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Therapeutics > 65: Diarrhea > Flashcards

65: Diarrhea Flashcards

1
Q

diarrhea physiology

A

-9 liters of fluid enters small intestine every day
-if SI water scapacity exceeded, chyme overloads colon

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2
Q

Increased intestinal motility causes

A

diarrhea

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3
Q

decreased intestinal motility causes

A

constipation

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4
Q

Segmenting contractions

A

-delay passage and mix intestinal contents allowing for greater absorption
-fewer in pt w diarrhea

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5
Q

Diarrhea

A

-inc frequency and dec consistency of fecal discharge
-episodes begin abruptly and usually subside 1-2 days w/o tx
-often symptom of systemic disease

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6
Q

Fecal Incontinence

A

-inability to control bowels
-stool leaking from rectum
-may occur temporarily during diarrhea bout
-can be chronic/recurring
-more common in women and in the elderly

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7
Q

Diarrhea epidemiology

A

-not routinely reported to CDC
-big time in daycare centers
-5% population
-Norovirus most common foodborne cause
-leading cause of childhood death in developing countries (typhoid fever)

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8
Q

Types of diarrhea

A

-Secretory
-Osmotic
-Exudative
-Altered Intestinal Transit

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9
Q

Secretory diarrhea

A

-change in active ion transport
-either dec Sodium absorption or
-or inc chloride secretion into lumen (water follows)

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10
Q

Causes of secretory diarrhea

A

-pancreatic tumors, unabsorbed fat
-laxatives
-bacterial toxins
-LARGE STOOL volumes >1L/day
-normal ionic stool content
-not altered by fasting

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11
Q

Osmotic diarrhea

A

-when poorly absorbed substances retained in intestinal fluids
-results in influx of water and electrolytes into lumen

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12
Q

Causes of osmotic diarrhea

A

-malabsorption syndromes
-LACTOSE intolerance
-admin of divalent ions (mg antacid)
-consumption of poorly soluble CHOs
-improves with fasting! (no eating no diarrhea)

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13
Q

Exudative diarrhea

A

-subset of secretory
-secondary to IBD
-IBD discharge mucus, proteins, and blood into gut
-characterized by LARGE stool volumes

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14
Q

Bacterial causes of diarrhea

A

-shigella
-salmonella (most common in US)
-campylobacter
-staph
-e. coli

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15
Q

viral causes of diarrhea

A

-Norovirus #1
-Rotavirus

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16
Q

Drug-induced diarrhea

A

-laxatives
-antacids w Mg
-electrolytes
-sorbitol in liquid formulations
-antimicrobials
-motility agents
-cholinergic meds
-antiHTN
-misoprostol
-colchicine
-PPI and H2RAs
-mycophenolate
-metformin

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17
Q

Drug induced diarrhea in cancer pts

A

-antineoplactics (-ecan)
-lots of mABs
-oral, IV, immunotherapy

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18
Q

Diarrhea presentation

A

-small intestinal involvement: cramps, sounds, lower right pain w cramping
-Large intestinal involvement: aching sensation with straining (tenesmus)

-N/V, HA, pain, fever, chills
-weight loss if chronic
-hyperperistalsis w generalized local tenderness on exam

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19
Q

Diarrhea diagnosis

A

-stool analysis
-endoscopic visualization and biopsy
-radiographic studies

20
Q

Complications of diarrhea

A

-QOL
-social isolation
-DEHYDRATION
-electrolyte imbalance = cardiac

21
Q

Dehydration from Diarrhea

A

-dry mucous membranes
-concentrated urine
-skin tenting
-dizziness when standing
-orhtostatic hypotension

22
Q

Desired outcomes of diarrhea tx

A

-manage diet
-prevent excessive water/electrolyte disturbances
-provide symptomatic relief
-treat curable causes
-manage secondary causes of diarrhea

