How would acute dehydrating, bloody, 'septic' diarrhea be treated?
–obtain stool for culture and O&P
–hospitalization, IV fluids
–IV fluoroquinolone (cipro); avoid with EHEC
What are some risk factors for iatrogenic C. diff colitis?
–Extremes of age
–Hospitalization or institutionalization
What causes C. diff colitis?
C. diff is commensal so ABX allow it to flourish and produce cytoxins A and B which destroy intestinal mucosa and promote formation of pseudomembranes
How is C. diff colitis diagnosed?
–pseudomembraneous colitis on rectal endoscopy (below)
–Stool assay for Toxin A (+/- B)
How is C. diff colitis treated?
–stop the offending antibiotic (if possible)
–metronidazole or vancomycin po
–cholestyramine to bind toxins
C. diff is highly infectious!
What are some causes of chronic diarrhea with NO mucosal injury?
•Maldigestion and Malabsorption Syndromes
–Disaccharidase deficiencies, Bacterial overgrowth, Pancreatic insufficiency, Short bowel syndrome (after surgery/congenital)
–Irritable Bowel Syndrome, Hyperthyroidism, Diabetic neuropathy, Alcoholism
How does lactase deficiency present?
An osmotic diarrhea, with flatulence and acidic stool pH
bacteria should not be in the small bowel!
Unconjugate bile acids cause a secretory diarrhea when they reach the colon. Take ABX to clean out the small bowel
Basically the diagnosis would be if you had abdominal pain (have to have pain/bloating for diagnosis)/bloating with either the constipation or diarrhea and relief of those symptoms when bowel function returns to normal
There isnt anything functional with the bowels in IBS
How is IBS treated?
–anti-cholinergic medications (diarrhea)
–5-HT receptor antagonists (constipation)
What are some causes of chronic diarrhea WITH mucosal injury?
–HIV, Parasites / worms (Strongyloides, etc.), Tropical sprue and Whipple’s disease
•Allergic / Immune-mediated
–Food allergy (milk, soy, etc.), Celiac sprue,Inflammatory Bowel Disease (Crohn’s and Ulcerative Colitis), Eosinophilic gastroenteritis
–Microscopic (lymphocytic and collagenous) colitis
UC is only in the colon with CD can be in the colon or the small bowel or both
What is microscopic colitis?
•Two Types (Lymphocytic and Collagenous colitis) marked by a chronic watery, non-bloody diarrhea in adults
How is microscopic colitis tx?
Notice the nocturnal diarrhea!