diarrhea and IBS Flashcards
(35 cards)
diarrhea
increased frequency and decreased consistency of fecal discharge compared to an individual’s normal bowel patterns
episodes usually begin abruptly and subside within 1-2 days without treatment
often a symptom of a systemic disease
acute diarrhea
less than 14 days duration
usually caused by an infectious process
persistent diarrhea
over 14 days in duration
chronic diarrhea
over 30 days in duration
chronic idiopathic diarrhea
persistently loose stools for over 4 weeks without identifiable cause*, and occurring in absence of systemic illness, the diarrhea is second degree in nature and does not respond to antibiotics, but resolves in several months
infectious causes of diarrhea
bacterial: shigella, salmonella, campylobacter, staphylococcus, e coli***
viral: norovirus, rotovirus (most common)
diarrhea etiology:
not routinely reported to CDC
not uncommon in daycare centers and LTCF
chronic diarrhea impacts 5% of US population
leading cause of childhood illness and death in developing countries
diarrhea physiology
9 L of fluid enter the proximal small intestine every day
1 L of chyme typically enters the colon and is reduced to 100 mL
**if small intestine water absorptive capacity is exceeded, chyme overloads the colon, resulting in diarrhea
diarrhea may result from an imbalance of secretion and reabsorption of fluids and electrolytes
segmenting contractions delay passage and mix intestinal contents allowing for greater absorption
secretory diarrhea
characterized by a change in active ion transport by either a decrease in sodium absorption or an increase in chloride secretion into the lumen and water follows
pancreatic tumors, unabsorbed fat, laxatives, bacterial toxins
*large stool volumes (over 1 L/day)
*not altered by fasting
osmotic diarrhea
caused when poorly absorbed substances draw in and retain intestinal fluids in the lumen
malabsorption syndrome
lactose intolerance
administration of divalent ions (Mg containing antacids)
consumption of poorly soluble CHOs (lactulose, sorbitol)
*causes if patient resorts to fasting state
exudative diarrhea
diarrhea second to inflammatory diseases of the bowel
IBD discharge mucus, proteins, and blood into gut
large stool volumes
altered (increased) intestinal transit diarrhea
decrease time of exposure between intestinal epithelium and chyme leads to irregular absorption and secretion
typically caused by bowel restriction or promotility medications such as metoclopramide
altered motility d/t neuropathy from DM
causes of drug induced diarrhea
excessive laxatives magnesium containing antacids antineoplastics sorbitol containing products* NSAIDs misoprostol metoclopramide lithium antimicrobials (clindamycin, broad spectrum (cephalosporins))
nonpharm treatment of diarrhea
rehydration with pedialyte, gatorade
d/c solid foods and dairy products x 24 hours ?
probiotics? yogurt?
mild, digestible, low-residue diet x 24 hours
BRAT diet*
desired outcomes when treating diarrhea
manage the diet prevent excessive water, electrolyte and acid-base disturbances *provide symptomatic relief treat curable causes manage secondary causes
treating acute diarrhea
symptoms lasting fewer than 3 days
most cases can be treated with OTC products
no fever or systemic sxs: fluid and electrolyte replacement, loperamide, diphenoxylate or absorbent, diet
fever or systemic symptoms: check feces for WBC/RBC/ ova and parasites
negative: symptomatic therapy
positive: use appropriate antibiotic and systematic therapy
treating persistent/chronic diarrhea
symptoms lasting over 14 days*
patients experiencing symptoms for greater than 14 days should always be referred to a physician**
if idiopathic, some patients may require chronic management with loperamide or another agent
possible causes: GI infection, IBD, malabsorption, secretory hormonal tumor, drug, mobility disturbance
select appropriate diagnostic studies
no dx: symptomatic therapy - replete hydration, d/c potential drug inducer, adjust diet, loperamide or absorbent
diagnosis: treat specific cause
traveler’s diarrhea
most cases are infective, primarily caused by bacteria
presents as acute, watery diarrhea
duration: 2-3 days
treatment: **most cases can be controlled by oral rehydration solutions paired with an anti-motility agent; antimicrobials are effective but are rarely used (resistance)
prevention: drink bottled water and drinks, be sure fruits and vegetables are properly washed and prepared, consider peptobismol 1-4x daily
drug induced diarrhea
decreased transit time leading to irregular absorption and secretion, alteration bowel flora (antimicrobials)
may range from a mild inconvenience to a life-threatening antibiotic associated
duration depends on causative agent
tx: d/c offending agent when possible**, oral rehydration solutions and anti-motility agents may be needed
antimotility drugs
works by activating the mu opioid receptors on the smooth muscle of the bowel to reduce peristalsis and increase segmentation
loperamide, diphenoxylate, difenoxin, codeine (15-30 mg q6h PRN)
loperamide
imodium
4 mg initially, then 2 mg after each loose stool
NTE 16 mg/day
recent concern about potential arrhythmias from excessive doses (abuse)
diphenoxylate/atropine
usually combined with atropine (ACh, prevents abuse due to limits) lomotil 5 mg (2 tabs) QID NTE 20 mg/day Rx only
diphenoxin/atropine
motofen
2 mg (2 tabs) initially, then 1 with each loose stool
NTE 8 tabs/day
absorbents
used for some patients with chronic diarrhea when they have trouble forming solid stools
effectiveness unproven
oral, non-absorbed agents
kaolin-pectin (now used in animals), attapulgite, polycarbophil, metamucil (powder)
