OnlineMedEd: Gastroenterology - "Acute Diarrhea" Flashcards
What is the difference between acute and chronic diarrhea?
- Acute: less than 2 weeks
* Chronic: greater than 4 weeks
Why is it helpful to differentiate between acute and chronic diarrhea?
Acute diarrhea is likely to be infectious; chronic diarrhea is not.
Inflammatory diarrhea can be diagnosed by ______________.
fever, hematochezia, and WBCs in the feces
Non-inflammatory (enterotoxic) diarrhea is characterized by ______________.
watery diarrhea with lack of fever and lack of fecal WBCs
WBCs are not the most specific test for inflammatory diarrhea. The most is ____________.
lactoferrin
List the etiologies of non-inflammatory diarrhea and their risk factors.
- ETEC (third-world traveler’s diarrhea)
- C. difficile (recent antibiotic use)
- V. cholerae (third-world outbreaks)
- Giardia lamblia (camping/hiking)
- B. cereus (reheated rice)
- S. aureus (proteinaceous food like egg salad)
List the etiologies of inflammatory diarrhea and their risk factors/associations.
- Shigella (HUS)
- Campylobacter (most common cause)
- EHEC (E. coli O157;H7) (raw meat)
- Amoeba histolytica (AIDS)
- Salmonella (eggs, poultry)
What is a good way to determine if a case of diarrhea is viral gastroenteritis?
- If the person is lacking signs of inflammatory diarrhea (fever greater than 104, bloody stool, severe abdominal pain) and the exposures that would make you worry about non-inflammatory diarrhea, then viral gastroenteritis is more likely.
- Also, if the person is vomiting, then it is more likely to be viral gastroenteritis.
List two treatment options for viral gastroenteritis.
- ORT
* Loperamide
If the person has signs and symptoms that suggest a more severe illness than viral gastroenteritis, then you should _______________.
evaluate first for C. diff (testing for toxin) and then do a stool culture and O&P
Testing for toxin is the old technique of evaluating for C. diff. Now, it’s more common to use _____________.
NAAT
Go through the treatment protocol for C. diff.
• 1st occurrence: try oral metronidazole, then vancomycin if that fails
•2nd occurrence: try oral metronidazole, then vancomycin if that fails
3rd occurrence: fidaxomycin
•Fecal transplant
Discuss the more severe presentation of C. diff.
- Fever, leukocytosis, and abdominal distention (suggesting toxic megacolon) can occur in severe C. diff infections.
- Treat with oral vancomycin and IV metronidazole.