Diarrhea Flashcards
(111 cards)
1
Q
increased stool frequency, liquidity, or volume
A
Diarrhea
2
Q
before interpreting diarrhea, It is mandatory to know the individual’s ……….
A
normal bowel habits
3
Q
normal bowel habits frequency
A
3 times/day – once/3 days
4
Q
Frequency <2 weeks
A
Acute diarrhea
5
Q
usually infectious but occasionally is due to drugs or a first presentation of inflammatory bowel disease
A
Acute diarrhea
6
Q
Frequency >4 weeks
A
Chronic/relapsing diarrhea
7
Q
may reflect colorectal cancer or inflammatory bowel disease, but the most frequent cause is irritable bowel syndrome
A
Chronic/relapsing diarrhea
8
Q
Large stool volume is a sing of ………
A
Small intestine disease
9
Q
Rare mucus in feces
A
Small intestine disease
10
Q
Blood in feces is unusual
A
Small intestine disease
11
Q
Sometimes there is fat in feces this is a sing of ………
A
Small intestine disease
12
Q
Variable feces color is a sing of ………
A
Small intestine disease
13
Q
Undigested food is occasionally in
A
Small intestine disease
14
Q
Tenesmus defecation is rare in
A
Small intestine disease
15
Q
Frequency of defection is 2-3 times per day is in
A
Small intestine disease
16
Q
Urgency defecation is uncommon in
A
Small intestine disease
17
Q
Sometimes there is vomiting in patients with
A
Small intestine disease
18
Q
Weight loss is a common sing of ………
A
Small intestine disease
19
Q
Small stool volume is a sing of ………
A
Large intestine disease
20
Q
Mucus in feces is a common sing of ………
A
Large intestine disease
21
Q
Fat in feces is absent in
A
Large intestine disease
22
Q
Feces color is normal in
A
Large intestine disease
23
Q
Undigested food in feces is absent in
A
Large intestine disease
24
Q
Defecation Tenesmus is common a sing of ………
A
Large intestine disease
25
Frequency of defecation is >3 times per day is a sing of ………
Large intestine disease
26
Defecation urgency is common in
Large intestine disease
27
Vomiting is uncommon in
Large intestine disease
28
Weight loss is rare in
Large intestine disease
29
an abnormality in absorption of food nutrients across the gastrointestinal (GI) tract
Malabsorption
30
Impairment can be of …….. nutrients depending on the abnormality
single or multiple
31
Diarrhea and weight loss in patients with a normal diet is likely to be caused by …….
malabsorption
32
Bulky, pale and offensive stools which float in the toilet
It signify fat malabsorption
Steatorrhea
33
Steatorrhea signify ………
fat malabsorption
34
Pallor in anemic patient
Sign of malabsorption of iron
35
Angular stomatitis
Sign of malabsorption of vitamin B2 (riboflavin) + other vitamins B + iron
36
Glossitis
Sign of malabsorption of vitamin B2 (riboflavin) + other vitamins B + iron
37
Bleeding gum
Sign of malabsorption of vitamin C
38
follicular hyperkeratosis
Sign of malabsorption of vitamin A
39
Koilonychias
Sign of malabsorption of iron
40
Muscle wasting
Sign of malabsorption of protein
41
Leg edema
Sign of malabsorption of protein
42
Clubbing
Sign of malabsorption
43
pathophysiologic mechanisms of diarrhea include (4)
• Osmotic
• Secretory
• Inflammatory
•Altered motility
44
Osmotic
pathophysiologic mechanism of diarrhea
45
Secretory
pathophysiologic mechanism of diarrhea
46
Inflammatory
pathophysiologic mechanism of diarrhea
47
Altered motility
pathophysiologic mechanism of diarrhea
48
in most of the cases the pathophysiologic mechanism of diarrhea is
multifactorial
49
involves an unabsorbed substance that draws water from the plasma into the intestinal lumen along osmotic gradients
Osmotic diarrhea
50
results from disordered electrolyte transport
Secretory diarrhea
51
diarrhea with exudative, secretory, or osmotic components
Diarrhea caused by Inflammatory diseases
52
may alter fluid absorption by increasing or decreasing the exposure of luminal content to intestinal absorptive surface
Altered motility of the intestine or colon
53
Bloody Diarrhea
Either ……… or ………
INFECTIVE
NON-INFECTIVE
54
INFECTIVE diarrhea
Invasive organisms
Cytotoxic organisms
55
Cytotoxic organisms
INFECTIVE Diarrhea
56
Invasive organisms
INFECTIVE Diarrhea
57
Campylobacter
Invasive organisms
58
Shigella
Invasive organisms
59
Amoeba
Invasive organisms
60
C. difficile
Cytotoxic organisms
61
E. coli O157
Cytotoxic organisms
62
When patients with infective diarrhea
What to do
Send CBC, CRP
Take three stool samples in all patients
blood cultures if fever is present.
63
Test stool for ………. if the patient has risk factors
(lives nursing home, recently hospitalized, received antibiotics within the last 3 months or is >65 years. In high-risk patients send ≥3 samples before ruling out the diagnosis.)
