Tutorial 40 - Chronic Diarrhea Flashcards
What is the definition of chronic diarrhea?
Loose stools and/or increased stool frequency for four or more weeks in duration.
What is the criteria for a diagnosis of Irritable bowel syndrome (IBS)
Recurrent abdominal pain at least 1 day of the week in the last 3 months, associated with 2 or more of the following criteria:
- related defecation (either increasing or improving pain).
- associated with a change in frequency of stool.
- associated with a change in form (appearance) of stool.
What is the criteria for functional diarrhea?
- Loose or watery stools, without predominant abdominal pain or bothersome bloating, occuring in 25% of stools.
- Must not meet criteria for diarrhea-predominant IBS
What is the mechanism of secretory diarrhea?
increased secretion and decreased reabsorption of electrolytes across gut mucous membrane.
What is the mechanism of osmotic diarrhea?
when non-absorbable molecules (ex. Lactose) in the gut draw and keep electrolytes and fluid.
What is the mechanism of fatty diarrhea
maldigestion/malabsorption of fat that causes an osmotic fluid shift into the gut lumen
Include celiac disease, pancreatic insufficiency.
What is the mechanism of inflammatory (aka dysenteric) diarrhea?
Destruction of GI mucosa results in impaired absorption, shedding of mucous and blood
What is the mechanism of dysmotility OR reduced absortive surface diarrhea?
- decreased GI transit time
OR - surface area fr absorption of electrolytes and nutrients is reduced (ie. bowel resection)
If a patient has watery diarrhea, what are the 3 diarrhea syndromes by which this can occur?
- secretory
- osmotic
- functional/dysmotility/reduced surface area
Based on this tutorial, Inflammatory diarrhea can occur by which two etiologies?
- inflammatory bowel disease (CD or UC)
- infectious etiology (ex. c.diff colitis)
A patient presents with watery-osmotic type diarrhea, and complains of abdominal distention and discomfort. Upon laboratory investigation, the patient is found to have iron deficiency anemia. What is the most likely diagnosis?
Celiac disease
How is celiac disease screened?
IgA TTG. If positive, progress to IgA anti-endomysial (EMA)
If IgA TTG and IgA EMA are positive, what is the confirmatory step to diagnose celiac disease?
colonoscopy with small bowel biopsy
What is the treatment to celiac disease?
Gluten free diet
How can you differentiate ulcerative colitis and Crohn’s disease based on affected areas of the GI system?
Ulcerative colitis almost always involves the rectum, while crohn’s disease is variable in location.
Crohn’s disease almost always involves the terminal ileum so look for right lower quadrant pain. Crohn’s disease is also characterized by skip lesions while ulcerative colitis is continuous along the colon.
What is the confirmatory test of Inflammatory bowel disease (Crohn’s disease or Ulcerative Colitis)?
GI endoscopy with biopsies
A patient has just returned from a trip overseas and complaines about watery diarrhea and bloating. The patient tells you that he drank lake water during a hike. Based on this tutorial, what is the most likely diagnosis?
Giardia infection
What is the confirmatory test for Giardia?
Stoop ova and parasites (Stoop O+P)
What is microscopic colitis?
An inflammatory forom of colitis that is idiopathic.
it is characterized by a normal macroscopic appearance on colonoscopy of the bowel, but collagenous or lymphocytic infiltrates on microscopy
Based on this tutorial, watery-secretory diarrhea can be caused by what two diagnosis?
- giardia infection
- microscopic colitis
Based on this tutorial, osmotic diarrhea can be caused by what two diagnosis?
- celiac disease
- lactose intolerance
Based on this tutorial, fatty chronic diarrhea can be caused by what diagnosis?
chronic pancreatitis
A patient on the hospital ward presents with watery diarrhea that occurs more than 3 times a day. The patient has recently finished a course of antibiotics. What is the most likely diagnosis?
C.diff colitis
What is the confirmatory test for c.diff infection?
C.diff toxin stool test
