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Abdel > diarrhoea > Flashcards

diarrhoea Flashcards

1
Q

causes of diarrhoea

A

viral/bacterial infection
drugs
IBS/IBD

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2
Q

4 types of diarrhoea

A

osmotic
secretory
chronic and inflammatory
dysfunctional

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3
Q

What is osmotic diarrhoea caused by?

A

decreased absorption or increased secretion of water and electrolytes by intestinal epithelium
too much water into bowel

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4
Q

main causes of osmotic diarrhoea

A

bacterial enterotoxins (cholera, E. Coli)
luminal secreting agents (bile acids, laxatives)
circulating secreting agents (hormones, drugs, poisons)
medical problems (Addison’s disease, carcinoid tumour, vipoma)

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5
Q

What malabsorption syndromes is osmotic diarrhoea common in?

A

lactose intolerance

Celiac disease

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6
Q

How to distinguish between osmotic and secretory diarrhoea?

A

calculating the fecal osmotic gap

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7
Q

What is the stool osmotic gap?

A

difference between Na and K ions in the stool

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8
Q

What is normal osmolarity?

A

50 - 100 mOsm/kg

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9
Q

What osmolarity indicated secretory diarrhoea?

A

< 50 mOsm/kg

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10
Q

osmolarity for osmotic diarrhoea?

A

> 100 mOsm/kg

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11
Q

secretory/osmotic affected by fasting?

A

osmotic decreases in severity with fasting

osmotic load removed

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12
Q

What causes chronic/inflammatory diarrhoea?

A

inflammation in the bowel mucosa causes decreased fluid resorption

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13
Q

inflammatory diarrhoea in what diseases?

A

CD
UC
intestinal infections - clostridiodies difficile or shigella

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14
Q

What’s in stool in inflammatory diarrhoea?

A

blood
WBCs
mucous

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15
Q

What is functional diarrhoea?

A

chronic or recurrent diarrhoea not explained by structural or biochemical abnormalaties

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16
Q

most common functional diarrhoea

A

IBS

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17
Q

What could be a cause of functional diarrhoea?

A

alterations in microbiome of intestine and rapid transit time of contents through GIT

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18
Q

cause of diarrhoea due to impaired intestinal motility

A

abnormal intestinal motility where transit time is accelerated and absorption is decreased

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19
Q

exudative diarrhoea?

A

caused by drugs that cause imflammation and ulceration in the intestine

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20
Q

microscopic colitis cause of diarrhoea

A

drugs cause thick submucosal band of collagen in intestine

results in watery diarrhoea

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21
Q

Most common cause in adults?

A

campylobacter

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22
Q

most common cause in children?

A

rotavirus

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23
Q

Most common cause of travellers diarrhoea?

A

enterotoxigenic E coli

24
Q

how long until symptoms?

A

72 hours

25
Q

What indicates bacterial toxins are being produced?

A

onset of 6 hours after meal

26
Q

How long does it last?

A

short duration

4 - 7 days

27
Q

When to refer?

A 
>72hrs healthy adult
>48hrs elderly
>24hrs diabetics
severe vomiting and fever
change in bowel habit
blood/mucus
suspected drug reaction
alternating constipation/diarrhoea in elderly (fecal impaction)
28
Q

What types are self limiting?

A

acute infective
and
teaveller’s

29
Q

What should be given in moderate/severe Traveller’s?

A

antibiotics

30
Q

4 examples of antimotility agents

A

codeine phosphate
loperamide
diphenoxylate
kaolin/opiate preparations

31
Q

Can antimotility agents be given to children?

A

no

risk of respiratory depression or paralytic ileus

32
Q

when to avoid antimotility agents

A

in severe gastroentritis

33
Q

What is useful with antimotility agents in Traveller’s diarrhoea?

A

antibiotics

34
Q

What is combined with antimotility agents for severe diarrhoea/dysentry?

A

antimicrobial therapy

35
Q

2 opioid receptor agonsits used for diarrhoea

A

loperamide

diphenoxylate

36
Q

Where does loperamide work?

A

mu opioid receptors in the myenteric plexus of the large intestine

37
Q

How does loperamide work?

A

reduces peristalsis
increases transit time
enhances water/electrolyte reabsorption
reduces gut secretions

38
Q

How long does loperamide take to work?

A

1 hour

39
Q

loperamide dose

A

4mg initially

followed by 2mg as needed

40
Q

side effects of loperamide

A

free from CNS side effects

CNS depression in overdose

41
Q

What is diphenoxylate used in combination with?

A

atropine

42
Q

age for diphenoxylate

A

over 13 years

43
Q

What is diphenoxylate metabolised to?

A

difenoxin

44
Q

action of dyphehnydramine

A

slows down contractions in the intestine

45
Q

Side effects of dyphenhydramine

A

euphoria - abuse

dependence in prolonged use

46
Q

Why is atropine given with diphenhydramine?

A

reduces abuse

47
Q

combination produce with dihpenhydramine and atropine

A

Lomotil

48
Q

Lomotil dose

A 
4 times a day
4 tabs (2.5mg) followed by 2 tabs every 6 hours
49
Q

Why is operamaide the drug of choice?

A

don’t need to add atropine
doesn’t cross BBB
no abuse

50
Q

4 examples of bulking agents

A

wheat bran
isphaghula husk
methylcellulose
sterculia

51
Q

What do bulking agents do?

A

control fecal consistency (in IBS, colostomy, ileostomy)

52
Q

Are bulking agents recommended for acute diarrhoea?

A

no

53
Q

what meds are not absorbed as well with antidiarrhoeal drugs?

A 
slowly absorbed drugs - antiepileptics, m/r formulations
antidiabetics
anti-coagulants
anti-malarials
oral contraceptives
54
Q

what to eat/drink with diarrhoea

A

clear fluids

light, easily digested foods

55
Q

what to avoid

A

high sugar drinks

milk

56
Q

why avoid milk?

A

temporary lactose intolerance due to damage by infecting organisms to lining of intestine
makes diarrhoea worse

Abdel (3 decks)

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