiac

Answer 20

no, can be gluten sensitivity with normal TTG causing it

Question 21

asking when diarrhea comes is helpful in what

Answer 21

if DOESN’T come at night, more likely to be IBS

Question 22

test for small bowel bacterial overgrowth

Answer 22

lactulose test