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MC > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

_______ is defined as an intestinal disorder
characterised by abnormal frequency and liquidity of
faecal evacuations

A

Diarrhoea

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2
Q

In Australia most infective cases of diarrhea are _____

A

viral

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3
Q

Disorders of the ______ tend to produce
diarrhoea stools that are copious, watery or fatty,
pale yellow or green

A

upper GIT

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4
Q

______ tends to produce stools that are
small, of variable consistency, brown and may
contain blood or mucus

A

Colonic disorder

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5
Q

T or F

Acute gastroenteritis should be regarded as a
diagnosis of exclusion

A

T

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6
Q

Chronic diarrhoea is more likely to be due to

_______than bacillary dysentery

A 
protozoal infection (e.g. amoebiasis, giardiasis or
Cryptosporidium )
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7
Q

Certain antibiotics can cause an overgrowth
of Clostridium difficile, which produces
__________

A

pseudomembranous colitis

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8
Q

Diarrhoea can be classified broadly into

4 types:

A

— acute watery diarrhoea
— bloody diarrhoea (acute or chronic)
— chronic watery diarrhoea
— steatorrhoea

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9
Q

Red flag pointers for diarrhoea

A
  • Unexpected weight loss
  • Persistent/unresolved
  • Fever
  • Overseas travel
  • Severe abdominal pain
  • Family history: bowel cancer, Crohn disease
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10
Q

Important causes of chronic infectious diarrhea

A

Giardia lamblia, C. difficile, Yersinia, Entamoeba

histolytica, Cryptosporidium and HIV infection

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11
Q

In children, ________can present as chronic diarrhoea while intussusception, although not causing true diarrhoea, can present as loose, redcurrant jelly-like stools and should not be misdiagnosed (as gastroenteritis

A

coeliac disease and fibrocystic disease

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12
Q

Infection with enterohaemorrhagic strains
of E. coli (e.g. O157:H7, O111:H8) may lead to
the _____ or ______ particularly in children.

A

haemolytic uraemic syndrome or thrombotic

thrombocytopenic purpura,

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13
Q

Death cap mushroom (the world’s most lethal)—
_________ —causes severe
gastroenteritis followed by delayed hepatic failure
and AKF

A

Amanita phalloides

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14
Q

General pitfalls
• Not considering acute appendicitis in acute
diarrhoea—can be _______
• Missing _______ with spurious diarrhoea
• Failing to consider _________ in an
elderly patient with the acute onset of bloody
diarrhoea stools (following sudden abdominal
pain in preceding 24 hours)

A

retrocaecal or pelvic appendicitis

faecal impaction

acute ischaemic colitis

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15
Q

This colitis can be caused by the use of any antibiotic,
especially clindamycin, lincomycin, ampicillin and
the cephalosporins (an exception is vancomycin

A 
Pseudomembranous colitis (antibioticassociated
diarrhoea
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16
Q

Cause of Pseudomembranous colitis

A

overgrowth of C. difficile, which
produces a toxin that causes specific inflammatory
lesions, sometimes with a pseudomembrane

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17
Q

Character of Pseudomembranous colitis

A

• Within 2 days of taking antibiotic (can start up to
4 to 6 weeks after usage)
• Persists 2 weeks (up to 6) after ceasing antibiotic

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18
Q

Mx of Pseudomembranous colitis

A

Cease antibiotic
Mild to moderate: metronidazole 400 mg (o) tds
for 10 days
Severe: vancomycin 125 mg (o) qid for 10 days
(in consultation with specialist

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19
Q

The________ which is a
very common condition, may reflect underlying
psychological factors and most patients find that
the symptoms are exacerbated by stress

A

irritable bowel syndrome,

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20
Q

In children chronic diarrhoea can occur with the socalled
______ characterised
by growth and developmental retardation due to
adverse psychosocial factors

A

‘maternal deprivation syndrome’,

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21
Q

Central colicky abdominal pain indicates involvement
of the _____, while lower abdominal pain points
to the_____

A

small bowel

large bowel

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22
Q

If small volume, consider ________

of colon; if large volume, consider ______

A

inflammation or carcinoma

laxative abuse and
malabsorption

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23
Q

If there is profuse bright red bleeding, consider
____________, and if small
amounts with mucus or mucopus consider
______

A

diverticulitis or carcinoma of colon

inflammatory bowel disorder

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24
Q

In______ the stools are distinctively pale,
greasy, offensive, floating and difficult to flush. It is
exacerbated by fatty foods.

