Flashcards in B2.051 Big Case Diarrhea and Abdominal Pain Deck (51)
3 or more loose/watery stools per day
change from normal bowel habits
usually >200 /day
diarrhea with blood
infection of the GA tract by bacteria, viruses, parasites
what accounts for improvement in mortality from diarrhea
better sanitation and food safety
improved case management (rehydration)
what are some adverse outcomes of recurrent diarrhea?
what is the distinction between chronic/acute diarrhea?
more or less than 2 weeks
what are the 4 mechanisms of diarrhea?
outline the mechanisms of absorption in the intestines
sodium coupled solute transporter takes things like glucose, galactose, AAs, etc. through the mucosa against concentration gradients while water moves into enterocytes along gradient
Na+/H+ exchangers allow for electrolyte absorption without other solutes
paracellular transport allows for passive solute transport across enterocyte membrane
outline the mechanisms for intestinal secretion
chloride channels in small bowels allow Na+ and water to follow Cl- into the lumen
Cl-/HCO3- and Na+/H+ exchangers in colon
what are the 4 characteristics of secretory diarrhea
1. increased water secretion by activation of Cl- channels
2.decreased Na+ and water absorption
3. severe fluid and electrolyte losses
4. isotonic, low stool osmotic gap, persists during fasting
what are the 3 characteristics of osmotic diarrhea
1. increased osmotic pressure due to non-absorbed solutes
2. water pulled into lumen
3. high stool osmotic gap, abates during fasting
what are 2 characteristics of malabsorptive diarrhea
1. failure of nutrient absorption
2. steatorrhea (fat in diarrhea)
what are 2 characteristics of inflammatory/exudative diarrhea
2. fecal leukocytes, persists during fasting
what do you look for in a physical exam of a patient w diarrhea?
degree of dehydration
pallor, icterus, petechiae, rash
abdominal distention, tenderness
characterize <5% dehydration state
characterize 5-10% dehydration state
skin recoils slowly
characterize >10% dehydration
drinks poorly/unable to drink
skin recoils very slowly
what are the two major classes of acute diarrhea?
infectious (viral, bacterial, parasitic)
non infectious (drugs, food allergies, extraintestinal infections, surgical conditions)
what is intussusception?
telescoping of the intestines caused by the inhibiting of periscopic movements by a tumor/neoplasia/etc
diminishes blood supply to part of the intestine resulting in necrosis/inflammation/diarrhea
what are some causes of chronic diarrhea?
what blood tests would you do in a case of acute diarrhea?
CBC with differential
what stool tests would you do in a case of acute diarrhea?
ova and parasites
extend for immunocompromised patients
what additional blood tests would you get for chronic diarrhea?
other organ function measures
what additional stool tests would you get for chronic diarrhea?
fecal leukocytes and fat
what tests other than blood/stool would you look into for chronic diarrhea?
ssRNA virus of Caliciviridae family
most common cause of acute gastroenteritis in US
person to person
nausea, vomiting, watery diarrhea, abdominal pain
mild mucosal abnormalities
self limited in immunocompetent host
dsRNA virus, encapsulated
common cause of diarrheal mortality in children worldwide
protection by maternal antibodies in first 6 months