Chapter 43 - Diarrhea Flashcards
(194 cards)
1
Q
one of the most common causes of mortality in developing
countries, particularly among impoverished infants, accounting for
1.8 million deaths per year.
A
Acute infectious diarrhea
2
Q
results in environmental enteropathy with long-term
impacts on physical and intellectual development.
A
Recurrent, acute diarrhea in children in
tropical countries
3
Q
primary function of the small intestine
A
digestion and
assimilation of nutrients from food
4
Q
function of small intestine and colon
A
regulate the secretion and
absorption of water and electrolytes, the storage and subsequent
transport of intraluminal contents aborally, and the salvage of some
nutrients
5
Q
Alterations in motor and sensory functions of the colon result in highly
prevalent syndromes such as _______, _______, and _________
A
irritable bowel syndrome (IBS), chronic
diarrhea, and chronic constipation
6
Q
also called the enteric nervous system, comprises
myenteric, submucosal, and mucosal neuronal layers
A
intrinsic innervation
7
Q
regulates smooth-muscle function through intermediary pacemaker-
like cells called the interstitial cells of Cajal
A
myenteric
plexus
8
Q
affects secretion, absorption, and mucosal blood flow
A
submucosal
plexus
9
Q
receives input from the extrinsic nerves, but it
is capable of independent control of these functions.
A
enteric nervous system
10
Q
innervations of the small intestine and colon are part of
the autonomic nervous system and also modulate motor and secretory
functions.
A
extrinsic innervations
11
Q
convey visceral sensory pathways
from and excitatory pathways to the small intestine and colon
A
parasympathetic nerves
12
Q
Parasympathetic fibers via the vagus nerve reach the small intestine
and proximal colon along the branches of the
A
superior mesenteric
artery
13
Q
distal colon is supplied
A
sacral parasympathetic nerves
(S2–4) via the pelvic plexus
14
Q
chief excitatory neurotransmitters
controlling motor function
A
acetylcholine and the tachykinins,
such as substance P
15
Q
modulates motor
functions and reaches the small intestine and colon
A
sympathetic nerve supply
16
Q
Sympathetic input to the gut is generally __________ to
sphincters and ________ to non-sphincteric muscle
A
excitatory
inhibitory
17
Q
___ of fluid enter the GI tract, ___ of residual fluid
reaches the colon, and the stool excretion of fluid constitutes about
_____.
A
9L
~1 L
0.2 L/d
18
Q
During the fasting period, the motility of the small intestine is characterized
by a cyclical event called the ___________),
which serves to clear nondigestible residue from the small intestine
(the intestinal “housekeeper”).
A
migrating motor complex (MMC)
19
Q
MMC lasts for how long and occurs every???
A
lasts for 4min and occurs every 60-90min
20
Q
acts as a reservoir, emptying intermittently by bolus
movements. This action allows time for salvage of fluids, electrolytes,
and nutrients.
A
distal ileum
21
Q
Segmentation by ______
compartmentalizes the colon and
facilitates mixing, retention of residue,
and formation of solid stools
A
haustra
22
Q
The resident microorganisms, predominantly \_\_\_\_\_\_\_\_\_\_, in the colon are necessary for the digestion of unabsorbed carbohydrates that reach the colon even in health, thereby providing a vital source of nutrients to the mucosa.
A
anaerobic bacteria
23
Q
regions
of colon function as reservoirs (average
transit time,____)
A
ascending and transverse regions
15h
24
Q
region of the colon that acts as a conduit (average transit time, ____).
A
descending colon
3h
25
efficient
at conserving sodium and water, a function that is particularly important
in sodium-depleted patients in whom the small intestine alone
is unable to maintain sodium balance
colon
26
result from alteration in the reservoir function of the proximal colon
or the propulsive function of the left colon.
