4.2.1 Pathophysiology of Diarrhea

Question 1

Patient has linear ulceration. What is the diagnosis?

Answer 1

Chron’s Dz

Question 2

Answer

Answer 2

B) carcinoid (neuroendocrine tumor)

Question 3

Describe how solute absorption/secretion is related to water absorption/secretion

Answer 3

Question 4

What are some of the more important/common causes of acute diarrhea?

Answer 4

Drugs, Bacterial infection, Viral infection, Protozoa infection, Parasite infection, Traveler’s diarrhea

Question 5

What are some of the pathophysiologies that cause diarrhea due to dismotility?

Answer 5

Question 6

What is considered acute diarrhea? Chronic?

Answer 6

Acute: <2 wks

Chronic: >4 wks

Question 7

What are some of the charcteristics features of bacterial entertoxins that cause diarrhea?

Answer 7

Question 8

How does nutrient and electrolyte assimulation differ in regions of the adult intestine?

Answer 8

Question 9

What are some labratory exams that could be useful in understanding the cause of a patient’s diarrhea?

Answer 9

CBC, electrolytes, BUN, Cr, total protein, albumin, globulin

Stool: weight, fat, culture, ova/parasite

Na, K, Mg, pH, occult blood, fecal WBC

laxative screen, C. diff PCR

Stool osmolality

Endoscopy

Abdominal imaging

Question 10

What is considered fatty diarrhea?

Answer 10

> 14 g/day of fat is considered steatorrhea (normal is < 6 g/day)

Question 11

Describe how permeability changes as you pass through the bowels

Answer 11

Decreases as you go through

Question 12

What is the most common type of drug that causes acute diarrhea?

Answer 12

Antibiotics (duh, you’re changing the gut microflora)

Question 13

What are the three characteristics of diarrhea?

Answer 13

>3 BM/day

Weight >200g/day

Increased liquidity

Question 14

What is this condition?

Answer 14

Traveler’s diarrhea

Question 15

Give some examples of pumps/channels/carriers present in intestinal cells

Answer 15

Question 16

Give some examples of ion transporters found in intestinal cells

Answer 16

Question 17

What are some of the factors that regulate/module intestinal solute and water transport?

Answer 17

Question 18

What are some characteristic features of the three types of chronic diarrhea?

Answer 18

Watery: No fecal WBC/RBC (Osmotic - stops with fasting/high osmotic gap; secretory - variable clinical picture)

Exudative: bloody, pus, other inflammatory reactions

Fatty: severe, weight and nutrient loss

Question 19

What are some of the possible causes of steatorrhea?

Answer 19

Question 20

What are some of the locations/issues that can cause chronic diarrhea?

Answer 20

Question 21

What are some of the different classifications of bacterial diarrheas and toxins that cause them?

Answer 21

Question 22

What are some important points to elucidate while taking a clinical history of a patient with dirrhea?

Answer 22

1. Duration
2. Severity
3. Stool characteristics
4. Relationship to eating/fasting
5. Surgery
6. Medications
7. Diet
8. History of radiation
9. Travel

Question 23

What are some of the pathophysiologies associated with secretory diarrhea?

Answer 23

Question 24

What vitamins are not absorbed properly in steatorrhea?

Answer 24

Fat soluble (Vits ADEK)

Question 25

What is the diagnostic approach to chronic diarrhea?

Answer 25

Question 26

Compare and constrast diarrheas as a result of small bowel colonic issues versus recto-sigmoid issues

Answer 26

Question 27

What pathophysiologies are asssociated with exudative diarrhea?

Answer 27

Question 28

What are the arrows pointing at? What organism can cause this?

Answer 28

Pseudomembranous colitis; C. Diff

Question 29

What are the three types of chronic diarrhea?

Answer 29

Watery (osmotic/secretory), Exudative (infection/inflammation), Fatty (Malabsorption/maldigestion)

Question 30

What staining method is shown here? What type of diarrhea is this used for?

Answer 30

Sudan; Fatty diarrhea

Question 31

How do you calculate stool osmotic gap?

Answer 31

Question 32

Answer 32

D) IBS

Question 33

What are some of the pathophysiologies associated with osmotic diarrhea?

Answer 33

Question 34

Answer 34

D) Celiac spruce

Question 35

What are the characteristics of stool in steatorrhea?

Answer 35

Greasy, oily, floats, malodorous

Question 36

What 6 points should be covered in your clinical examination?

Answer 36

1. Assess severity 2. Skin 3. Thyroid exam 4. R side heart murmur 5. Arthritis 6. Lymphadenopathy

Question 37

What is associated with exudative diarrhea?

Answer 37

Pain, tenesmus (cramping rectal pain), urgency