OnlineMedEd: Gastroenterology - "Acute Diarrhea"

Question 1

What is the difference between acute and chronic diarrhea?

Answer 1

• Acute: less than 2 weeks

* Chronic: greater than 4 weeks

Question 2

Why is it helpful to differentiate between acute and chronic diarrhea?

Answer 2

Acute diarrhea is likely to be infectious; chronic diarrhea is not.

Question 3

Inflammatory diarrhea can be diagnosed by ______________.

Answer 3

fever, hematochezia, and WBCs in the feces

Question 4

Non-inflammatory (enterotoxic) diarrhea is characterized by ______________.

Answer 4

watery diarrhea with lack of fever and lack of fecal WBCs

Question 5

WBCs are not the most specific test for inflammatory diarrhea. The most is ____________.

Answer 5

lactoferrin

Question 6

List the etiologies of non-inflammatory diarrhea and their risk factors.

Answer 6

• ETEC (third-world traveler’s diarrhea)
• C. difficile (recent antibiotic use)
• V. cholerae (third-world outbreaks)
• Giardia lamblia (camping/hiking)
• B. cereus (reheated rice)
• S. aureus (proteinaceous food like egg salad)

Question 7

List the etiologies of inflammatory diarrhea and their risk factors/associations.

Answer 7

• Shigella (HUS)
• Campylobacter (most common cause)
• EHEC (E. coli O157;H7) (raw meat)
• Amoeba histolytica (AIDS)
• Salmonella (eggs, poultry)

Question 8

What is a good way to determine if a case of diarrhea is viral gastroenteritis?

Answer 8

• If the person is lacking signs of inflammatory diarrhea (fever greater than 104, bloody stool, severe abdominal pain) and the exposures that would make you worry about non-inflammatory diarrhea, then viral gastroenteritis is more likely.
• Also, if the person is vomiting, then it is more likely to be viral gastroenteritis.

Question 9

List two treatment options for viral gastroenteritis.

Answer 9

• ORT

* Loperamide

Question 10

If the person has signs and symptoms that suggest a more severe illness than viral gastroenteritis, then you should _______________.

Answer 10

evaluate first for C. diff (testing for toxin) and then do a stool culture and O&P

Question 11

Testing for toxin is the old technique of evaluating for C. diff. Now, it’s more common to use _____________.

Answer 11

NAAT

Question 12

Go through the treatment protocol for C. diff.

Answer 12

• 1st occurrence: try oral metronidazole, then vancomycin if that fails
•2nd occurrence: try oral metronidazole, then vancomycin if that fails
3rd occurrence: fidaxomycin
•Fecal transplant

Question 13

Discuss the more severe presentation of C. diff.

Answer 13

• Fever, leukocytosis, and abdominal distention (suggesting toxic megacolon) can occur in severe C. diff infections.
• Treat with oral vancomycin and IV metronidazole.