Diarrhea or constipation
27
result from disturbances of the rectal or sigmoid reservoir, typically
as a result of dysfunction of the pelvic floor, the anal sphincters, the
coordination of defecation, or dehydration.
constipation
28
associated with mass movements through the colon and
normally occur approximately five times per day, usually on awakening
in the morning and postprandially
short duration or phasic contractions
high-amplitude (>75 mmHg) propagated contractions (HAPCs)
29
refers to the background contractility upon which
| phasic contractile activity (typically contractions lasting <15 s) is superimposed
Colonic tone
30
After meal ingestion, colonic phasic and tonic contractility increases for
a period of ____
~2 h
31
The initial phase (~10 min) is mediated by the ______ in response to mechanical distention of the stomach
vagus nerve
32
Tonic contraction of the ____________, which forms a sling
| around the rectoanal junction, is important to maintain continence
puborectalis muscle
33
during defecation, ______________ relax this muscle,
| facilitating the straightening of the rectoanal angle
sacral parasympathetic nerves
34
Distention
of the rectum results in transient relaxation of the internal anal
sphincter via _______________.
intrinsic and reflex sympathetic innervation
35
loosely defined as passage of abnormally liquid or
| unformed stools at an increased frequency
Diarrhea
36
diarrhea in adults
typical
| Western diet, stool weight >200 g/d
37
acute diarrhea
<2 weeks
38
persistent diarrhea
2-4 weeks
39
chronic diarrhea
>4 weeks
40
frequent
passage of small volumes of stool, is often associated with rectal
urgency, tenesmus, or a feeling of incomplete evacuation, and accompanies
IBS or proctitis
Pseudodiarrhea
41
involuntary discharge of
rectal contents and is most often caused by neuromuscular disorders
or structural anorectal problems
Fecal incontinence
42
may occur in nursing
home patients due to fecal impaction that is readily detectable by rectal
examination.
Overflow diarrhea
43
More than 90% of cases of acute diarrhea are caused by ______________
infectious
| agents
44
acute diarrhea is accompanied by_________
vomiting, fever, and
| abdominal pain
45
Disturbances of flora by antibiotics can lead to diarrhea
by reducing the digestive function or by allowing the overgrowth of
pathogens, such as ____________
Clostridium difficile
46
five high-risk groups in US
- Travelers
- Consumers of certain foods
- Immunodeficient persons
- Daycare attendees and their family members
- Institutionalized persons
47
Nearly 40% of tourists to endemic regions of Latin America,
Africa, and Asia develop so-called traveler’s diarrhea, most commonly
due to __________
enterotoxigenic or enteroaggregative Escherichia coli as
well as to Campylobacter, Shigella, Aeromonas, norovirus, Coronavirus,
and Salmonella
48
Visitors to Russia (especially St. Petersburg) may
| have increased risk of _________
Giardia-associated diarrhea
49
Campers, backpackers, and swimmers in
| wilderness areas may become infected with __________
Giardia
50
Cruise ships
may be affected by outbreaks of gastroenteritis caused by agents
such as ______
norovirus
51
chicken
Salmonella, Campylobacter, or Shigella
52
undercooked hamburger
enterohemorrhagic
| E. coli (O157:H7)
53
fried rice or other reheated food
Bacillus cereus
54
mayonnaise or creams
Staphylococcus aureus or
| Salmonella
55
eggs
Salmonella
56
fresh or frozen uncooked foods or soft cheeses
Listeria
57
seafood
Vibrio species,
| Salmonella, or acute hepatitis A
58
primary immunodeficiency
IgA deficiency,
common variable hypogammaglobulinemia, chronic granulomatous
disease
59
secondary immunodeficiency
| states
AIDS, senescence, pharmacologic suppression
60
In patients with AIDS, agents
transmitted venereally per rectum or by extension from vaginal
infection (e.g., Neisseria gonorrhoeae, Treponema pallidum, Chlamydia)
may contribute to ________
proctocolitis
61
most common microorganism in institutionalized persons
C. difficile
62
Profuse, watery diarrhea secondary to small-bowel hypersecretion
occurs with _____________, _______________, ____________
ingestion of preformed bacterial toxins
enterotoxin-
producing bacteria
enteroadherent pathogens
63
Diarrhea
associated with marked vomiting and minimal or no fever may occur
abruptly within a few hours
ingestion of preformed bacterial toxins
enterotoxin-
producing bacteria
64
vomiting is usually less, abdominal cramping or bloating is greater,
and fever is higher
enteroadherent pathogens
65
cause high fever and abdominal pain
Cytotoxin-producing and invasive
| microorganisms
66
cause bloody diarrhea
Invasive
| bacteria and Entamoeba histolytica
67
bloody diarrhea
dysentery
68
invades the terminal ileal and proximal colon
mucosa and may cause especially severe abdominal pain with tenderness
mimicking acute appendicitis
Yersinia
69
Reactive arthritis (formerly known as Reiter’s syndrome),
arthritis, urethritis, and conjunctivitis may accompany or follow infections
by _______, ____________, ________, _______.
