Lecture 1: shit

Question 1

Who are 5 groups at high risk for acute infectious diarrhea?

Answer 1

1) travelers/outdoors (endemic infections, cruise ships, picnics)
2) immunocompromised
3) daycare kiddos
4) healthcare facilities
5) antibiotic use

Question 2

What are 5 pathophysiologic causes of chronic diarrhea

(>4 weeks)?

Answer 2

1) osmotic
2) secretory
3) maldigestive/ malabsorptive
4) inflammatory
5) functional

Question 3

What are the 2 pathophysiologic mechanisms in acute diarrhea (

Answer 3

1) infection-90%

2) medications

Question 4

What are some meds that frequently cause acute diarrhea?

Answer 4

1) antibiotics
2) NSAIDS
3) diabetic meds-Metformin
4) anti-hypertensives-beta blockers
5) antidepressants-SSRIs
6) antacids-proton pump inhibitors and misoprostol

Question 5

What type of diarrhea is:

1) watery/no blood in stool
2) diarrhea resolves with fasting
3) bloating
4) no weight loss

Answer 5

Chronic diarrhea: osmotic

Question 6

What are some common causes of chronic diarrhea due to osmotic problems?

Answer 6

1) Magnesium
2) Carb malabsorption-disaccharidase deficiency, monosaccharide overload, non-absorbable sugars
3) other diseases with malabsorbed carbs-celiac disease, crohns, small intestinal back overgrowth, pancreatic insufficiency, gastric/intestinal resection

Question 7

How do you test for chronic diarrhea caused by OSMOTIC disturbances?

Answer 7

1) calculate osmotic gap=290-(2x (Na+K))
Gap>125 suggest osmotic diarrhea

2) stool pH low in carb malabsorption

Question 8

What type of diarrhea is:

1) watery larger volume stools
2) no gross volume
3) NOCTURNAL diarrhea
4) continues with FASTING
5) recurrent dehydration

Answer 8

chronic diarrhea-secretory

Question 9

What are some common causes of chronic diarrhea due to secretory problems?

Answer 9

1) toxins
2) inflammation-common
3) meds
4) neuroendocrine tumor
5) bile acids
6) villous adenoma

Question 10

What do you see on labs for chronic diarrhea due to secretory problems?

Answer 10

fecal Na and K is

Question 11

What type of diarrhea is:

1) resolves with fasting
2) steatorrhea (greasy stools)
3) associated with weight loss

Answer 11

Chronic diarrhea due to malabsorption and maldigestion

Question 12

How do you test for chronic diarrhea due to malabsorption and maldigestion?

Answer 12

1) Usually endoscopic evaluation of small bowel mucosa to rule out Celiac Disease and Crohn’s Disease
2) identify risk factors such as alcoholism, celiac disease, CF, chronic infections

3) testing
- duodenal biopsies and tissue trasnglutaminase IgA
- quantitative fecal fat>7 g fat/d
- breath testing
- pancreatic calcifications

Question 13

What type of diarrhea presents with:

1) abdominal pain-small bowel
2) blood in stool-colonic
3) weight loss-small bowel
4) urgency and tenesmus-colonic
5) +/- fever

Answer 13

Chronic diarrhea-inflammatory

Question 14

What type of diarrhea are:

1) celiac disease
2) inflammatory bowel disease
3) microscopic colitis
4) NSAID enteritis

Answer 14

Chronic diarrhea-Inflammatory

Question 15

How do you test for chronic diarrhea caused by inflammation?

Answer 15

1) stool leukocytes
2) fecal occult blood test
3) serum tissue transglutaminase IgA and total IgA
4) upper endoscopy with biopsy of small intestines
5) colonscopy

Question 16

What type of diarrhea is alternating constipation and diarrhea and has abdominal pain relieved by defecation?

Answer 16

Functional chronic diarrhea

-IBS mimics this!

Question 17

Acute diarrhea with toxicity

Answer 17

send stool culture

Question 18

acute diarrhea with toxicity and antibiotic use

Answer 18

send C diff toxin or C diff PCR

Question 19

chronic diarrhea with blood in stool

Answer 19

do colonoscopy

Question 20

chronic diarrhea with malabsorption/ maldigestion

Answer 20

evaluate small bowel and pancreas

Question 21

chronic diarrhea without red flags or alarm symptoms

Answer 21

conservative management (bulking agent and antispasmodics)