C. difficile toxin (CDT)
64
Test stool for ………. if the patient has severe systemic upset
C. difficile toxin (CDT)
65
Test stool for ………. if the patient has ↑↑WBC
C. difficile toxin (CDT)
66
Request analysis of stool for ova, cysts and parasites in patients with ……. Or when …….
history of recent foreign travel
suspect immune compromised state
67
Ischemic colitis
NON-INFECTIVE
68
inflammatory diarrhea
NON-INFECTIVE
69
NON-INFECTIVE
Ischemic colitis
or inflammatory diarrhea
70
bloody diarrhea is preceded by sudden onset of LLQ abdominal pain or in any patient >50 years with known atherosclerotic disease or a source of systemic embolism e.g. atrial fibrillation
ischemic colitis
71
In ischemic colitis Check for ….. (3)
ECG, CT Angio, Colonoscopy
72
Patient without risk factors of ischemic colitis may has
inflammatory cause
e.g. Inflammatory Bowel Disease (IBD)
73
In inflammatory cause diarrhea
e.g. Inflammatory Bowel Disease (IBD)
Check …… (2)
Refer to …….
Stool for leukocytes and leukocyte proteins
inflammatory markers: CRP and ESR
colonoscopy for histological confirmation and assess the disease severity
74
calprotectin or lactoferrin
Check Stool for leukocytes and leukocyte proteins
75
Non bloody diarrhea (3)
Protozoal infection
Gastroenteritis
Drug-related diarrhea
76
Protozoal infection
Non bloody diarrhea
77
Gastroenteritis
Non bloody diarrhea
78
Most cases are self-limiting viral or toxin mediated infections and do not require further investigation or antimicrobial treatment
Gastroenteritis
79
Gastroenteritis
If symptoms persist ……….. , seek specialist advice and consider further assessment as for
>14 days
chronic/relapsing diarrhea
80
Drug-related diarrhea
Non bloody diarrhea
81
*Laxatives (including occult laxative abuse)
cause Drug-related diarrhea
82
* Antibiotics (especially macrolides)
Can cause Drug-related diarrhea
83
* Alcohol (especially chronic/excess)
Can cause Drug-related diarrhea
84
* NSAIDs
Can cause Drug-related diarrhea
85
*Proton pump inhibitors
Can cause Drug-related diarrhea
86
* Cytotoxic agents
Can cause Drug-related diarrhea
87
Metformin
Can cause Drug-related diarrhea
88
Colchicine
Can cause Drug-related diarrhea
89
Orlistat
Can cause Drug-related diarrhea
90
SSRIs
Can cause Drug-related diarrhea
91
Nicorandil
Can cause Drug-related diarrhea
92
high index of suspicion for overflow diarrhea in frail, immobile or confused elderly patients
Always do ……..
PR examination
93
Hard or impacted stool in rectum
Always do ………
PR examination
94
If hard or impacted stool found, treat with …….. , then ………
fecal softeners and laxatives
reassess
95
If the PR is normal, ………..
but consider an ………. if there is strong clinical suspicion
overflow diarrhea is unlikely
abdominal X-ray
96
If steatorrhea is present
Ensure that the patient is not taking ………..
Check ………. and ………
orlistat
celiac serology (AntiTTG) and faecal elastase
97
↓in pancreatic insufficiency
faecal elastase
98
steatorrhea is present
If ↓fecal elastase or a strong suspicion of pancreatic disease, consider ………
pancreatic imaging (CT/MRCP)
99
steatorrhea is present
If AntiTTG is +ve
Duodenal biopsy to confirm celiac disease
100
to confirm celiac disease
Duodenal biopsy
101
steatorrhea is present
If all other possibility were excluded do (2)
small bowel investigation
Screen for nutritional deficiencies
102
e.g. duodenal biopsy, video capsule, MRI
small bowel investigation
103
Consider colonoscopy, to exclude
colorectal cancer/inflammatory bowel disease
104
if the patient has persistent diarrhea with any of the following:
•PR bleeding
•palpable rectal/abdominal mass •weight loss
•iron deficiency anemia
•new presentation in a patient >45 years.
Do …..
colonoscopy
to exclude colorectal cancer/inflammatory bowel disease
105
With Alarm features (5)
•PR bleeding
•palpable rectal/abdominal mass •weight loss
•iron deficiency anemia
•new presentation in a patient >45 years.
106
Clinical or laboratory features suggesting organic disease
Screen for hyperthyroidism, hypercalcemia and celiac disease
Refer to GI for further small bowel investigation
107
if large volume, non-bloody stool, previous gastric/small bowel surgery or evidence of nutritional deficiencies
Refer to GI for further small bowel investigation
108
if there is a positive family history, mouth ulcers, fever, ↑CRP/ESR or extra-intestinal manifestations
Exclude inflammatory bowel disease
109
If no Hard or impacted stool in rectum, Steatorrhea, Alarm features, and Clinical or laboratory features suggesting organic disease
So it’s…….
functional cause
110
irritable bowel syndrome, particularly when typical symptoms are present
Is example of …..
functional cause
111
If patient is with functional cause diarrhea provide ……..
If symptoms progressive distressing or disabling, ………
reassurance and explanation +/- symptomatic Rx
Refer to GI