23
Q

Non-pharma tx of diarrhea

A

-diet
-electrolyte replacement

24
Q

Diet managment for diarrhea

A

-more important w OSMOTIC
-need to eliminate causative agent
-do not stop feedings in children w bacterial diarrhea
-mild, digestable, low-residue
-Bananas, Rice, Applecause, Toast

25
Q

Electrolyte replacement

A

-re-hydrate and prevent electrolyte disturbances
-infants and elderly at most risk
-enteral admin preffered
-IV for pt in shock, severe dehydration, or cant stop vomitting
-pedialyte and enfalyte

26
Q

Diarrhea pharma tx goals

A

-eliminate cause
-dec fluid in lumen
-dec PROPULSIVE contraction
-inc MIXING contractions

27
Q

Treatment of acute diarrhea with no fever

A

-fluid/electrolyte replacement
-loperamide, diphenoxylate or absorbent
-diet

28
Q

Tx of acute diarrhea WITH fever/symptoms

A

-check for parasites
-if no parasites treat like regular
-if positive, use antibiotic and symptomatic therapy

29
Q

Tx of chronic diarrhea

A

-treat specific cause
-if no diagnosis:
-replete hydration
-D/C potential drug inducer
-adjust diet
-loperamide or absorbent

30
Q

Traveller’s Diarrhea

A

-most caused by bacteria
-acute watery diarrhea
-lasts 2-3 days

31
Q

Prevention of traveller’s diarrhea

A

-drink bottled water and drinks
-wash fruits and veggies
-antimicrobial prophylaxis should NOT be used routinely, consider for pt at high risk of complications then use rifaimin
-Bismuth subsalicylate may be considered for any traveler
-NOT fluoroquinolones

32
Q

Treatment of traveler’s diarrhea

A

-oral rehydration solutions for all
-loperamide adjunctive therapy

33
Q

tx of mild traveller’s diarrhea

A

-no antibx
-loperamide of BSS 60ml 2 tabs QID

34
Q

tx of moderatte traveler’s diarrhea

A

-antibx MAY be used
-Loperamide alone or w antibiotic

35
Q

tx of severe traveler’s diarrhea

A

-antibx SHOULD be used
-single-dose preffered
-loperamide considered as adjunctive

36
Q

Drug-induced diarrhea etiology/presentatino

A

-dec transit time leads to irregular absorption and secretion
-alteration of bowel flora (antimicrobials)
-mild to life-threatening
-varied duration depending on causing agent

37
Q

Tx of drug induced diarrhea

A

-d/c offender if possible
-oral rehydration solutions
-anti-motility agents

38
Q

Antimotility drug action

A

-activate mu opioid receptors on smooth muscle of bowel to reduce peristalsis and inc segmentation
=delayed transit of intraluminal contents

39
Q

Antimotility drug concerns

A

-should NOT be used long term (esp opioid derivatives)
-not to be used w C. diff diarrhea

40
Q

Antimotility drugs

A

-diphenoxylate/atropine not for young kids
-loperamide OTC
-codeine

41
Q

Loperamide

A

-antimotility
-4mg start, 2mg after each loose stool no more than 16mg.day
-high doses can lead to death and bad heart problems

42
Q

Absorbents

A

-absorbe nutrients, toxins, drugs, juices
-symptomatic relief
-used for some patients w chronic diarrhea when they have trouble forming solid stools
-absorb water and reduce intestinal motility
-effectiveness if a lil iffy

43
Q

Absorbents

A

-Psyllium (metamucil)
-polycarbophil (fibercon) (can absorb more)
-use for diarrhea or constipation

44
Q

Antisecretory tx of diarrhea

A

-reduce secretions in gut
-bismuth subsalicylate

45
Q

Bismuth subalicylate

A

-pepto-bismol, kaopectate
-antimicrobial/antiinflammatory effects
-2 tabs every 30-60 min as needed up to 8 doses/day
-may potentiate anticoagulants
-cause stool and tongue to turn black
-do not use in kids

Therapeutics (78 decks)

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