Lecture 19 - Management of Constipation and Diarrhea

Question 1

Stool osmotic gap formula:

_____ - ___(fecal___ + fecal ___)

Note:

< ____ is secretory diarrhea.

> ____ is suggestive for osmotic diarrhea.

> ____ is more specific for Osmotic diarrhea.

Answer 1

290 - 2(fecal Na+ + fecal K+)

< 50 is secretory

> 50 suggests osmotic

> 100 is more specific for osmotic

Question 2

Osmotic diarrhea is a result of a large increase in _______ osmoles, while typical osmoles remain more normal.

How does Secretory diarrhea compare?

Answer 2

Unmeasured osmoles

Secretory diarrhea is more an issue of abhorrent secretion of typical osmoles, with little contribution from unmeasured osmoles.

Question 3

Acute diarrhea is classified as lasting < ___ weeks.

Chronic is > ____ weeks.

Which one is mostly associated with infections?

Which is associated with IBD, malabsorption, meds, or tumors?

Answer 3

< 4 weeks

> 4 weeks

Acute –> infections

Chronic –> IBD, malabsorption, tumors, or meds. Chronic can be infection related, but this is mostly for immunocompromised!

Question 4

Large volume diarrhea is typically ______ (painful or painless?), while Small volume diarrhea is typically ______.

Why is that?

Answer 4

Painless

Painful

This is because most water absorption occurs in the small bowel –> so large volume suggest issue with small bowel, where you do not generally feel pain in the small bowel.

Small vol suggests issue with distal colon –> pain IS felt here

Question 5

Patients with diabetes are susceptible to acquiring diarrhea from meds, particularly ______, which may also cause _____ acidosis. Is diarrhea associated with meds Osmotic or Secretory?

Answer 5

Metformin

Lactic acidosis

Secretory

Question 6

Because Osmotic diarrhea occurs from an increase in unmeasured osmoles, how would fasting affect the symptoms?

Answer 6

Stool output would NORMALIZE with fasting.

Question 7

For osmotic diarrhea due to carbohydrate malabsorption, the stool pH is typically < _____. In this case, look for ______ deficiency.

Answer 7

pH < 5.3

Lactase

Question 8

Patients who have had their Gallbladder out are at higher risk for ______ diarrhea, as there is no storage for bile –> medications that absorb bile salts alleviate symptoms.

Answer 8

Secretory diarrhea (specifically fatty)

Question 9

_____ colitis is a cause of inflammatory (secretory) diarrhea –> look for male patients receiving treatment for Prostate cancer.

Answer 9

Radiation colitis

Question 10

Sigmoidoscopy and/or colonoscopy is indicated for patients with suspected CMV infection, HSV infection, IBD, and ____ ___ ____ _____.

Answer 10

Graft vs Host Disease (GVHD)

Question 11

Broad spec antibiotics are contraindicated in patients with the following infections:

__. _____, _____, and/or ________.

Answer 11

C. diff

EHEC

Salmonella

C. diff is obvious. EHEC –> release of toxin causing HUS.
Salmonella –> prolongs shedding of salmonella.

Question 12

______ infection is the most common cause of diarrhea.

Answer 12

VIRAL

Question 13

For constipation diagnosis, remember the rule of “____%.”

Answer 13

25%

Question 14

_____ (which gender?) is at higher risk for constipation, especially during which part of their lives?

Dehydration and _______ are also risk factors.

Answer 14

Females

Child-bearing age

Inactivity

Question 15

More than ______ tablets per week of Acetaminophen increases risk for constipation.

Answer 15

7 tablet per week

Question 16

Up to 25% of constipation patients suffer from defecatory problems –> incomplete evacuation, sometimes with the need for manual maneuvers to facilitate defecation. How can incomplete evacuation be diagnosed?

Answer 16

Abnormal balloon expulsion test (takes > 2mins to expel deflated balloon from booty) and/or anorectal manometry (measures discrepancies in pressure change relationship between rectum and anus).

Question 17

______ is a common cause for rectal obstruction postpartum.

Answer 17

Rectocele

Question 18

Darkening of colon can occur with use of _____ laxatives. It is NOT from necrosis.

Answer 18

Senna

Question 19

________ are a good treatment for opioid-induced constipation, as they do NOT alter the pain relieving effects on the CNS.

Answer 19

PAMORAs (Peripherally Acting Mu Opioid Receptor Antagonists)