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Term 1 > Week 101: Diarrhoea > Flashcards

Week 101: Diarrhoea Flashcards

1
Q

What are the signs of clinical dehydration?

A 
⇒	Appears to be unwell/deteriorating
⇒	Altered responsiveness (e.g. irritable/lethargic)
⇒	Sunken eyes
⇒	Tachycardia
⇒	Tachypnoea
⇒	Reduced skin turgor
  • Decreased urine output
  • Dry mucous membranes

⇒ Symptoms of the hand indicate shock

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2
Q

What are the signs of clinical shock?

A
  • Decreased level of consciousness
  • Pale or mottled skin
  • Cold extremities
  • Tachycardia
  • Tachypnoea
  • Weak peripheral pulses
  • Prolonged capillary refill time
  • Hypotension (decompensated shock)

⇒ Symptoms of the hand indicate shock

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3
Q

How is diarrhoea caused in severe acute malnutrition (SAM)?

A

Higher levels of potassium are excreted from the cells than normal which leads to diarrhoea

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4
Q

What fluid management would you use for shock?

A
  • 20ml/kg in 30 minutes
  • Repeat if still in shock
  • Then move to maintenance fluid
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5
Q

Maintenance fluid post shock?

A
  • 0.9% saline

- 100ml/kg/day

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6
Q

Maintenance fluid (not post shock)?

A
  • 0.9% saline

- 50ml/kg/day

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7
Q

Maintenance fluid in children?

A

⇒ 4-2-1 rule

  • 4: first 10kg, 4ml/kg/hour
  • 2: next 10kg, 2ml/kg/hour
  • 1: more weight, 1ml/kg/hour
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8
Q

What is the calculation to work out electrolytes in the stool?

A

290 - 2(concentration (Na+K))

  • 290 is the normal osmolality of blood
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9
Q

How does osmotic diarrhoea work?

A
  • Electrolytes are absorbed normally
  • Other things malabsorbed
  • Little Na and K excretion
  • Normal osmolality

⇒ Caused by malabsorption (coeliac disease)

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10
Q

How does secretory diarrhoea work?

A
  • Damage to membrane leads to a loss of Na and K
  • Low answer to calculation, low osmolality

⇒ Mainly caused by infection

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11
Q

How to tell the difference between osmotic and secretory diarrhoea?

A
  • Osmotic diarrhoea stops when eating stops

- Secretory diarrhoea continues regardless

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12
Q

What are the drugs that can cause diarrhoea?

A
  • Antibiotics
  • NSAIDs
  • Digoxin
  • Lipase inhibitor
  • Magnesium
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13
Q

What is the leading cause of gastroenteritis worldwide?

A

Rotavirus

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14
Q

What causes infant diarrhoea?

A

Rotavirus

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15
Q

What causes an outbreak of diarrhoea in a hospital amongst staff?

A

Norovirus

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16
Q

What is the most likely cause of diarrhoea amongst patients in a hospital?

A

Clostridium difficile

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17
Q

What is the most likely cause of diarrhoea after a barbecue?

A

Campylobacter

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18
Q

What is the most likely cause of diarrhoea after raw eggs?

A

Salmonella

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19
Q

What is the most likely cause of diarrhoea after working on a farm in the US?

A

EHEC

20
Q

What is the most likely cause of diarrhoea after working on a farm in a developing country?

A

ETEC

21
Q

What is the most likely cause of diarrhoea due to war or water?

A

Cholera

22
Q

What are the most likely causes of diarrhoea after travelling?

A

Giardiasis

ETEC

23
Q

What is the most likely cause of diarrhoea amongst elderly/hospitalised/antibiotic using?

A

Clostridium difficile

24
Q

What is the main sign of giardiasis?

A

Cysts in the faeces

  • It is spread by cysts in faeces
  • Cysts are not always present
25
Q

What are the pharmacological treatments of diarrhoea?

A

⇒ Loperamide

  • Opioid antagonist
  • Receptors in bowel
  • Gives gut more time to absorb fluid

⇒ Oral rehydration solution

  • Dioralyte
  • WHO oral rehydration spoon
26
Q

What is the difficulty with tachypneic patients?

A
  • Getting rid of too much CO2
  • Leads to respiratory alkalosis
  • Body can’t compensate
27
Q

How would you treat respiratory alkalosis?

A
  • iv Ringer’s Lactate

- iv Hartman’s Lactate

28
Q

What are the differences between crystalloids and colloids?

A

⇒ Crystalloid

  • Small molecules
  • Can cross semi-permeable membranes
  • E.g. sodium chloride

⇒ Colloid

  • Large molecules
  • Can expand fluid in blood cells
  • Increase blood pressure
  • E.g. albumin
29
Q

What is the main organism that colonises the duodenum?

A

⇒ Giardia

- Won’t find giardia anywhere else

30
Q

What is the main function of the jejunum?

A

Food absorbed

31
Q

What is absorbed in the distal ileum?

A
  • Bile acids

- Vitamin B12 with intrinsic factor

32
Q

What are the main immune cells in the ileum?

A

Payer’s Patches

33
Q

What are goblet cells?

A

Goblet cells contain clear mucin granules, mucous secretion serves a protective role

Denser in proximal intestine, sparser on villus tip

34
Q

What are absorptive cells?

A

Have well adapted microvilli, found in small intestine

35
Q

What are crypt cells?

A

Smaller with fewer less developed microvilli than absorptive cells, have narrow apices

Found in the small intestine

36
Q

What are paneth cells?

A

Found at the base of the crypt villi
Contain eosinophilic secretory granules
More common in the ileum than the jejunum
Probably involved in intestinal barrier function

37
Q

What are m cells?

A

M cells are found over Peyer’s Patches
Rapidly transport luminal macromolecules and some microorganisms by transcytosis
Probably important for processing and presenting antigens to the mucosal immune system

38
Q

Where is food absorbed?

A

In the jejunum

39
Q

What are Peyer’s Patches?

A

Immune cells found in the ileum

40
Q

What is submucosa?

A

Contains blood vessels, connective tissue lymphatics, and lymphoid aggregations

41
Q

What is the main organism that colonies the duodenum?

A

Giardiasis

42
Q

Embryologically, what divisions of the embryo form the gastrointestinal system?

A

Foregut, midgut, hindgut, mesenteries

43
Q

What does ectoderm make?

A 
Hair
Retina
Outer layer of skin
Central nervous system
Outer lining of everything
Enteric nervous system (neural tube)
Extrinsic innervation
44
Q

What does the mesoderm make?

A 
Muscle
Bone
Organs
Mesentery
Connective tissues
Blood vessels
45
Q

What does endoderm make?

A 
Lining of the gut
Secretory cells of the GI tract
Inner linings (including respiratory tract)
Epithelium
Glands
46
Q

What is diarrhoea?

A

3 or more loose or watery stools in a 24-hour period

Term 1 (14 decks)

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