Salmonella, Campylobacter, Shigella, and Yersinia
70
may
| also lead to an autoimmune-type thyroiditis, pericarditis, and glomerulonephritis.
Yersiniosis
71
can
lead to the hemolytic-uremic syndrome with an attendant high mortality
rate
enterohemorrhagic E. coli (O157:H7) and Shigella
72
recognized as
| a complication of infectious diarrhea
postinfectious IBS
73
may precede the diagnosis of celiac disease or Crohn’s disease
acute gastroenteritis
74
most
common noninfectious causes of acute diarrhea, and etiology may be
suggested by a temporal association between use and symptom onset
Side effects from medications
75
frequently incriminated medications that may produce diarrhea
antibiotics, cardiac antidysrhythmics,
antihypertensives, nonsteroidal anti-inflammatory drugs
(NSAIDs), certain antidepressants, chemotherapeutic agents, bronchodilators,
antacids, and laxatives
76
typically occurs in persons aged >50 years; often presents as
acute lower abdominal pain preceding watery, then bloody diarrhea;
and generally results in acute inflammatory changes in the sigmoid or
left colon while sparing the rectum
Occlusive or nonocclusive ischemic
| colitis
77
Indications for evaluation in acute diarrhea
profuse diarrhea with
dehydration,
grossly bloody stools,
fever ≥38.5°C (≥101°F)
duration
>48 h without improvement, recent antibiotic use, new community
outbreaks, associated severe abdominal pain in patients aged
>50 years, and elderly (≥70 years) or immunocompromised patients
78
cornerstone of diagnosis in those suspected of severe acute
| infectious diarrhea
microbiologic analysis of the stool
79
Workup
| included in microbiologic analysis of the stool
cultures for bacterial and viral pathogens; direct inspection
for ova and parasites; and immunoassays for certain bacterial toxins
(C. difficile), viral antigens (rotavirus), and protozoal antigens (Giardia,
E. histolytica)
80
Persistent diarrhea is commonly due to _____ (Chap. 218),
but additional causative organisms that should be considered
include _____ (especially if antibiotics had been administered),
E. histolytica, Cryptosporidium, Campylobacter
Giardia
C. difficile
81
If stool
studies are unrevealing, _________ with biopsies and
________ with duodenal aspirates and biopsies may be
indicated
flexible sigmoidoscopy
| upper endoscopy
82
abrupt-onset diarrhea that persists for at least
4 weeks, but may last 1–3 years, and is thought to be of infectious
origin
Brainerd diarrhea
83
appropriate in patients with uncharacterized
persistent diarrhea to exclude IBD or as an initial approach in patients
with suspected noninfectious acute diarrhea such as might be caused
by ischemic colitis, diverticulitis, or partial bowel obstruction
Structural examination by sigmoidoscopy, colonoscopy, or
| abdominal computed tomography (CT) scanning
84
central importance to
| all forms of acute diarrhea
Fluid and electrolyte replacement
85
should be instituted promptly
with severe diarrhea to limit dehydration, which is the major cause
of death
Oral sugar-electrolyte solutions (iso-osmolar sport
| drinks or designed formulations)
86
group of people that needs IV rehydration during acute diarrhea
Profoundly dehydrated patients, especially infants and the
| elderly
87
In moderately severe nonfebrile and nonbloody diarrhea,
antimotility and antisecretory agents such as _______ can be
useful adjuncts to control symptoms
loperamide
88
loperamide should be avoided with _______, which may be exacerbated or prolonged by
them.
