Diarrhea

Question 1

Types

Answer 1

Osmotic = decreases w/ fasting
Secretory = continues despite fasting
Large bowel = small volume, frequent, bloody, pus
Small bowel = large, infrequent, watery

Question 2

Acute causes

Answer 2

Parasitic (giardia, cryptosporidiam, cyclospora, lsospora, amoebiasis)
Bacterial (campylobacter, salmonella, shigella, listeria, C diff, S aurea, clostridium perfrigens)
Viral (hep A, rotavirus, norovirus)
Travel (ETEC, norovirus, campylobacter, giardia)
Daycare (campylobacter, cryptosporidiua, parvum)
Hospital (c diff, norovirus, rotavirus)

Question 3

Chronic causes

Answer 3

Functional (IBS, overflow, incontinence)
Osmotic agents (lactose, sugars)
Inflammatory (IBD, microscopic or collagenous colitis)
Metabolic (Addisons, hyperthyroidism, uremia, CF)
Malabsorption (pancreatitis, celiac, short bowel syndrome)
Neoplastic (colorectal cancer, carcinoid tumor, gastrinoma, medullary thyroid cancer)
Iatrogenic (drugs, alcohol, caffeine, radiation)

Question 4

What to ask for in hx

Answer 4

Ask about infectious contacts, travel, recent abx use, meds, common eating places for multiple sick pts

recently admitted or recent use of abx

Question 5

Meds to avoid in c diff

Answer 5

Antimotility Agents
Opiods

Question 6

Most common cause of travelers diarrhoea

Answer 6

Enterotoxigenic Escherichia coli (ETEC)

Question 7

Management of travellers diarrhoea

Answer 7

Loperamide
Fluoroquinolones (ciprofloxacin, norfloxacin, ofloxacin, levofloxacin)
Macrolides (azithromycin)

Question 8

Which probiotics prevent diarrhea in pediatrics?

Answer 8

saccjaromyces + lactobacillus