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Diarrhea Flashcards

1
Q

increased stool frequency, liquidity, or volume

A

Diarrhea

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2
Q

before interpreting diarrhea, It is mandatory to know the individual’s ……….

A

normal bowel habits

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3
Q

normal bowel habits frequency

A

3 times/day – once/3 days

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4
Q

Frequency <2 weeks

A

Acute diarrhea

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5
Q

usually infectious but occasionally is due to drugs or a first presentation of inflammatory bowel disease

A

Acute diarrhea

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6
Q

Frequency >4 weeks

A

Chronic/relapsing diarrhea

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7
Q

may reflect colorectal cancer or inflammatory bowel disease, but the most frequent cause is irritable bowel syndrome

A

Chronic/relapsing diarrhea

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8
Q

Large stool volume is a sing of ………

A

Small intestine disease

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9
Q

Rare mucus in feces

A

Small intestine disease

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10
Q

Blood in feces is unusual

A

Small intestine disease

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11
Q

Sometimes there is fat in feces this is a sing of ………

A

Small intestine disease

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12
Q

Variable feces color is a sing of ………

A

Small intestine disease

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13
Q

Undigested food is occasionally in

A

Small intestine disease

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14
Q

Tenesmus defecation is rare in

A

Small intestine disease

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15
Q

Frequency of defection is 2-3 times per day is in

A

Small intestine disease

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16
Q

Urgency defecation is uncommon in

A

Small intestine disease

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17
Q

Sometimes there is vomiting in patients with

A

Small intestine disease

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18
Q

Weight loss is a common sing of ………

A

Small intestine disease

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19
Q

Small stool volume is a sing of ………

A

Large intestine disease

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20
Q

Mucus in feces is a common sing of ………

A

Large intestine disease

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21
Q

Fat in feces is absent in

A

Large intestine disease

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22
Q

Feces color is normal in

A

Large intestine disease

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23
Q

Undigested food in feces is absent in

A

Large intestine disease

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24
Q

Defecation Tenesmus is common a sing of ………

A

Large intestine disease

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25
Q

Frequency of defecation is >3 times per day is a sing of ………

A

Large intestine disease

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26
Q

Defecation urgency is common in

A

Large intestine disease

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27
Q

Vomiting is uncommon in

A

Large intestine disease

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28
Q

Weight loss is rare in

A

Large intestine disease

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29
Q

an abnormality in absorption of food nutrients across the gastrointestinal (GI) tract

A

Malabsorption

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30
Q

Impairment can be of …….. nutrients depending on the abnormality

A

single or multiple

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31
Q

Diarrhea and weight loss in patients with a normal diet is likely to be caused by …….

A

malabsorption

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32
Q

Bulky, pale and offensive stools which float in the toilet

It signify fat malabsorption

A

Steatorrhea

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33
Q

Steatorrhea signify ………

A

fat malabsorption

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34
Q

Pallor in anemic patient

A

Sign of malabsorption of iron

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35
Q

Angular stomatitis

A

Sign of malabsorption of vitamin B2 (riboflavin) + other vitamins B + iron

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36
Q

Glossitis

A

Sign of malabsorption of vitamin B2 (riboflavin) + other vitamins B + iron

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37
Q

Bleeding gum

A

Sign of malabsorption of vitamin C

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38
Q

follicular hyperkeratosis

A

Sign of malabsorption of vitamin A

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39
Q

Koilonychias

A

Sign of malabsorption of iron

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40
Q

Muscle wasting

A

Sign of malabsorption of protein

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41
Q

Leg edema

A

Sign of malabsorption of protein

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42
Q

Clubbing

A

Sign of malabsorption

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43
Q

pathophysiologic mechanisms of diarrhea include (4)

A

• Osmotic
• Secretory
• Inflammatory
•Altered motility

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44
Q

Osmotic

A

pathophysiologic mechanism of diarrhea

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45
Q

Secretory

A

pathophysiologic mechanism of diarrhea

46
Q

Inflammatory

A

pathophysiologic mechanism of diarrhea

47
Q

Altered motility

A

pathophysiologic mechanism of diarrhea

48
Q

in most of the cases the pathophysiologic mechanism of diarrhea is

A

multifactorial

49
Q

involves an unabsorbed substance that draws water from the plasma into the intestinal lumen along osmotic gradients

A

Osmotic diarrhea

50
Q

results from disordered electrolyte transport

A

Secretory diarrhea

51
Q

diarrhea with exudative, secretory, or osmotic components

A

Diarrhea caused by Inflammatory diseases

52
Q

may alter fluid absorption by increasing or decreasing the exposure of luminal content to intestinal absorptive surface

A

Altered motility of the intestine or colon

53
Q

Bloody Diarrhea
Either ……… or ………

A

INFECTIVE

NON-INFECTIVE

54
Q

INFECTIVE diarrhea

A

Invasive organisms

Cytotoxic organisms

55
Q

Cytotoxic organisms

A

INFECTIVE Diarrhea

56
Q

Invasive organisms

A

INFECTIVE Diarrhea

57
Q

Campylobacter

A

Invasive organisms

58
Q

Shigella

A

Invasive organisms

59
Q

Amoeba

A

Invasive organisms

60
Q

C. difficile

A

Cytotoxic organisms

61
Q

E. coli O157

A

Cytotoxic organisms

62
Q

When patients with infective diarrhea
What to do

A

Send CBC, CRP

Take three stool samples in all patients

blood cultures if fever is present.

63
Q

Test stool for ………. if the patient has risk factors

(lives nursing home, recently hospitalized, received antibiotics within the last 3 months or is >65 years. In high-risk patients send ≥3 samples before ruling out the diagnosis.)

