Lecture 65 Flashcards
diarrhea (scott)
acute
under 14 days
usually caused by an infectious process
persistent
over 14 days
chronic
over 30 days
chronic idiopathic
greater than or equal to 4 weeks
persistently loose stools without identifiable cause
classification of diarrhea
based on increased frequency and decreased consistency of fecal discharge compared to an individual’s normal bowel patterns
secretory diarrhea
a change in active ion transport by either a decrease in sodium absorption or an increase in chloride secretion into the lumen (water follows)
caused by - pancreatic tumors, unabsorbed fat, laxatives, bacterial toxins
large stool volume (>1 L per day)
normal ionic stool content
not altered by fasting
osmotic diarrhea
caused when poorly absorbed substances are retained in interstitial fluids, resulting in influx of water and electrolytes into the lumen
caused by malabsorption syndrome, lactose intolerance, administration of divalent ions, and consumption of poorly soluble CHOs
improves with fasting state
exudative diarrhea
subset of secretory (Secondary to inflammatory disease of the bowel)
caused by IBD discharging mucus, proteins, and blood into the gut
characterized by large stool volumes
causes of diarrhea
bacterial
viral
drug induced
bacterial causes of diarrhea
shigella
salmonella
campylobacter
staphylococcus
E coli
viral causes of diarrhea
norwalk (norovirus)
rotavirus
drug induced causes of diarrhea
laxatives
antimicrobials
metformin
among others…
salmonella
most bacteria in the US due to increased industrialization of farms and shared food sources
norwalk
number one cause of diarrhea in the US due to outbreaks being on cruise ships and spreading to other parts of the world
acute diarrhea
presentation - lasting less than 3 days
treatment based on if fever or systemic symptoms are present
acute diarrhea with a fever or systemic symptoms
check feces for WBC/RBC/ova and parasites
if negative, symptomatic therapy
if positive, use appropriate antibiotic and symptomatic therapy
acute diarrhea without fever or systemic symptoms
fluid electrolyte replacement
loperamide, diphenoxylate, or absorbent
diet change
chronic diarrhea
presentation - lasting more than 14 days
etiology - intestinal infection, IBD, malabsorption, secretory hormonal tumor, drug induced, motility disturbance
treatment should always be refered
treatment of chronic diarrhea
determine possible cause by history and physical exam
determine possible cause by diagnostic studies (stool culture, sigmoidoscopy, intestinal biopsy)
if leads to no diagnosis, replete hydration, d/c potential drug inducer, adjust diet, and loperamide or absorbent
if leads to diagnosis, treat specific cause
traveler’s diarrhea
presentation - acute watery diarrhea, last 2-3 days with no treatment (sometimes not desirable due to lack of treatment)
etiology - most cases infective, primarily caused bacteria
can be prevented and treated
prevention of traveler’s diarrhea
drink bottled water and drinks
be sure fresh fruit/vegetables are properly washed and prepared
antimicrobial prophylaxis should not be used routinely (due to antibiotic resistance) but can be considered for complications like Rifaximin
BSS may be considered
Fluorquinolones are not recommended, insufficient evidence to recommend prebiotics or probiotics
treatment of travelers diarrhea
based on mild, moderate, and severe cases
Oral rehydration solution (ORS) should be use aggressively regardless of severity
Mild travelers diarrhea treatment
loperamide or BSS may be considered
antibiotics are not recommended
moderate travelers diarrhea treatment
antibiotic treatment may be used
loperamide may be considered as monotherapy or adjunctive therapy
