final exam lecture 5 Flashcards
Increase in intestinal motility leads to_____. Decrease un intestinal motility leads to_____
diarrhea, constipation
relationship between segmenting contractions and diarrhea
patients with diarrhea often have fewer spontaneous segmenting contractions
classifications of diarrhea
Acute, persistent, chronic, chronic idiopathic
difference between acute, persistent, chronic and chronic idiopathic
acute diarrhea <14 days (usually caused by infectious process)
persistent >14 days
chronic >30 days
chronic idiopathic >or equal to 4 weeks (persistently loose stool without identifiable cause)
chronic diarrheaaffects what percent of people
5%
most common foodborne cause of diarrhea and vomiting
Norovirus
What is fecal incontinence
Inability to control bowel movements, causing stool to leak unexpectadely
4 ways to classify diarrhea
Secretory
osmotic
exudative
altered intestinal transit
Secretory diarrhea mechanism? what does it cause?
Change in active ion transport causes water to move into the intestine. Causes large stool volumes (>1L/day). It does not improve with fasting
how is osmotic diarrhea caused? What does it cause?
It is caused when poorly absorbed substances are retained in intestinal fluids; resulting in influx of water. Causes lactose intolerance. Improves with fasting.
Exudative diarrhea define
Subset of diarrhea. secondary to inflammatory disease of the bowel. We see mucus, protein and blood in gut.
3 infectious organisms commonly associated with causing diarrhea
Bacteria (salmonella) most common bacteria in US), viral
viral- norovirus/ rota virus
common medications for drug induced diarrgea
Laxatives, metformin etc
complications of diarrhea
dehydration
electrolyte imbalance
evaluating a patient for dehydration
skin tenting, concentrated urine, dizziness when standing, dry mucous membrane
questions to ask patients regarding their diarrhea
When did symptoms begin
Frequency, consistency and color of stool
abdominal pain?
recent travel?
non pharmacologic treatment for diarrhea. What kind of diarrhea is it more important for?
BRAT diet (banana, rice, apple sauce, toast)
more important foo osmotic diarrhea
fluid- electrolyte replacement
Treatment if acute diarrhea (<3 days) with no fever or systemic symptoms
Symptomatic therapy
1) fluid/electrolyte
2) loperamide, diphenoxylate
3) diet
How to treat acute diarrhea with fever or systemic symptoms
Check feces for WBC/RBC/Ova and parasites.
If negative- symptomatic therapy.
If positive- use appropriate antibiotic therapy
treatment of chronic diarrhea
Always refer to physician
Give hydration and loperamide
how to prevent travelers diarrhea
drink bottled water
antimicrobial prophylaxis should not be used routinely
medicine to prevent travelers diarrhea
Bismuth subsalicylate
When is the only time we can use antimicrobial prophylaxis to treat travelers diarrhea? What antibiotic is recommended
Rifaximin is recommended. Only used for at risk populations.
Treatment for mild travelers diarrhea
Oral rehydration is used on ALL patients with travelers diarrhea.
Antibiotic use is not recommended
Loperamide or BSS may be considered
BSS dose: 60 ml or 2 tabs QID