A

C. difficile toxin (CDT)

64
Q

Test stool for ………. if the patient has severe systemic upset

A

C. difficile toxin (CDT)

65
Q

Test stool for ………. if the patient has ↑↑WBC

A

C. difficile toxin (CDT)

66
Q

Request analysis of stool for ova, cysts and parasites in patients with ……. Or when …….

A

history of recent foreign travel

suspect immune compromised state

67
Q

Ischemic colitis

A

NON-INFECTIVE

68
Q

inflammatory diarrhea

A

NON-INFECTIVE

69
Q

NON-INFECTIVE

A

Ischemic colitis

or inflammatory diarrhea

70
Q

bloody diarrhea is preceded by sudden onset of LLQ abdominal pain or in any patient >50 years with known atherosclerotic disease or a source of systemic embolism e.g. atrial fibrillation

A

ischemic colitis

71
Q

In ischemic colitis Check for ….. (3)

A

ECG, CT Angio, Colonoscopy

72
Q

Patient without risk factors of ischemic colitis may has

A

inflammatory cause

e.g. Inflammatory Bowel Disease (IBD)

73
Q

In inflammatory cause diarrhea
e.g. Inflammatory Bowel Disease (IBD)
Check …… (2)
Refer to …….

A

Stool for leukocytes and leukocyte proteins

inflammatory markers: CRP and ESR

colonoscopy for histological confirmation and assess the disease severity

74
Q

calprotectin or lactoferrin

A

Check Stool for leukocytes and leukocyte proteins

75
Q

Non bloody diarrhea (3)

A

Protozoal infection

Gastroenteritis

Drug-related diarrhea

76
Q

Protozoal infection

A

Non bloody diarrhea

77
Q

Gastroenteritis

A

Non bloody diarrhea

78
Q

Most cases are self-limiting viral or toxin mediated infections and do not require further investigation or antimicrobial treatment

A

Gastroenteritis

79
Q

Gastroenteritis
If symptoms persist ……….. , seek specialist advice and consider further assessment as for

A

> 14 days

chronic/relapsing diarrhea

80
Q

Drug-related diarrhea

A

Non bloody diarrhea

81
Q

*Laxatives (including occult laxative abuse)

A

cause Drug-related diarrhea

82
Q
  • Antibiotics (especially macrolides)
A

Can cause Drug-related diarrhea

83
Q
  • Alcohol (especially chronic/excess)
A

Can cause Drug-related diarrhea

84
Q
  • NSAIDs
A

Can cause Drug-related diarrhea

85
Q

*Proton pump inhibitors

A

Can cause Drug-related diarrhea

86
Q
  • Cytotoxic agents
A

Can cause Drug-related diarrhea

87
Q

Metformin

A

Can cause Drug-related diarrhea

88
Q

Colchicine

A

Can cause Drug-related diarrhea

89
Q

Orlistat

A

Can cause Drug-related diarrhea

90
Q

SSRIs

A

Can cause Drug-related diarrhea

91
Q

Nicorandil

A

Can cause Drug-related diarrhea

92
Q

high index of suspicion for overflow diarrhea in frail, immobile or confused elderly patients

Always do ……..

A

PR examination

93
Q

Hard or impacted stool in rectum

Always do ………

A

PR examination

94
Q

If hard or impacted stool found, treat with …….. , then ………

A

fecal softeners and laxatives

reassess

95
Q

If the PR is normal, ………..

but consider an ………. if there is strong clinical suspicion

A

overflow diarrhea is unlikely

abdominal X-ray

96
Q

If steatorrhea is present

Ensure that the patient is not taking ………..

Check ………. and ………

A

orlistat

celiac serology (AntiTTG) and faecal elastase

97
Q

↓in pancreatic insufficiency

A

faecal elastase

98
Q

steatorrhea is present

If ↓fecal elastase or a strong suspicion of pancreatic disease, consider ………

A

pancreatic imaging (CT/MRCP)

99
Q

steatorrhea is present

If AntiTTG is +ve

A

Duodenal biopsy to confirm celiac disease

100
Q

to confirm celiac disease

A

Duodenal biopsy

101
Q

steatorrhea is present

If all other possibility were excluded do (2)

A

small bowel investigation

Screen for nutritional deficiencies

102
Q

e.g. duodenal biopsy, video capsule, MRI

A

small bowel investigation

103
Q

Consider colonoscopy, to exclude

A

colorectal cancer/inflammatory bowel disease

104
Q

if the patient has persistent diarrhea with any of the following:
•PR bleeding
•palpable rectal/abdominal mass •weight loss
•iron deficiency anemia
•new presentation in a patient >45 years.
Do …..

A

colonoscopy

to exclude colorectal cancer/inflammatory bowel disease

105
Q

With Alarm features (5)

A

•PR bleeding
•palpable rectal/abdominal mass •weight loss
•iron deficiency anemia
•new presentation in a patient >45 years.

106
Q

Clinical or laboratory features suggesting organic disease

A

Screen for hyperthyroidism, hypercalcemia and celiac disease

Refer to GI for further small bowel investigation

107
Q

if large volume, non-bloody stool, previous gastric/small bowel surgery or evidence of nutritional deficiencies

A

Refer to GI for further small bowel investigation

108
Q

if there is a positive family history, mouth ulcers, fever, ↑CRP/ESR or extra-intestinal manifestations

A

Exclude inflammatory bowel disease

109
Q

If no Hard or impacted stool in rectum, Steatorrhea, Alarm features, and Clinical or laboratory features suggesting organic disease
So it’s…….

A

functional cause

110
Q

irritable bowel syndrome, particularly when typical symptoms are present

Is example of …..

A

functional cause

111
Q

If patient is with functional cause diarrhea provide ……..
If symptoms progressive distressing or disabling, ………

A

reassurance and explanation +/- symptomatic Rx

Refer to GI

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