B2.051 Big Case Diarrhea and Abdominal Pain Flashcards Preview

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Flashcards in B2.051 Big Case Diarrhea and Abdominal Pain Deck (51)
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1

classify diarrhea

3 or more loose/watery stools per day
change from normal bowel habits
usually >200 /day

2

dysentery

diarrhea with blood

3

gastroenteritis

infection of the GA tract by bacteria, viruses, parasites

4

what accounts for improvement in mortality from diarrhea

better sanitation and food safety
improved case management (rehydration)
rotavirus vaccine

5

what are some adverse outcomes of recurrent diarrhea?

malnutrition
micronutrient deficiencies
developmental delays

6

what is the distinction between chronic/acute diarrhea?

more or less than 2 weeks

7

what are the 4 mechanisms of diarrhea?

secretory
osmotic
malabsorptive
exudative/inflammatory

8

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

9

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

10

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

11

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

12

what are 2 characteristics of malabsorptive diarrhea

1. failure of nutrient absorption
2. steatorrhea (fat in diarrhea)

13

what are 2 characteristics of inflammatory/exudative diarrhea

1. multifactorial
2. fecal leukocytes, persists during fasting

14

what do you look for in a physical exam of a patient w diarrhea?

degree of dehydration
growth chart
pallor, icterus, petechiae, rash
abdominal distention, tenderness
rectal exam
extraintestinal manifestations

15

characterize <5% dehydration state

well, alert
normal eyes
drinks normally
skin recoils

16

characterize 5-10% dehydration state

restless, irritable
sunken eyes
thirsty
skin recoils slowly

17

characterize >10% dehydration

lethargic, unconscious
sunken eyes
drinks poorly/unable to drink
skin recoils very slowly

18

what are the two major classes of acute diarrhea?

infectious (viral, bacterial, parasitic)
non infectious (drugs, food allergies, extraintestinal infections, surgical conditions)

19

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

20

what are some causes of chronic diarrhea?

malabsorption
inflammation
congenital disorders
intestinal failure
infectious
drug induced
neurohormonal
fecal impaction
IBS

21

what blood tests would you do in a case of acute diarrhea?

electrolytes
CBC with differential
peripheral smear

22

what stool tests would you do in a case of acute diarrhea?

culture
ova and parasites
extend for immunocompromised patients

23

what additional blood tests would you get for chronic diarrhea?

other organ function measures
TSH
celiac disease
vitamins

24

what additional stool tests would you get for chronic diarrhea?

pH
electrolytes
osmotic gap
fecal leukocytes and fat

25

what tests other than blood/stool would you look into for chronic diarrhea?

sweat chloride
radiology
endoscopy

26

characterize norovirus

ssRNA virus of Caliciviridae family
most common cause of acute gastroenteritis in US

27

transmission/incubation norovirus

contaminated food/water
person to person
short incubation

28

symptoms norovirus

nausea, vomiting, watery diarrhea, abdominal pain
mild mucosal abnormalities
self limited in immunocompetent host

29

characterize rotavirus

dsRNA virus, encapsulated
common cause of diarrheal mortality in children worldwide
protection by maternal antibodies in first 6 months
vaccine available

30

transmission/incubation rotavirus

contaminated food/water
person to person
small infection inoculum
short incubation period