febrile dysentery
89
may reduce symptoms of vomiting
and diarrhea but should not be used to treat immunocompromised
patients or those with renal impairment because of the risk of
bismuth encephalopathy.
Bismuth subsalicylate
90
Many physicians treat moderately to severely ill patients with
febrile dysentery empirically without diagnostic evaluation using a
quinolone, such as _______________
ciprofloxacin (500 mg bid for 3–5 d).
91
Empirical
| treatment can also be considered for suspected giardiasis with ______________.
metronidazole
| 250 mg qid for 7 d
92
Because of resistance to first-line treatments, newer agents
such as ________ may be required for Giardia and Cryptosporidium
infections.
nitazoxanide
93
may reduce the frequency of traveler’s
| diarrhea
Bismuth subsalicylate
94
Antibiotic prophylaxis is only indicated for certain patients
traveling to high-risk countries in whom the likelihood or seriousness
of acquired diarrhea would be especially high, including those with
_____________
immunocompromise, IBD, hemochromatosis, or gastric achlorhydria
95
may reduce bacterial
| diarrhea in such travelers by 90%
ciprofloxacin, azithromycin, or rifaximin
96
is not suitable for
invasive disease but rather as treatment for uncomplicated traveler’s
diarrhea.
rifaximin
97
most of the causes
| of chronic diarrhea are ________.
noninfectious
98
are due to derangements
| in fluid and electrolyte transport across the enterocolonic mucosa
Secretory diarrheas
99
They are characterized clinically by watery, large-volume fecal outputs
that are typically painless and persist with fasting
Secretory diarrheas
100
are the most common secretory causes of chronic diarrhea
Side effects from regular ingestion of drugs and toxins
101
may cause a secretory-type diarrhea due to enterocyte
injury with impaired sodium and water absorption as well as rapid
transit and other alterations
Chronic ethanol
| consumption
102
is associated with diarrhea due to sprue-like
| enteropathy
oral angiotensin-receptor
| blocker, olmesartan
103
These
conditions may result in a secretory-type diarrhea because of inadequate
surface for reabsorption of secreted fluids and electrolytes
BOWEL RESECTION, MUCOSAL DISEASE, OR ENTEROCOLIC FISTULA
104
this subset of conditions tends to
| worsen with eating
BOWEL RESECTION, MUCOSAL DISEASE, OR ENTEROCOLIC FISTULA
105
bile acids are functionally malabsorbed from a
| normal-appearing terminal ileum
idiopathic secretory diarrhea or bile acid diarrhea
| BAD
106
diseases that are present with bile acid diarrhea
Crohn’s ileitis or resection of
| <100 cm of terminal ileum
107
may
| paradoxically lead to increased fecal output due to fluid hypersecretion
Partial bowel obstruction, ostomy stricture, or fecal impaction
108
may produce
watery diarrhea alone or as part of the carcinoid syndrome that comprises
episodic flushing, wheezing, dyspnea, and right-sided valvular
heart disease.
Metastatic gastrointestinal
| carcinoid tumors or, rarely, primary bronchial carcinoids
109
Diarrhea is due to the release into the circulation of
| potent intestinal secretagogues including ____________
serotonin, histamine, prostaglandins,
and various kinins
SHPK
110
one of the most common neuroendocrine tumors, most typically
presents with refractory peptic ulcers, but diarrhea occurs in up
to one-third of cases and may be the only clinical manifestation in 10%
Gastrinoma
111
While other secretagogues released with gastrin may play a role, the
diarrhea most often results from ___________ by low intraduodenal pH
fat maldigestion owing to pancreatic
| enzyme inactivation
112
watery diarrhea
| hypokalemia achlorhydria syndrome
pancreatic cholera
113
non-β cell pancreatic adenoma
VIPoma
114
secretory diarrhea in pancreatic cholera is often massive
with stool volumes ____; daily volumes as high as ____ have been
reported.
