Patient has linear ulceration. What is the diagnosis?
B) carcinoid (neuroendocrine tumor)
Describe how solute absorption/secretion is related to water absorption/secretion
What are some of the more important/common causes of acute diarrhea?
Drugs, Bacterial infection, Viral infection, Protozoa infection, Parasite infection, Traveler's diarrhea
What are some of the pathophysiologies that cause diarrhea due to dismotility?
What is considered acute diarrhea? Chronic?
Acute: <2 wks
Chronic: >4 wks
What are some of the charcteristics features of bacterial entertoxins that cause diarrhea?
How does nutrient and electrolyte assimulation differ in regions of the adult intestine?
What are some labratory exams that could be useful in understanding the cause of a patient's diarrhea?
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
What is considered fatty diarrhea?
> 14 g/day of fat is considered steatorrhea (normal is < 6 g/day)
Describe how permeability changes as you pass through the bowels
Decreases as you go through
What is the most common type of drug that causes acute diarrhea?
Antibiotics (duh, you're changing the gut microflora)
What are the three characteristics of diarrhea?
What is this condition?
Give some examples of pumps/channels/carriers present in intestinal cells
Give some examples of ion transporters found in intestinal cells
What are some of the factors that regulate/module intestinal solute and water transport?
What are some characteristic features of the three types of chronic diarrhea?
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
What are some of the possible causes of steatorrhea?
What are some of the locations/issues that can cause chronic diarrhea?
What are some of the different classifications of bacterial diarrheas and toxins that cause them?
What are some important points to elucidate while taking a clinical history of a patient with dirrhea?
- Stool characteristics
- Relationship to eating/fasting
- History of radiation
What are some of the pathophysiologies associated with secretory diarrhea?
What vitamins are not absorbed properly in steatorrhea?
Fat soluble (Vits ADEK)
What is the diagnostic approach to chronic diarrhea?
Compare and constrast diarrheas as a result of small bowel colonic issues versus recto-sigmoid issues
What pathophysiologies are asssociated with exudative diarrhea?
What are the arrows pointing at? What organism can cause this?
Pseudomembranous colitis; C. Diff
What are the three types of chronic diarrhea?
Watery (osmotic/secretory), Exudative (infection/inflammation), Fatty (Malabsorption/maldigestion)
What staining method is shown here? What type of diarrhea is this used for?
Sudan; Fatty diarrhea
How do you calculate stool osmotic gap?
What are some of the pathophysiologies associated with osmotic diarrhea?
D) Celiac spruce
What are the characteristics of stool in steatorrhea?
Greasy, oily, floats, malodorous
What 6 points should be covered in your clinical examination?
- Assess severity
- Thyroid exam
- R side heart murmur
What is associated with exudative diarrhea?
Pain, tenesmus (cramping rectal pain), urgency