Feb19 M3-Diarrhea Acute and Chronic Flashcards
diarrhea def
higher frequency of bowel mvmts every day + stools more watery than usual
acute vs chronic diarrhea
acute = last 7 days chronic = more 4 wks
acute diarrhea causes (but are not chronic diarrhea causes)
infections, food poisoning, allergies, medications
osmotic diarrhea def
osmoticaly active food poorly absorbed keeps water in GI tract lumen
osmotic diarrhea causes
osmotically active salts (Mg, ..), sugars and alcohols sugars (mannitol, sorbitol, lactulose), FODMAP
FODMAP diet used in who
in pts with IBS that is diarrhea dominant
classical cause of osmotic diarrhea
lactase deficiency
causes of secretory diarrhea
- exogenous and endogenous (carcinoid tumor) secretagogues
- ischemia
- lack of ion transporter
- loss of surface area
most common cause of acute diarrhea
infections (bacterial = tourista, e.coli, salmonella, shigella, etc., viral = on cruise ships, parasitic = single cell organisms. most common is giardia lamblia, NOT WORMS)
diarrhea complications and how to avoid that
dehydration, electrolyte loss, shock (hydrate, correct electrolytes imbalance)
diarrhea treatment
Abx sometimes but many diarrheas self limited to 2-3 days
important questions in chronic diarrhea
- 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*)
ddx of chronic diarrhea
IBD, diverticulitis, ischemic colitis, radiation, neoplastic, endocrine (hyperT), meds, microscopic colitis
celiac: charact of the diarrhea
is oily (steatorrhea)
treatment of the different infectious diarrheas
treat: shigella, giardia, campylobacter
go away on their own: salmonella, e.coli, viruses.., ..
meds causing diarrhea
Abx, antacids (have Mg), HIV meds, NSAIDs, antihypertensives, ..
4 tests to do in diarrhea pt
- CBC, electrolytes + Cr and urea for how dehydrated
- T4 and TSH
- stool culture (parasites, c diff, etc.)
- anti-TTG (for gluten sensitivity)
- calprotectine
imaging in diarrhea and when
weird cases: can do CT, colonoscopy, capsule endoscopy, ..
questions in diarrhea history
surgeries, travelling, radiation, endocrine conditions, meds and if changed, IBS history, food interolerances
does gluten problem causing celiac has to be celiac
no, can be gluten sensitivity with normal TTG causing it
asking when diarrhea comes is helpful in what
if DOESN’T come at night, more likely to be IBS
test for small bowel bacterial overgrowth
lactulose test