>3 L/d
20 L
115
may present with watery diarrhea caused by
| calcitonin, other secretory peptides, or prostaglandins
Medullary
| carcinoma of the thyroid
116
may be associated with the skin lesion urticaria pigmentosa, may cause diarrhea that is either secretory and
mediated by histamine or inflammatory due to intestinal infiltration
by mast cells
Systemic mastocytosis
117
may rarely be associated
with a secretory diarrhea that may cause hypokalemia, can be inhibited
by NSAIDs, and are apparently mediated by prostaglandins
colorectal villous adenomas
118
defective Cl−/HCO3
| − exchange with alkalosis
congenital
| chloridorrhea
119
defective Na+/H+ exchange
congenital sodium diarrhea
120
Some hormone deficiencies may be associated with watery diarrhea,
such as occurs with _________
that may be accompanied by skin hyperpigmentation
adrenocortical insufficiency (Addison’s disease)
121
occurs when ingested, poorly
absorbable, osmotically active solutes draw enough fluid into the
lumen to exceed the reabsorptive capacity of the colon
ceases with fasting or with discontinuation of the
causative agent
Osmotic diarrhea
122
Ingestion of ________ may induce osmotic diarrhea typified
| by a stool osmotic gap
magnesium-containing antacids,
| health supplements, or laxatives
123
One of the
most common causes of chronic diarrhea in adults is _________,
which affects three-fourths of nonwhites worldwide and 5–30% of
persons in the United States; the total lactose load at any one time
influences the symptoms experienced.
lactase deficiency
124
are frequently malabsorbed,
and diarrhea ensues with ingestion of medications, gum, or
candies sweetened with these poorly or incompletely absorbed sugars
sorbitol, lactulose, or fructose
125
osmotic diarrhea with a low pH
Carbohydrate malabsorption
126
recognized as symptoms of non-celiac gluten intolerance
(which is associated with impaired intestinal or colonic barrier
function) and intolerance of fermentable oligosaccharides, disaccharides,
monosaccharides, and polyols (FODMAPs).
Chronic diarrhea, bloating, and
| abdominal pain
127
may lead to greasy,
foul-smelling, difficult-to-flush diarrhea often associated with weight
loss and nutritional deficiencies due to concomitant malabsorption
of amino acids and vitamins.
Fat malabsorption
128
steatorrhea
stool fat exceeding the normal 7 g/d
129
rapid-transit diarrhea
fecal fat up to 14 g/d
130
average daily fecal fat of small-intestinal diseases
15–25 g
131
average daily fecal fat of pancreatic exocrine
| insufficiency
>32 g
132
these diseases may produce steatorrhea
Intraluminal maldigestion, mucosal malabsorption, or
| lymphatic obstruction
133
This condition most commonly results
from pancreatic exocrine insufficiency, which occurs when >90% of
pancreatic secretory function is lost
INTRALUMINAL MALDIGESTION
134
usually a
| sequel of ethanol abuse, most frequently causes pancreatic insufficiency.
