Diarrhea

Question 1

Where is 90% of fluid absorbed in healthy individuals?

Answer 1

Small intestine

Question 2

What is the definition of diarrhea?

Answer 2

loose/watery stools or

increased frequency accompanied by abnormal increase in daily weight

Question 3

What is Acute, Persistent, Chronic Diarrhea?

Answer 3

Acute - dx within 14 days of onset
Persistent - 2-4 weeks
Chronic - Lasting > 14 days

Question 4

What are the 3 types of Chronic Diarrhea?

Answer 4

watery, fatty, inflammatory

Question 5

What is the most common cause of acute diarrhea?

Answer 5

Viral infections

norovirus, rotavirus, adenovirus

Question 6

What are bacterial infection related diarrhea related to?

Answer 6

travel, foodborne illnesses

Question 7

What are indications for diagnostic testing for diarrhea?

Answer 7

>3 days of Sx
bloody diarrhea
international travel
old or immunocompromised
recent Abx usage

Question 8

What are characteristics of noninflammatory vs Inflammatory Diarrheal syndrome?

Answer 8

Noninflammatory:
mild Sx, large/watery diarrhea, no blood, little urgency, no tenesmus = SMALL BOWEL Involvement

Inflammatory:
low volume, dysenteric stools (bloody/mucous), urgency, tenesmus = LARGE BOWEL Involvement

Question 9

What are most likely causes of Noninflammatory Diarrhea?

Answer 9

Viruses (rotavirus, Norwalk virus)
Enterotoxigenic E. Coli (traveler’s diarrhea)
Vibrio cholerae
Toxins (S. aureus, C. perfringen, B. cereus)
Giardia

infect small bowel, adhere to mucos without invasion
toxins cause bowel EXCRETIONS

Question 10

What are common sources of the following bacterial food poisoning:

1. Bacillus cereus
2. Clostridium perfringens
3. Staphylococcal
4. Listeria

Answer 10

1. Rice, incubation: 6-14 hours
2. Clostridium perfringens - rewarmed cooked food (incubatioon 7-16 hours)
3. Staphylococcal: incubation 1-6 hours
4. Listeria - raw milk, cheese, hotdogs

Question 11

What are additional Sx of inflammatory Diarrhea?

Answer 11

1. pts appear toxic and usually febrile
2. Abdominal cramping, fecal urgency, tenesmus
3. Invasive, elaborate cytotoxins
4. see RBC and WBCs in stool

Question 12

What are Sx of Shigella infection?

Answer 12

Invasion of colonic epithelium, able to survive acidic conditions

Severe mucosa inflammation, a/w reactive arthritis, Hemolytic uremic syndrome (HUS), colonoscopy similar to ulcerative colitis

Question 13

Enterohemorrhagic E. coli is most a/w what kind of food?

Answer 13

undercooked ground beef, unpasteurized apple juice, milk

Question 14

What are Sx and lab findings of EHEC?

Answer 14

10-12 watery stools w progression to bloody stools
Severe abdominal pain, cramps, nausea, vomiting, abd distention and diffuse pain

Labs: microangiopathic hemolysis, low platelets, renal insufficiency (HUS)

Question 15

What is the criteria for Stool osmotic gap (high/low) and how does that affect Tx?

Answer 15

Stool osmotic gap = 290-2*(stool Na + stool K)
High osmotic gap (>50mosm/kg) = osmotic diarrhea
Low osmotic gap (<50mosm/kg) = secretory diarrhea

osmotic - improves w fasting
secretory - continues w fasting`

Question 16

What are causes of osmotic diarrhea?

Answer 16

artificial sweeteners

Mg, Phosphate, Sulfate in laxatives or antacids

Question 17

What are 4 common causes of fatty malabsorption diarrhea syndromes?

Answer 17

1. Mucosal disease - celiac
2. Giardia
3. Whipple’s Disease
4. Tropical Sprue

Question 18

What are characteristics of Giardia lamblia

Answer 18

protozoal infection - campers, daycares (cysts in contaminated water)

• sudan stain (spot check for fat in stool)
• B12, folate deficiency seen
• Tx w/ flagyl

Question 19

What are characteristics of Whipple’s disease?

Answer 19

chronic bacterial infection - actinobacter (T. whippleii)
occurs mainly in older white males
protein losing enteropathy w/ hypoalbuminemia + edema

Small bowel infiltrate w/ foamy macropages containing PAS positive material which distorts villi