Diarrhea

Question 1

what constitutes diarrhea? (2)

Answer 1

increased stool frequency over 3x per day
OR
loose/watery stools

Question 2

what is the most common cause of acute diarrhea in adults?

Answer 2

infectious

Question 3

diarrhea for 14 days or fewer

Answer 3

acute

Question 4

diarrhea for more than 14 days but less than 30 days

Answer 4

persistent

Question 5

diarrhea for more than 30 days

Answer 5

chronic

Question 6

what will be different between inflammatory and noninflammatory diarrhea?

Answer 6

inflammatory diarrhea results in bloody stools, fecal leukocytes, and fevers

Question 7

what is the most common cause of nausea, vomiting, and diarrhea in the US?

Answer 7

viral gastroenteritis

Question 8

what is the most common cause of the stomach flu?

Answer 8

norovirus

Question 9

what virus is most likely found in infants and young kids?

Answer 9

rotaviruses

Question 10

protozoa found in untreated water while camping with beavers, spreads quickly within families

Answer 10

giardia

Question 11

protozoa found in untreated water while camping, affecting immune suppressed individuals

Answer 11

cryptosporidium

Question 12

preformed enterotoxin found in meats eggs, diary products; causes N/V, diarrhea, and cramping

Answer 12

staph aureus

Question 13

preformed enterotoxin found in starchy foods left at room temperature

Answer 13

bacillus cereus

Question 14

preformed enterotoxin found in beef, poultry, and gravy; causes diarrhea and cramping

Answer 14

clostridium perfringes

Question 15

enterotoxin found in undercooked ground beef, unpasteurized milk/juice, and water. causes diarrhea and cramping.

Answer 15

E. coli

Question 16

enterotoxin found in fecal contamination of food and water; causes profuse watery diarrhea (rice-water stools)

Answer 16

vibrio cholerae

Question 16

virus that is more common in immunocompromised patients

Answer 16

cytomegalovirus

Question 16

parasite from untreated water

Answer 16

entamoeba hystolytica

Question 17

found in contaminated oysters or shellfish with onset of 2-24 hours

Answer 17

vibrio parahaemolyticus

Question 18

opportunistic infection when normal flora has been reduced, caused by antibiotic usage

Answer 18

C. difficile

Question 19

found in sandwiches, salads, and raw food that come into contact with infected person

Answer 19

shigella

Question 20

causes fever, stiff neck, confusion and vomiting

Answer 20

listeria

Question 21

what 6 labs should be ordered for acute diarrhea?

Answer 21

CBC/CMP
stool leukocytes/culture
stool assay for C. diff
PCRs

Question 22

what diagnostic should be ordered for acute diarrhea that is present over 10 days?

Answer 22

stool O&P

Question 23

what 4 S&S indicate dehydration?

Answer 23

tachycardia hypotension orthostatic hypotension dry mucous membranes

Question 24

what 3 S&S indicate inflammatory disease?

Answer 24

fever bloody stools severe abd pain/tenderness

Question 25

what is the treatment for acute diarrhea? (2)

Answer 25

BRAT diet + hydration loperamide: only for mild-moderate probiotics

Question 26

for acute diarrhea, when should empiric antibiotics be considered? (7)

Answer 26

fever > 6 stools/day bloody stools immunocompromised pts clinical dehydration > 70 yo comorbidities

Question 27

what are the empiric antibiotics that can be used?

Answer 27

azithromycin x 3 days ciprofloxacin x 3-5 days

Question 28

increased stool frequency of more than 3/day, stool weight over 200 g/day, and decreased fecal consistency over a 4-week period

Answer 28

chronic diarrhea

Question 29

what is the most common cause of osmotic diarrhea (increased stool osmotic gap)?

Answer 29

malabsorption syndromes

Question 30

characterized by abdominal distention, bloating, and flatulence d/t increased gas production

Answer 30

malabsorption of carbs

Question 31

how to diagnose malabsorption syndrome? (2)

Answer 31

elimination trial x 2-3 weeks hydrogen breath test

Question 32

high volume of stool, with normal stool osmotic gap

Answer 32

secretory diarrhea

Question 33

what causes secretory diarrhea? (2)

Answer 33

endocrine tumors bile salt malabsorption

Question 34

what is the most common cause of chronic diarrhea in young adults?

Answer 34

IBS

Question 35

abnormal motility and malabsorption without pain or abnormal findings

Answer 35

functional diarrhea

Question 36

what inflammatory processes cause chronic diarrhea? (2) what symptoms present? (2)

Answer 36

ulcerative colitis crohn disease blood pus

Question 37

what lab is recommended for signs of malabsorption?

Answer 37

IgA-tTG

Question 38

what positive test suggests malabsorption?

Answer 38

fecal fat

Question 39

what diagnostic is recommended to rule out IBD and cancers?

Answer 39

colonoscopy w/ mucosal biopsy

Question 40

what diagnostic is recommended for suspected small intestinal malabsorption conditions?

Answer 40

upper endoscopy

Question 41

what are 4 antidiarrheal options for chronic diarrhea?

Answer 41

loperamide codeine + opium clonidine octreotide

Question 42

what med can be used for secretory diarrhea?

Answer 42

octreotide

Question 43

diarrhea beginning 2-10 days into travel; commonly a bacterial infection

Answer 43

traveler's diarrhea

Question 44

what are 3 most common etiologies of traveler's diarrhea?

Answer 44

E. coli shigella campylobacter

Question 45

a patient presents with 7-10 stools/day, abdominal cramping, and nausea +/- vomiting. Dx?

Answer 45

traveler's diarrhea

Question 46

what is the treatment for mild traveler's diarrhea? (3)

Answer 46

hydration bismuth subsalicylate loperamide (use caution)

Question 47

what is the treatment for moderate-severe traveler's diarrhea? (3)

Answer 47

hydration *+/- antibiotics if fever, bloody stools, or worsening abdominal pain:* **azithromycin x 3 days** OR **ciprofloxacin x 3-5 days**