Chronic pancreatitis
135
this may deconjugate bile acids and alter micelle formation, impairing fat
digestion
Bacterial overgrowth
136
Bacterial overgrowth in the small intestine occurs with _____
blind-loop, small-bowel diverticulum
| or dysmotility and is especially likely in the elderly
137
mucosal malabsorption most commonly occurs from ______
celiac disease
138
gluten-sensitive enteropathy affects all ages and is characterized by
villous atrophy and crypt hyperplasia in the proximal small bowel and
can present with fatty diarrhea associated with multiple nutritional deficiencies
of varying severity
celiac disease
139
frequently presents
without steatorrhea, can mimic IBS, and has many other GI and extraintestinal
manifestations
celiac disease
140
may produce a similar histologic
and clinical syndrome with celiac disease but occurs in residents of or travelers to tropical
climates;
abrupt onset and response to antibiotics suggest an infectious
etiology
Tropical sprue
141
due to the bacillus Tropheryma whipplei and
histiocytic infiltration of the small-bowel mucosa, is a less common
cause of steatorrhea that most typically occurs in young or middle-aged
men;
it is frequently associated with arthralgias, fever, lymphadenopathy,
and extreme fatigue, and it may affect the CNS and endocardium
Whipple’s disease
142
a rare defect of chylomicron formation and fat malabsorption in
children, associated with acanthocytic erythrocytes, ataxia, and retinitis
pigmentosa.
Abetalipoproteinemia
143
unique constellation of fat malabsorption
with enteric losses of protein (often causing edema) and lymphocytopenia.
Carbohydrate and amino acid absorption are preserved
POSTMUCOSAL LYMPHATIC OBSTRUCTION
144
POSTMUCOSAL LYMPHATIC OBSTRUCTION is due to ________
rare congenital intestinal lymphangiectasia
or to acquired lymphatic obstruction secondary to trauma, tumor, cardiac
disease or infection
145
generally
accompanied by pain, fever, bleeding, or other manifestations of
inflammation.
Inflammatory diarrheas
146
unifying feature on stool analysis of inflammatory diarrhea
presence of leukocytes or
| leukocyte-derived proteins such as calprotectin
147
generalized edema
anasarca
148
among the most common organic causes of chronic diarrhea in adults
and range in severity from mild to fulminant and life-threatening under idiopathic inflammatory bowel disease
Crohn’s disease and chronic ulcerative colitis
149
They may be associated with uveitis, polyarthralgias, cholestatic liver
disease (primary sclerosing cholangitis), and skin lesions (erythema
nodosum, pyoderma gangrenosum)
Crohn’s disease and chronic ulcerative colitis
150
cholestatic liver
| disease
primary sclerosing cholangitis
151
skin lesions in Crohn’s disease and chronic ulcerative colitis
erythema
| nodosum, pyoderma gangrenosum
152
an increasingly recognized cause
of chronic watery diarrhea, especially in middle-aged women and
those on NSAIDs, statins, proton pump inhibitors (PPIs), and selective
serotonin reuptake inhibitors (SSRIs
biopsy of a normal-appearing
colon is required for histologic diagnosis.
typically responds well to anti-inflammatory drugs (e.g., bismuth),
the opioid agonist loperamide, or to budesonide
Microscopic colitis, including both
| lymphocytic and collagenous colitis
153
diarrhea that is
particularly prevalent and often the result of giardiasis, bacterial overgrowth,
or sprue
selective IgA
| deficiency or common variable hypogammaglobulinemia
154
disease that presents diarrhea, pain, vomitting, or ascites
EOSINOPHILIC GASTROENTERITIS
hx of atopy, charcot-leyden crystals
155
may accompany many diarrheas
as a secondary or contributing phenomenon, but primary dysmotility
is an unusual etiology of true diarrhea
Rapid transit
156
stool features of rapid transit
secretory diarrhea
157
may produce hypermotility with resultant
| diarrhea
Hyperthyroidism, carcinoid syndrome, and certain drugs (e.g., prostaglandins,
prokinetic agents)
158
may lead to stasis with secondary bacterial
| overgrowth causing diarrhea
Primary visceral neuromyopathies or idiopathic acquired
| intestinal pseudoobstruction
159
often accompanied
by peripheral and generalized autonomic neuropathies, may occur in
part because of intestinal dysmotility.
Diabetic diarrhea
160
characterized by disturbed intestinal and colonic motor
and sensory responses to various stimuli.
Symptoms of stool frequency
typically cease at night, alternate with periods of constipation, are
accompanied by abdominal pain relieved with defecation, and rarely
result in weight loss.