A

steatorrhoea

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25
Q

______stool is characteristic of cholera and

_______ stool of typhoid fever.

A

‘Rice water’

‘pea soup’

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26
Q

Loose with bits of faeces

Watery, offensive, bubbly ____

Liquid or semiformed, mucus ± blood_____

Bulky, pale, offensive ______

Pellets or ribbons ____

A

Colonic disorder

Giardia lamblia infection

Entamoeba histolytica

Malabsorption

Irritable bowel syndrome

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27
Q 
China clay \_\_\_\_\_\_\_
Black stool \_\_\_\_\_
Pea soup \_\_\_\_\_\_\_
Rabbit pellets \_\_\_\_\_\_
Redcurrant jelly\_\_\_\_\_\_\_\_
Rice water \_\_\_\_\_\_
Silver stool \_\_\_\_\_\_
Toothpaste \_\_\_\_\_\_
A 
Obstructive jaundice
Melaena (blood) in faeces
Typhoid fever
Irritable bowel syndrome
 Intussusception
Cholera
Carcinoma of ampulla of Vater
Hirschsprung disease
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28
Q

It must be emphasised that______are never indicated for management of acute
diarrhoea in infants and children

A

antimotility

drugs

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29
Q

Common causes of malabsorption syndromes

A

coeliac disease, chronic pancreatitis and postgastrectomy

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30
Q

Vitamin deficiencies associated with malabsorption

A

ADEK

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31
Q

What type of anemia associated with malabsorption

A

Hypochromic or megaloblastic anaemia

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32
Q

What is the pathology causing malabsorption

Gluten-sensitive enteropathy (coeliac disease)
Tropical sprue
Lactose intolerance (lactase deficiency)
Crohn disease (regional enteritis)
Whipple disease
Parasite infections (e.g. Giardia lamblia)
Lymphoma

A

Primary mucosal disorders

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33
Q

Non-GIT presentation of Celiac disease

A

tiredness.

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34
Q

diarrhoea, weight loss, iron/folate deficiency, abdominal bloating

Diarrhoea with constipation (alternating)

Pale and thin patient

No subcutaneous fat

A

Coeliac disease

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35
Q

Celiac disease

Characteristic duodenal biopsy: ____
(key test

A

villous atrophy

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36
Q

Ab testing in Celiac disease

• _______ (screening—limited)
• _______ (>90% sensitivity and specificity
_________ (>90% sensitivity and specificity)

A

IgA antigliadin antibodies

IgA anti-endomysial antibodies

IgA transglutaminase antibodies

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37
Q 
Associations of Celiac dse
1
2
3
4
5
6
7
8
9
10
11
12
A 
• Iron-deficiency anaemia
• Type 1 diabetes
• Pernicious anaemia
• Primary biliary cirrhosis
• Subfertility
• Malignancy, especially lymphoma
• Dermatitis herpetiformis
• IgA deficiency
• Autoimmune thyroid disease
• Osteoporosis
• Neurological (e.g. seizures, ataxia, peripheral
neuropathy)
• Down syndrome
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38
Q

What type of diet in Celiac disease

A

high complex carbohydrate and
protein, low fat, gluten-free (no wheat, barley,
rye and oats)

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39
Q

What vaccination in Celiac

A

Give pneumococcal vaccination (increased risk of

pneumococcus sepsis)

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40
Q

This is a rare malabsorption disorder usually affecting

white males. It may involve the heart, lungs and CNS.

A

Whipple disease

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41
Q

Causative agent of Whipple disease

A

It is caused by the bacillus Tropheryma

whipplei.

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42
Q

Type of Arthralgia in Whipple

A

Arthralgia (migratory seronegative arthropathy

mainly of peripheral joints

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43
Q

Dx of Whipple

A
  • PCR for T. whipplei

* Jejunal biopsy—stunted villi

44
Q

Tx of Whipple

A

IV ceftriaxone for 2 weeks then cotrimoxazole or

tetracycline for up to 12 months

45
Q

This is due to atheromatous occlusion of mesenteric

vessels (low blood flow)

A

Ischaemic colitis

46
Q

PE of ischemic colitis

A

maybe loud bruits over central abdomen

• other evidence of generalised atherosclerosis

47
Q

Barium enema of ischemic colitis

A

‘thumb printing’ sign due

to submucosal oedema

48
Q

Definitive test for ischemic colitis

A

the definitive test is aortography and selective

angiography of mesenteric vessels

49
Q

MC cause of diarrhea in children

A

infective gastroenteritis and antibiotic-induced diarrhoea

50
Q

__________from gastroenteritis is an
important cause of death, particularly in obese infants
(especially if vomiting accompanies the diarrhoea

A

Dehydration

51
Q

It is an illness of acute onset, of less than 10 days’
duration associated with fever, diarrhoea and/or
vomiting, where there is no other evident cause for
the symptoms

A

Acute gastroenteritis

52
Q

AGE causes

Mainly \_\_\_\_\_\_ (developed countries) and
\_\_\_\_\_\_: viruses account for about 80%
A

rotavirus

adenovirus

53
Q

MC bacterial causes

Bacterial: _____________. (two
commonest), E. coli and Shigella sp.

