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Flashcards in Pathology of Diarrhea Deck (50)
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31

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 

32

What are some risk factors for iatrogenic C. diff colitis?

–Antibiotic usage

–Extremes of age

–Hospitalization or institutionalization

33

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

34

How is C. diff colitis diagnosed?

–pseudomembraneous colitis on rectal endoscopy (below)

–Stool assay for Toxin A (+/- B) 

35

How is C. diff colitis treated?

–stop the offending antibiotic (if possible)

–metronidazole or vancomycin po

–cholestyramine to bind toxins

36

C. diff is highly infectious!

37

38

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)

 

•Hypermotility

–Irritable Bowel Syndrome, Hyperthyroidism, Diabetic neuropathy, Alcoholism

 

•Neuroendocrine Malignancies

–VIPoma, carcinoid

 

•Factitious

–Laxative abuse

39

How does lactase deficiency present?

An osmotic diarrhea, with flatulence and acidic stool pH

40

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

41

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

42

How is IBS treated?

–anti-cholinergic medications (diarrhea)

–5-HT receptor antagonists (constipation)

–reassurance

43

What are some causes of chronic diarrhea WITH mucosal injury?

•Chronic Infections

–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

 

•Malignancies

–Colon cancer

–Lymphoma

44

45

UC is only in the colon with CD can be in the colon or the small bowel or both

46

What is microscopic colitis?

•Two Types (Lymphocytic and Collagenous colitis) marked by a chronic watery, non-bloody diarrhea in adults

47

How is microscopic colitis tx?

–Bismuth

–Aminosalisylates

–steroids

48

49

Notice the nocturnal diarrhea!

50