Diarrhea Flashcards
Diarrhea
Increase in the frequency or decrease in the consistency of bowel movements
Stool mass is the best gauge of diarrhea
What is the best gauge of diarrhea?
Stool mass
> 250 grams
70-95% water
2 times per day
Chronic diarrhea
> 30 days
Acute diarrhae
<14 days
Persistent diarrhea
> 14
Osmotic diarrhea
Occurs when the intraluminal water load exceeds the absorptive capacity of the GI tract
Ingestion of nonabsorbable or poorly absorbed solutes
Ingestion of selected foods
Failure to transport osmotically active dietary factors
What are the characteristics of osmotic diarrhea?
Reduces with fasting
Stool volume is <1L
Osmotic gap: (Na + K) x 2 >50 mOsm
What are exogenous reasons for osmotic diarrhea?
Laxatives
Antacids
Artificial sugars
Medications
What are endogenous reasons for osmotic diarrhea?
Congenital
Generalized
Acquired
What are acquired reasons for osmotic diarrhea?
Post-enteritis disaccharide deficiency
Pancreatic insufficiency
What are congenital reasons for osmotic diarrhea?
Disaccharide deficiency (lactase) Glucose-galactose or fructose
Lactose intolerance is an example of which type of diarrhea?
Osmotic
What is a classic example of small bowel malabsorption?
Celiac sprue
Autoimmune intolerance to gluten
How do you dx celiac sprue?
Serology
- anti-endomysial Ab with normal IgA
- anti-tissue tansflutaminase Ab
Small bowel biopsy
-blunted or absent small bowel villi (proximal > distal)
What are the sxs of celiac?
Based on extent of small bowel involvement
Malabsorption causes diarrhea, steatorrhea, weight loss
What are the complications of celiac sprue?
Ulcerative jejunoileitis
Collagenoous sprue
Lymphoma
Oropharyngeal, esophageal and small bowel cancer
Whipple’s Disease
Infection with the Whipple bacillus - Tropheryma Whippellii
Diarrhea, weight loss, abdominal pain
Migratory, non destructive arthraligia
Fever, lymphadenopathy
Pericarditis, endocarditis
Dementia
What is the treatment for Whipple’s disease?
Bactrim bid x 1 year
Secretory diarrhea
Active intestinal secretion or inhibition of ion absorption with concomitant flow of water
- infectious
- neoplastic
- misc.
What are the characteristics of secretory diarrhea?
No osmotic gap
Small bowel morphology is usually normal
Can come from inside or outside the gastrointestinal tract
Persists during fasting
Cholera
Secretory diarrhea
Sxs: severe diarrhea —volume depletion, dehydration, acidosis, death
4-7 day course with 50% mortality
It’s not that the infection itself causes sepsis —its the volume depletion that leads to acidosis
Epi of IBS
1 in 6 people
W > M (2 fold)
Chronic (12 weeks out of the year)
Everything is normal ….normal labs, etc.
Irregular peristalsis
Exudative diarrhea
Results from disruption of integrity of intestinal mucosa due to inflammation
Loss of proteins, blood, mucus, and pus
Fecal water and electrolytes are high
What are causes of exudative diarrhea?
Infectious
-salmonella, shigella, campylobacter, entamoeba
Inflammatory bowel disease
- ulcerative colitis
- chrons disease
Misc.
- radiation
- ischemia