IBS
161
accounts for up to 15% of unexplained
| diarrheas referred to tertiary care centers.
Factitial diarrhea
162
deception or self-injury for secondary gain
Munchausen syndrome
163
causes of factitial diarrhea
Munchausen syndrome
eating disorders, some patients covertly self-administer laxatives alone
or in combination with other medications (e.g., diuretics) or surreptitiously
add water or urine to stool sent for analysis
164
_______ and ________
| are common co-presenting features in factitial diarrhea
hypotension and hypokalemia
165
Measuring IgA
| tissue transglutaminase antibodies may help detect _______
celiac disease
166
confirmed by a scintigraphic radiolabeled bile
| acid retention test
Bile acid diarrhea
167
chronic watery diarrhea, which
| ceases with fasting in an otherwise healthy young adult, may justify a trial of a ___________
lactose-restricted diet
168
bloating and diarrhea persisting
since a mountain backpacking trip may warrant a trial of ________
for likely giardiasis
metronidazole
169
postprandial diarrhea persisting
following resection of terminal ileum might be due to bile acid
malabsorption and be treated with __________
before further evaluation.
cholestyramine or colesevelam
170
Patients suspected of
having IBS should be initially evaluated with __________
with colorectal biopsies to exclude IBD, or particularly microscopic
colitis
flexible sigmoidoscopy
171
Any patient
who presents with chronic diarrhea and hematochezia should be
evaluated with _______________
stool microbiologic studies and colonoscopy.
172
If stool weight is _______, additional stool analyses
should be performed that might include electrolyte concentration,
pH, occult blood testing, leukocyte inspection (or leukocyte protein
assay), fat quantitation, and laxative screens
>200 g/d
173
the most sensitive test for giardiasis
Giardia antigen
| assay
174
two most common
| causes of osmotic diarrhea
lactose intolerance and magnesium ingestion
175
Low fecal pH suggests _______
carbohydrate malabsorption
176
can be confirmed by lactose breath testing or by a
therapeutic trial with lactose exclusion and observation of the effect
of lactose challenge (e.g., a liter of milk).
lactose
| malabsorption
177
should be suspected by the
| presence of blood or leukocytes in the stool
Chronic inflammatory-type diarrheas
178
Whipple’s disease or tropical sprue treatment
antibiotic administration
179
trmt for lactase deficiency
elimination of dietary lactose
180
trmt for celiac sprue
elimination of gluten
181
trmt for idiopathic IBDs
use of glucocorticoids or other anti-inflammatory agents
182
trmt for bile acid malabsorption
use of bile acid sequestrants
183
trmt for gastric hypersecretion of gastrinomas
PPIs
184
trmt for malignant carcinoid
| syndrome
somatostatin analogues such as octreotide
185
trmt for medullary
| carcinoma of the thyroid
prostaglandin inhibitors such as indomethacin
186
trmt for pancreatic insufficiency
pancreatic enzyme replacement
187
often
| helpful in mild or moderate watery diarrhea
Mild opiates, such as diphenoxylate or loperamide
188
trmt for those with more
| severe diarrhea, _______ may be beneficial
codeine or tincture of opium
189
should be avoided with severe IBD, because toxic
| megacolon may be precipitated
antimotility agents
190
may allow control of diabetic diarrhea, although the medication
may be poorly tolerated because it causes postural hypotension
Clonidine, an α2-adrenergic agonist
191
may relieve
| diarrhea and urgency in patients with IBS diarrhea
5-HT3 receptor antagonists (e.g., alosetron, ondansetron
192
may induce sphincter of Oddi spasm and subsequent
| acute pancreatitis, usually in patients with prior cholecystectomy
eluxadoline
193
For all patients with chronic diarrhea, ___________
| is an important component of management
fluid and electrolyte repletion
194
___________ may also be necessary
| in patients with chronic steatorrhea
Replacement of fat-soluble vitamins
