GI 7 lecture

Question 1

Define diarrhea and the 3 main different time-based categories

Answer 1

Increased stool frequency (>3 BMs/day) or liquid feces
1) Acute: <14 days
2) Persistent: 14-30 days
3) Chronic: >30 days

Question 2

List the most common etiologies of acute diarrhea

Answer 2

Medications, infectious agents, inflammatory disease (IBD, ischemic colitis), malabsorption (pancreatic malabsorption, celiac, lactose intol,) secretory (laxative abuse) motility (functional, IBS, hyperthyroidism)

Question 3

List some associations with acute diarrhea

Answer 3

1) Community outbreaks: virus or common food source
2) Close contact illness: infectious etiology
3) Ingestion of improperly stored/prepared/unpasteurized food: food poisoning
-Pregnant/immune compromised-> listeriosis
4) Day care, camping, swimming: Giardia, Cryptosporidium
5) Recent travel: traveler’s diarrhea – usually bacterial; diarrhea accompanied by at least one of the following: n/v, abdominal pain or cramps, fever, or blood in the stool.
6) Recent antibiotic use: C. difficile

Question 4

Describe non-inflammatory acute diarrhea

Answer 4

1) Watery, non-bloody with periumbilical cramps, bloating, nausea, or vomiting
2) Suggests small bowel source
3) Virus, toxin-producing bacterium, or protozoa (ie, Giardia)
4) Typically mild
5) May lead to dehydration (hypokalemia, metabolic acidosis)
6) No leukocytosis (no tissue invasion)

Question 5

Describe inflammatory acute diarrhea

Answer 5

1) Fever & bloody diarrhea indicates tissue damage caused by invasion or toxin
2) Small-volume diarrhea (<1L/day), LLQ cramps, urgency, & tenesmus
3) Fecal leukocytes (or lactoferrin (inflammation of the gut)) usually present
4) E. coli O157:H7 (STEC/ETEC)
5) Distinguish from acute ulcerative colitis

Question 6

> 90% ______________________ diarrhea is mild & self-limited (testing unnecessary unless outbreak or high-risk for transmission)

Answer 6

acute non-inflammatory

Question 7

Differentiate Gastroenteritis vs food poisoning

Answer 7

1) Gastroenteritis = n/v/d/ abd cramps, fever most commonly caused by norovirus and typically self limiting. Very easily spread.
2) Food poisoning = caused by eating contaminated/ raw/undercooked foods can have similar symptoms to GE though less often diarrhea and typically starts with vomiting.
-Can be caused by Staph aureus. Occurs 1-6 hrs after ingesting contaminated foods. Not passed person to person.