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GI > Lecture 2: Diarrhea/Constipation > Flashcards

Lecture 2: Diarrhea/Constipation Flashcards

1
Q

In what demographic is especially diarrhea concerning in?

A

Infants

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2
Q

What are the 3 duration types of diarrhea?

A
  • Acute < 2 weeks
  • Persistent 2-4 weeks
  • Chronic > 4 weeks
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3
Q

What is the primary cause of acute diarrhea?

A

Infectious agents

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4
Q

What are the two ways acute diarrhea agents are transmitted?

A
  • Fecal oral transmission
  • Disturbance of GI flora due to ABX
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5
Q

Who are the 5 high risk groups for acute diarrhea?

A
  1. Traveler’s (E. coli + giardia)
  2. Food at a picnic, banquet, or restaurant
  3. Immunodeficient
  4. Daycare attendees and their family
  5. Institutionalized persons
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6
Q

How does inflammatory diarrhea present?

A
  • Bloody
  • Feverish
  • LLQ Cramps

Dysentery

Need stool cultures

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7
Q

How does noninflammatory diarrhea typically present?

A
  • Watery
  • Nonbloody
  • Periumbilical cramps

We only evaluate if severe or > 7 days.

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8
Q

How does a small bowel infection typically present in terms of diarrhea?

A
  • Abd cramping
  • Bloating, gas
  • Wt loss
  • Watery diarrhea

Fever is rare

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9
Q

What is the MCC of watery diarrheas?

A

Enteric viruses

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10
Q

What is the MCC of large, inflammatory diarrheas?

A

Bacterial pathogens

Large bowel infection

Bacteria are bigger than viruses = bigger diarrhea?

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11
Q

What are the only virus and only protozoan that cause inflammatory idarrhea?

A
  • CMV
  • Entamoeba histolytica
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12
Q

If acute diarrhea present 1-6 hrs post exposure, what are the likely culprits?

A
  • Staph
  • B Cereus
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13
Q

What pathogens cause diarrhea over a 1 week after exposure?

A
  • Cryptosporidium
  • Giardia
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14
Q

What are the likely pathogens if the history suggests exposure to a daycare, mountain stream, or community swiming pool?

A
  • Giardia
  • Cryptosporidium
  • Entamoeba
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15
Q

How are norovirus and enteric viruses typically transmitted?

A

Household/community spread

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16
Q

When does C diff associated diarrhea typically occur?

A

2 weeks - 1 month post ABX therapy

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17
Q

What are the most common ABX implicated in C diff diarrhea?

A
  • Fluoroquinolones
  • Clindamycin
  • Cephalosporins
  • PCNs
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18
Q

What would prompt us to hospitalize a patient for diarrhea?

A
  • Severe dehydration
  • Organ failure
  • Marked abdominal pain
  • AMS
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19
Q

What is the workup for most acute noninflammatory diarrheas?

A

* No diagnostic investigation!
* 90% are self-limited.

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20
Q

If we have persistent diarrhea, what labs do we order?

A
  • Fecal leukocyte
  • Stool culture
  • Stool for O & P
  • Stool for C. diff
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21
Q

What is the recommended diet for someone with persistent diarrhea?

A
  • Bananas
  • Rice
  • Applesauce
  • Toast

BRAT

Also soup and crackers

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22
Q

What is the home DIY Liquid IV recipe?

A
  • 1/2 tsp salt
  • 1 tsp baking soda
  • 8 tsp sugar
  • 8 oz OJ
  • 1L water dilution
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23
Q

How does loperamide work?

A

GI Opioid agonist that inhibits peristalsis.

Contraindicated in inflammatory diarrhea.

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24
Q

How does pepto-bismol work?

A
  • Reduce gut secretions
  • Avoid in preggos and children.
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25
Q

How does diphenoxylate/atropine work?

A

Anticholinergic

Contraindicated in acute and inflammatory diarrhea.

RISK: TOXIC MEGACOLON

26
Q

What are the empiric ABX therapy for diarrhea?

A
  • First-line: Cipro or Levofloxacin for 3 days
  • Alternatives: Bactrim DS or Doxy
27
Q

What are osmotic diarrheas and what resolves it?

A
  • Carb malabsorption
  • Laxative abuse
  • Malabsorption
  • RESOLVES DURING FASTING

Resolution from fasting = osmotic diarrhea

28
Q

What causes secretory disorders in chronic diarrhea?

A
  • Endocrine tumors
  • Bile salt malabsorption

NOT RESOLVED BY FASTING

29
Q

What are the two common inflammatory conditions that can result in chronic diarrhea?

A
  • Ulcerative colitis
  • Crohn disease

Subtypes of IBD

30
Q

What characterizes a malabsorptive condition?

A
  • Wt loss
  • Osmotic diarrhea
  • Steatorrhea
  • Nutritional deficiencies
31
Q

What is the MCC of chronic diarrhea in young adults?

