Small bowel Flashcards
Diarrhea important things to consider
Quality of stool, freq, duration, pt hx, diet, recent antibiotic use
Difference between acute, chronic and persistent
acute 14 days, chronic>30 days
Common causes of acute diarrhea
Viruses (norovirus, rotavirus, adenoviruses, astrovirus), Bacteria (salmonella, shigella, campylobacter, enterotoxigenic E coli, c. diff), Protozoan (Cryptosporium, giardia, cyclospora, entamoeba)
Assessment of acute diarrhea
Hx (travel, food, occupation), signs of dehydration, temperature, abdominal exam
Indications for further evaluation of acute diarrhea
watery diarrhea, hypovolemia, blood, fever, >6/24 hour, abd pain, elderly, recent antibiotic use, pregnant
Diagnostic test of acute diarrhea
fecal leukocyte in stool and occult blood, stool culture w/ gram stain, if bloody have plated on Macconkey-sorbitol agar to test for Ecoli
Indications for Ova or parasite testing in acute diarrhea
persistent, travellling, exposure to infants, MSM or AIDS pt, bloody w/ no fecal leukocytes
High risk pop that requires testing sooner of acute diarrhea
immunocompromised, comorbidities, severe inflammatory, IBS, pregnant women
Treatment of acute diarrhea
Hydration, rest bowel (BRAT diet), antibiotics (not in most cases), antidiarrheal agents
Antidiarrheal agents
Loperamide (Imodium), Diphenoxylate (Lomotil), bismuth subsalicylate (pepto bismol), avoid anticholinergics
Chronic diarrhea affects how many
5% of pop
Chronic diarrhea causes
medications, infections, functional disorder, malabsorption, IBS
Meds that can cause diarrhea
BB, ACEI, statins, furosemide, CNS meds: alprazolam, lithium, levodopa, fluoceine, Meformin, ibuprofen, naproxen, GI: PPI, Lactulose, magnesium, H2 receptor blockers
Whipple disease
rare, slow progression, tropheryma whippeli (bacillus), white men 40-60 yo
Symptoms of whipple disease
joint pain, Later: abd pain, diarrhea, fever, weight loss, lymphadenopathy, heart murmur
Diagnosis of whipple disease
EGD: duodenal biopsy, Acid schiff positive macrophages w/ bacillus
Treatment of whipple disease
Antibiotic: ceftriazone IV, bactrim bid for 1 year, dietary supplements, if untreated it’s fatal
Lactase deficiency
lactase hydrolyzes the disaccharide lactose into glucose and galactose, not usually produced past 12 yo
Symptoms of lactase deficiency
Chronic diarrhea, bloating, flatulence, abd pain after milk products
Confirming lactase deficiency
hydrogen breath test, bacteria produces hydrogen in presence of undigested foods
Antibiotic associated diarrhea
acute or chronic, most cases not C. diff
C. diff
mild to moderate green, foul-smelling watery diarrhea 5-15 times per day, lower abd cramping, mild LLQ, stools contain mucus, occasionally blood
C. diff treatment
D/c antibiotic, treat with metronidazole (flagyl), or vancomycin, in severe cases WBC > 15 or creatinine>1.5 times baseline
Irritable bowel disease
Unknown pathology, maybe linked to pscyh, more common in females, late teens to 20 yo, most common cause of chronic diarrhea in US