A

C. jejuni and Salmonella sp

54
Q

Diarrhoea often follows acute gastroenteritis when

milk is reintroduced into the diet

A

Sugar/CHO/Lactose intolerance

55
Q

Character of stools for Lactose intolerance

A

Stools may be watery, frothy,
smell like vinegar and tend to excoriate the buttocks.
They contain sugar.

56
Q

Study management of acute diarrhea in children

A

Okay

57
Q

Simple test for glucose intolerance

A

Line the napkin with thin plastic and collect fluid
stool.
• Mix 5 drops of liquid stool with 10 drops of water
and add a Clinitest tablet (detects lactose and
glucose but not sucrose).
• A positive result indicates sugar intolerance.

58
Q

dx of lactose intoleranc

A

lactose breath hydrogen test

59
Q

A clinical syndrome of loose, bulky, non-offensive
stools with fragments of undigested food in a well,
thriving child. The onset is usually between 8 and 20
months. Associated with high fructose intake (fruit
juice diarrhoea).

A

Toddler’s diarrhoea

60
Q

This is not as common as lactose intolerance.
Diarrhoea is related to taking a cow’s milk formula
and relieved when it is withdrawn

A

Cow’s milk protein intolerance

61
Q

These disorders, which include Crohn disease and

ulcerative colitis, can occur in childhoo

A

Inflammatory bowel disorders

62
Q

Organisms for chronic enteric infection

A

Responsible organisms include Salmonella sp.,

Campylobacter, Yersinia, G. lamblia and E. histolytica.

63
Q

____________– can

mimic coeliac disease.

A

Giardiasis

64
Q

The symptoms are usually as above but very severe
diarrhoea, especially if associated with blood or mucus,
may be a feature of a more serious bowel infection such
as amoebiasis

A

Traveller’s diarrhoea

65
Q

Most traveller’s
diarrhoea is caused by ______, which produces a watery
diarrhoea within 14 days of arrival in a foreign
country.

A

E. coli

66
Q

Any traveller with persistent diarrhoea after visiting
less developed countries, especially India and China,
may have a protozoal infection such as ____ and ________—-

A

amoebiasis or

giardiasis

67
Q

_______ is characterised
by abdominal cramps, flatulence and bubbly, foulsmelling
diarrhoea.

A

Giardiasis

68
Q

MX of diarrhea in adults

How to hydrate (moderate)

A

use oral rehydrate solution 2–3 L orally

over 24 hours if mild to moderate dehydration

69
Q

How to hydrate severe dehydration

A

intravenous rehydration with N saline is

recommended

70
Q

Abx for Shigella dysentery (moderate to severe

A

Cotrimoxazole (double strength) 1 tab (o) 12 hourly
for 5 days: use in children (children’s doses)
or
norfloxacin 400 mg (o) 12 hourly for 5 days
(preferred for adults)
or
ciprofloxacin 500 mg (o) bd for 5 days

71
Q

Abx for Giardiasis

A

Tinidazole 2 g (o), single dose (may need repeat)
or
metronidazole 400 mg (o) tds for 7 days
(in children: 30 mg/kg/day [to max. 1.2 g/day] as
single daily dose for 3 days)

72
Q

T or F

Salmonella enteritis
Antibiotics are not generally advisable but if severe or
prolonged use:

A

T

73
Q

Abx for Salmonella enteritis

A

ciprofloxacin 500 mg (o) bd for 5–7 days
or
azithromycin 1 g (o) day, then 500 mg for 6 days
or
ceftriaxone IV or ciprofloxacin IV if oral therapy
not tolerated

74
Q

Salmonella is a notifiable disease; infants
under____________are at risk of invasive Salmonella
infection

A

15 months

75
Q

A zoonosis that is usually self-limiting.
Antibiotic therapy indicated in severe or prolonged
cases

A

Campylobacter

76
Q

Abx for Campylobacter

A

azithromycin 500 mg (o) 12 hourly for 3 days
or

ciprofloxacin 500 mg (o) 12 hourly for 3 days
or

norfloxacin 400 mg (o) 12 hourly for 5 days

77
Q

Usually self-limiting, may need fluid and electrolytes
and anti-motility agents.
If severe, nitazoxamide

What organism?

A

Cryptosporidium species

78
Q

Pathogenicity is disputed: give therapy only if severe.
Associated with poor hygiene (travel, pets, dam/tank
water, oysters).

