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Clin Med GI > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

define tenesmus

A

painful rectal spasms with a strong urge to fefecate but little passage of stool

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2
Q

define dysentery

A

abdonimal pain, tenesmus and passage of bloody diarrhea

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3
Q

define hematochezia

A

passage of bright red bloody stools

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4
Q

what is acute diarrhea

A

diarrhea

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5
Q

most common cause of acute diarrhea

A

infectious

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6
Q

acute diarrhea can be divided into what two groups

A
  1. acute non inflammatory

2. acute inflammatory

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7
Q

what is non inflammatory diarrhea

A

watery, non bloody

associated with periumbilical cramps and bloating

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8
Q

severity of non inflammatory diarrhea

A

> 90% of cases are mild and self limiting

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9
Q

if N/V is associated with non inflammatory diarrhea - what does it suggest

A

small bowl source - disrupts normal absorption and secretory process in the small intestine

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10
Q

positive or negative fecal leukocytes in noninflammatory diarrhea

A

negative

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11
Q

causes of non inflammatory diarrhea

A
  1. viral: norovirus, rotabvirus
  2. protozoal: giardia, cryptosporidium, cyclospora
  3. bacterial: performed enterotoxin production: staph aureus, clostridium perfrigens
  4. bacterial: enterotoxin production: E.coli, vibrio cholerae
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12
Q

inflammatory diarrhea colonic tissue damage occurs why?

A

d/t bacterial invasion or toxin

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13
Q

other s/s of inflammatory diarrhea

A

fever, bloody/pus diarrhea d/t tissue damage

LLQ cramps, urgency, tenesmus

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14
Q

volume of stool in inflammatory diarrhea

A

small b/c these organisms involve the colon

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15
Q

positive or negative for fecal leukocytes in inflammatory diarrhea

A

positive

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16
Q

what other substance will be found in inflammatory diarrhea for testing

A

lactoferrin

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17
Q

causes of inflammatory diarrhea

A
  1. viral: CMV
  2. protozoal: entamoeba histolytica
  3. bacterial: cytotoxin: EHEC, Cdiff
  4. bacterial: mucosal invasion: shigella, campy, salmonella, Chlamydia, N. gonorrhoeae, listeria
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18
Q

non infectious causes of acute diarrhea

A 
IBD
IBS
celiac
lactose intolerance
colorectal cancer
diverticulitis
med side effect
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19
Q

mild dehydration

A

indicated by thirst, dry mouth, decreased sweat, decreased urine output, slight weight loss