A

IBS

32
Q

What kind of disorder is IBS and how does it present?

A

Motility disorder.

  • Lower abd pain
  • Altered bowel habits
  • NO evidence of serious organic disease
33
Q

What are the 5 MC pathogens associated with chronic diarrhea?

A
  1. Giardia
  2. E. histolytica
  3. Cyclospora
  4. Intestinal nematodes
  5. C. diff
34
Q

What two systemic conditions can cause chronic diarrhea?

A
  • Thyroid disease (hyper = hypermotility)
  • Diabetes
35
Q

What stool appearance is more suggestive of malabsorption? Inflammatory?

A
  • Malabsorption: Greasy, malodorous
  • Inflammatory: Blood or pus
36
Q

What specific serologic test might we look for in chronic diarrhea?

A

Celiac disease serology

37
Q

What is the MOA of loperamide and diphenoxylate?

A
  • MOA: Opioid receptor agonists to slow peristalsis.
38
Q

When should you NOT use loperamide or diphenoxylate?

A
  • Bloody/inflammatory diarrhea
  • C. diff related diarrhea
  • Pts < 2 yrs

Anything that slows gut motility is a nono in bloody diarrhea

39
Q

What is the MOA of bismuth and common reactions to it?

A
  • MOA: Reduces secretions, some antimicrobial effect.
  • Causes black stool and black tongue
40
Q

What is octreotide and how does it work?

A
  • Used for chronic, secretory diarrhea
  • Inhibits intestinal fluid secretion and stimulates absorption.

Secretory diarrhea = Does NOT resolve with fasting.

Secretory disorders are characterized by increased secretion and poor absorption, so octreotide does the opposite.

41
Q

What is the main concern with using octreotide?

A

Inhibition of many hormone productions.

Caution in DM, thyroid, pancreas, kidney, liver, or arrhythmias.

42
Q

What is cholestyramine used for and how does it work?

A
  • Indications: Chronic secretory or malabsorptive diarrhea
  • Binds intestinal bile acids

Also lowers cholesterol!

chole = bile acid and cholesterol

43
Q

What do hyoscyamine and dicyclomine do?

A
  • Relaxes intestinal smooth muscle
  • Inhibits spasms and contractions
  • Mainly used for diarrhea associated with IBS

Antispasmodics

44
Q

Who should antispasmodics NOT be used in?

A
  • Toxic megacolon
  • IBD
45
Q

Who is constipation MC in?

A

Elderly women

46
Q

What is constipation?

A
  • Infrequent stools < 3 a week
  • Hard stools
  • Excessive straining
  • Sense of incomplete evacuation
47
Q

How long is average colonic transit time?

A

35 hours

48
Q

What are the two MCC of constipation?

A
  • Inadequate fiber or fluid intake
  • Poor bowel habits
49
Q

What would prompt us to further workup constipation?

A
  • Severe constipation or age over 50.
  • Hematochezia, wt loss, positive FOBT
  • FMHx of colon cancer or IBD
  • Refractory constipation
50
Q

What does fiber do?

A

Promotes intestinal motility by absorbing water into stool.

51
Q

What exactly do stool softeners do?

A

Emollient that covers stool to soften it.

52
Q

What is the concern with using mineral oil as a stool softener?

A

Absorption of key nutrients.

53
Q

What do osmotic laxatives do?

A
  • Increase secretion of water into the lumen
  • Soften stool and promote defecation
  • Works within 24 hours
54
Q

What is used as a bowel cleanser and when?

A
  • Osmotic laxatives
  • Polyethylene glycol (PEG)
  • Mag citrate
  • Sodium phosphate (fleet enema)
  • Prior to colonoscopy or bowel surgery
55
Q

When are stimulant laxatives used and what do they do?

Bisacodyl, Senna, Cascara

A
  • For patients with poor response to osmotic agents.
  • Used as a rescue agent, not daily
  • Stimulation of fluid secretion and colonic contraction
56
Q

What are the main concerns with using stimulant laxatives?

A
  • Not for long-term or daily use
  • Electrolyte abnormalities
57
Q

What is the order of preference in pharmacologic managment of constipation?

A
  1. Fiber supplements
  2. Stool softeners
  3. Osmotic laxatives
  4. Stimulant laxatives
58
Q

What 5 conditions may predispose someone to fecal impaction?

A
  1. Medications
  2. Severe psychiatric disease
  3. Prolonged bed rest
  4. Neurogenic disorders of the colon
  5. Spinal cord disorders
59
Q

How does fecal impaction usually present clinically?

A
  1. Decreased appetite
  2. N/V
  3. Abd pain and distension
  4. Paradoxical diarrhea
60
Q

What is the initial management for a fecal impaction?

A
  • Enemas
  • Digital disimpaction

GI (17 decks)

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