A

Blastocystitis hominis (a parasitic infection

79
Q

Mx of Blastocystitis hominis (a parasitic infection

A

metronidazole for 7 days

80
Q

Abx for typhoid/paratyphoid fever

A

azithromycin 1 g (o) daily for 7 days
or
(if not acquired in the Indian subcontinent or SE
Asia)
ciprofloxacin 500 mg (o) 12 hourly for 7–10 days
(use IV if oral therapy not tolerated)

81
Q

If ciprofloxacin is contraindicated (e.g. in children)

or not tolerated, then use:

A

ceftriaxone 3 g IV daily until culture and

sensitivities available, then choose oral regimens

82
Q

Tx of Cholera

A

azithromycin 1 g (child 20 mg/kg up to 1 g)(o) as
a single dose
or
ciprofloxacin 1 g (o) as a single dose

83
Q

Tx of Cholera For pregnant women and children

A

amoxycillin (child: 10 mg/kg up to) 250 mg (o)

6 hourly for 4 days

84
Q

Ulcerative colitis

Begins in rectum (continues proximally)—affects
only the colon: it usually does not spread beyond
______

A

the ileocaecal valve

85
Q

Ulcerative colitis

increased risk of carcinoma after _____

A

7–10 years

86
Q

Dx of Ulcerative colitis

________: a sensitive test

_________: a granular red proctitis
with contact bleeding

Barium enema: characteristic changes

A

Faecal calprotectin

Proctosigmoidoscopy

87
Q

Prognosis of UC

A
  • 5% mortality in an acute attack

* Recurrent attacks common

88
Q

regional enteritis, granulomatous colitis.

The cause is unknown but there is a genetic link.

A

Crohn disease

89
Q

Signs of Crohn disease

A

Signs include perianal disorders (e.g. anal fissure,

fistula, ischiorectal abscess), mouth ulcers

90
Q

Describe skip areas of crohns

A

Skip areas in bowel: ½ ileocolic, ¼ confined to

small bowel, ¼ confined to colon, 4% in upper GIT

91
Q

Sigmoidoscopy findinfs Crohn disease

A

‘cobblestone’ appearance (patchy

mucosal oedema)

92
Q

_____: useful to differentiate from UC

A

Colonoscopy

93
Q

Tx for UC

________mainly UC): sulfasalazine (mainstay), olsalazine, mesalazine

— corticosteroids (mainly for acute flares): oral, parenteral, topical (rectal foam, suppositories or enemas)

— for severe disease, ___ and ____

A

5-aminosalicylic acid derivatives (

immunomodifying drugs (e.g. azathioprine, cyclosporin, methotrexate) and biological agents (e.g. infliximab

94
Q

Alternating diarrhoea and constipation are wellknown

symptoms of_____ and _____

A

incomplete bowel obstruction
(cancer of colon and diverticular disease) and irritable
bowel syndrome

95
Q

Dx criteria for IBS

In the preceding 3 months, the patient has had abdominal discomfort for at least 3 days per month with two of the following three features:

1
2
3

A 
• relieved by defecation
• onset associated with a change in stool frequency
• onset associated with a change in form (appearance)
of stool (loose, watery or pellet-like)
96
Q

Red flag pointers for non-IBS disease

A
  • Age of onset >50 years
  • Fever
  • Unexplained weight loss
  • Rectal bleeding
  • Pain waking at night
  • Persistent daily diarrhoea/steatorrhoea
  • Recurrent vomiting
  • Major change in symptoms
  • Mouth ulcers
  • ↑ CRP, ESR
  • Anaemia
  • Family history bowel cancer or IBD
97
Q

What is the FODMAP diet for IBS

A

fermentable oligosaccharides,
disaccharides, monosaccharides and polyols, which
are poorly absorbed

98
Q

________ is a problem of the colon (90% in descending colon) and is related to lack of fibre in the diet. It is usually symptomless

A

Diverticular disorder

99
Q

Diverticular DO Sx

A
  • Constipation or alternating constipation/diarrhoea
  • Intermittent cramping lower abdominal pain in LIF
  • Tenderness in LIF
100
Q

Oral antidiarrhoeal drugs are contraindicated

in children; besides being ineffective they may prolong ________

A

intestinal recovery

101
Q

_____can readily provoke dystonic reactions

in children, especially if young and dehydrated.

A

Anti-emetics

102
Q

Acute diarrhoea is invariably self-limiting (lasts

2–5 days). If it lasts longer than 7 days, investigate with______

A

culture and microscopy of the stools

103
Q

If diarrhoea is associated with episodes of

facial flushing or wheezing, consider

A

carcinoid

syndrome.

104
Q

Recurrent pain in the right hypochondrium is

usually a feature of ________

A

IBS (not gall bladder disease

105
Q

Recurrent pain in the right iliac fossa is more likely to be______

A

IBS than appendicitis

106
Q

Undercooked chicken is a common source of

_____

A

enteropathic bacterial infection.

107
Q

Consider_______ if a patient’s diarrhoea

resolves spontaneously on hospital admission

A

alcohol abuse

MC (90 decks)

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