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20
Q

moderate dehydration

A

orthostatic BP changes, skin tenting, sunken eyes

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21
Q

severe dehydration

A

lethargy, confusion, weak pulse, hypotension, shock

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22
Q

HR of dehydrated pt

A

increased

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23
Q

TEMP of dehydrated pt

A

high

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24
Q

BP of dehydrated pt

A

low

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25
weight of dehydrated pt
less than last visit
26
tx options of acute diarrhea
1. diet 2. rehydration** MAINSTAY 3. probiotics 4. antidiarrheal agents 5. antibiotics
27
diet tx for acute diarrhea
avoid high fiber, fats, milk products, caffeine and alcohol | BRAT diet
28
rehydration tx of acute diarrhea
fluid and electrolyte replacement - oral sugar-electrolyte solutions (sports drinks or designed formulations, pedialyte) - IV rehydration
29
antidiarrheal agents for tx of acute diarrhea
- used in mild to moderate diarrheal illnesses for symptomatic relief - do not use in pts with bloody diarrhea, high fever, or systemic toxicity - opioid agents (Loperamide - imodium) initially then 2mg after each loose stoll - bismuth subsalicylate (peptobismol)
30
antibiotic tx of acute diarrhea
- empiric tx NOT indicated for all pts 1. fluoroquinolones - oral drugs of choice 2. alternatives: TMP-SMX or doxycycline
31
when would you treat with specific antimicrobial treatment based on culture results
-recommended for shigellosis, cholera, extraintestinal salmonellosis, traveler's diarrhea, Cdiff, giardia and amebiasis
32
when is specific antimicrobial tx not recommended
Campylobacter, shigatoxin producing Ecoli, aeromonas, or yersinia -can increase toxin production
33
when to admit pt with acute diarrhea
1. severe dehydration for IV 2. bloody diarrhea that is severe or worsening 3. severe abdominal pain, worrisome for toxic colitis, IBD, intestinal ischemia, or surgical abdomen 4. signs of severe infection/sepsis 5. severe or worsening diarrhea in pts >70 or immunocompromised 6. signs of hemolytic uremic syndrome
34
infectious diarrhea prophylaxis
1. hand hygiene 2. travelers: eat only hot, freshly cooked food, avoid raw veggies/fruit 3. bismuth subsalicylate - prophylaxis 4. probiotic 5. prophylactic ABX - not recommended unless at high risk 6. vaccinations: rotavirus, S.typhi, and V cholerae
35
definition of chronic diarrhea
diarrhea that is present for >4weeks
36
cause of chronic diarrhea
most are non infectious
37
classifications of chronic diarrhea
1. secretory 2. osmotic 3. inflammatory 4. malabsorptive 5. motility 6. factitious 7. iatrogenic
38
what is secretory chronic diarrhea d/t?
d/t decreased fluid and electrolyte transport across the enterocolonic mucosa
39
s/s of secretory chronic diarrhea
watery, large volume stools that re painless, no change in symptoms with fasting
40
ex of secretory chronic diarrhea
1. microbial: giardia, Cdiff 2. s/p bowel resection, cholecystecomty, Crohn's (decreased mucosal surface for reabsorption - worsens with eating) 3. hormone producing tumors (carcinoid, gastrinomas, VIPoma, ZES) 4. laxative abuse
41
define diarrhea
passage of abnormally liquid or unformed stools at an increased frequency (>3/day)
42
osmotic causes of chronic diarrhea
d/t ingestion or malabsorption of an osmotically active substance
43
what will happen to stool volume during fasting in osmotic chronic diarrhea
decreases
44
when is an osmotic gap present in stool
osmotic chronic diarrhea - with fasting
45
most common causes of osmotic chronic diarrhea
carbohydrate malabsorption (lactose, fuctose), Mg containing antacids, or laxatives
46
what is the most common cause of chronic diarrhea in adults
lactase deficiency - leading to malabsorption of lactose
47
inflammatory chronic diarrhea s/s
presents with s/s of inflammation (abdominal pain, fever, weight loss, hematochezia
48
fecal leukocytes/lactoferrin in inflammatory chronic diarrhea
positive
49
ex. of inflammatory chronic diarrhea
1. IBD 2. microscopic colitis (secondary to meds) - statins, SSRI's, ARBs, PPIs, NSAIDS, metformin, allopurinol, stimulant laxatives, chronic ETOH 3. immunodeficiency 4. malignancy
50
malabsorption causes of chronic diearrhea
1. small mucosal intestinal dz (celiac, tropical sprue, Whipple dz, small bowel resection, Crohn's) 2. intestinal resections 3. lymphatic obstructions 4. pancreatic dz
51
s/s of malabsorption chronic diarrhea
weight loss, steatorrhea (greasy, foul smelling), and nutritional deficiencies
52
stool labs for malabsorption chronic diarrhea
positive fecal fat | osmotic gap present in stool
53
what is the most common cause of chronic diarrhea in young adults
IBS
54
what conditions cause rapid transit of bowels for motility disorders
hyperthyroidism carcinoid syndrome certain drugs
55
what surgeries can cause post surgical motility disorders of GI
vagotomy, partial gastrectomy, partial colectomy
56
factitious causes of chronic diarrhea
1. 15% unexplained 2. Munchausen's syndrome (deception or self injury for secondary gain) 3. eating disorders - laxative abuse
57
what symptoms warrant further evaluation when working up a patient for chronic diarrhea
1. noctural diarrhea 2. weight loss 3. anemia 4. positive FOBT
58
meds for chronic diarrhea: loperamide
mild opiate, used in mild to moderate diarrhea
59
meds for chronic diarrhea: diphenoxylate with atropine
mild opiate, used in mild to moderate diarrhea
60
meds for chronic diarrhea: codeine and deodorized tincture of opium
used in severe diarrhea
61
meds for chronic diarrhea: clonidine
alpha-2-adrenergic agonist that inhibits intestinal electrolyte secretion
62
meds for chronic diarrhea: cholestyramine
bile salt binding resin used in pts with bile salt induced diarrhea (s/p resection)

Clin Med GI (3 decks)

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