scott management of diarrhea and constipation

Question 1

GUT physiology

Answer 1

9 litera of fluid enters proximal small intesine everyday
if small intestine water absorptive capacity is exceeded, chyme overloads the colon, resulting in diarrhea

Question 2

Chyme

Answer 2

thick semifluid mass of partially digested food and digestive secretions formed in the stomach and intestine during digestion

Question 3

total ingested fluid

Answer 3

2000 ml

Question 4

GI secretions

Answer 4

7000 ml (stomach being the most, bile being the least)

Question 5

total fluid reaborsbed

Answer 5

8800 ml (jejunum being most, colon being least)

Question 6

stool output

Answer 6

200 ml

Question 7

diarrhea frequency and constitency

Answer 7

increased frequency and decreased consistency of fecal discharge compared to individuals normal bowel pattern

Question 8

how long does disrrhea go for

Answer 8

episodes usually begin abruptly and subside within 1-2 days without treatment
often a symptom of a systemic disease

Question 9

acute diarrhea

Answer 9

<14 days
usually caused by an infectious process

Question 10

persistent

Answer 10

> 14 days

Question 11

chronic

Answer 11

> 30 days

Question 12

chronic idiopathic

Answer 12

> or equal to 4 weeks
persistntly loose stools without identifiable causes

Question 13

epidemiology

Answer 13

exact incidence is unknown
chronic diarrhea impacts 5% of US population

Question 14

norovirus

Answer 14

most common foodborne cause of diarrhea and vomiting
caused inflammation in the stomach and intestines

Question 15

diarrhea is the leading cause of childhood illness and death in developing countries

Answer 15

typhoid fever

Question 16

types of diarrhea you can have

Answer 16

secretory, osmotic, exudative, altered intestinal transit

Question 17

secretory

Answer 17

characterized by a change in active ion trasnport by either a decrease in sodium absorption or an increase in chloride secretion into the lumen (water follows)

Question 18

secretory

Answer 18

caused by laxatives, not absorbing fat
large stool volumes (>1 L/day)
normal ionic stool content
not altered by fasting

Question 19

osmotic diarrhea

Answer 19

caused when poorly absorbed substances are retained in intestinal fluids; resulting influx of water and electrolytes into the lumen

Question 20

osmotic reasons

Answer 20

malasorption syndromes
lactose intolerance
administration of divalent ions like Mg containing antacids
consumption of poorly soluble CHOs like lactulose;sorbital
Improves with fasting state which means no eating=no diarrhea

Question 21

one of the biggest ingredients that caused osmotic

Answer 21

SUGAR ALCOHOLS in gum

Question 22

Exudative

Answer 22

subset of secretory
-secondary to inflammatory diseases of the bowel
IBD discharge mucus, proteins, and blood into gut
characterized by large stool volumes
Crohn’s disease

Question 23

bacterial causes of diarrhea

Answer 23

shigella
salmonella (MOST COMMON IN US)
campylobacter
staphylococus
e. coli

Question 24

viral causes of diarrhea

Answer 24

norwalk (norovirus) #1 in the US
rotavirus

Question 25

drug induced diarrhea

Answer 25

laxatives antacids with magnesium oral electrolyte repletion liquid formulations of medications with sorbitol antimicrobials like clindamycin motility agents like mteoclopramide

Question 26

Top drugs that cause diarrhea

Answer 26

LAXATIVES AND METFORMIN** thats why we start pt on a low dose of metformin

Question 27

for cancer patients, what causes the most diarrhea?

Answer 27

the -NIBS and the -NABS

Question 28

complications of diarrhea

Answer 28

inconvinence social isolation dehydration** electrolyte imbalance

Question 29

evaluating for dehydration

Answer 29

dry mucous membranes concentrated urine skin tenting dizziness when standing orthostatic hypotension

Question 30

tx of diarrhea

Answer 30

manage the diet prevent excessive water, electrolyte and acid base disturbances provide symptomatic relief treat curable causes manage secondary causes of diarrhea

Question 31

diet management

Answer 31

more important with osmotic diarrhea do not stop feedings in children with bacterial diarrhea mild, digestiblem low residue diet for 24 hours (BRAT)

Question 32

non pharm tx for diarrhea

Answer 32

electrolyter replacement

Question 33

electrolyte replacement

Answer 33

rehydrate and prevent electrolyte disturbances enteral administration is preferred

Question 34

tx of acute diarrhea with no fever or systemic sx

Answer 34

fluid/electrolyte therapy loperamide, diphenoxylate, or absorbent diet

Question 35

acute diarrhea tx with fever or systemic sx

Answer 35

check feces for WBC/RBC/ ova and parasites IF YES, use apprpriate antibiotic and symptomatic therapy IF NO, use symptomatic therapy only

Question 36

traveler's diarrhea

Answer 36

etiology -most cases are infective, primarily caused by bacteria clinical presentation -acute watery diarrhea duration -2-3 days

Question 37

prevention of traveler's diarrhea

Answer 37

Bismuth subsalicytate may be considered for any traveler to prevents traveler's diarrhea DO NOT USE ANTIBITOICS; ONLY IN SEVERE CASES

Question 38

tx of traveler's diarrhea

Answer 38

oral rehydration solutions should be used aggresively mild: antibitoic tx is nOT recommended; loperamide or BSS may be considered (60 ml or 2 tabs QID) moderate: antibitoic tx may be used; loperamide MAY be considered Severe: antibitoic tx SHOULD be used (Rifaximin 200 mg TID x 3 days preferred); loperamide may be used a adjunctive therapy

Question 39

tx of drug induced diarrhea

Answer 39

discontinue offending agent when possible REHYRDATE

Question 40

antimotility agents

Answer 40

TX OPTION for diarrhea SHOULD NOT BE USED LONG TERM* Not to be used with C. diff

Question 41

MOA of antimotility agents

Answer 41

MOA: activate the mu opioid receptors on the smooth muscle of the bowel to reduce perstalisis and increase segmentation; delaying transit of intrealuminal contents

Question 42

antimotility agents

Answer 42

diphenoxylate/atropine difenoxin/atropine LOPERAMIDE** codeine

Question 43

lopermide

Answer 43

4 mg initially, then 2 mg with each loose stool (max 16 mg day RX) (8 MG DAY OTC)

Question 44

LOPERMIDE cardiac risk

Answer 44

higher than recommended doses can cause serious heart problems that can lead to death

Question 45

absorbents

Answer 45

tx options symptomatic relief used for some patients with crhonic diarrhea when they have trouple forming sold stools effectiveness not based on clinical trials; remains unproven

Question 46

absorbent MOA

Answer 46

adsorb nutrients, toxins, drugs, and digestive juices

Question 47

examples of absorbents

Answer 47

psyllium (metamucil) polycarbophil attapulgite kaolin-pectin mixture

Question 48

antisecretory tx

Answer 48

act by reducing secretions in the gut PEPTO BISMOL may potentiate anti-coagulants avoid in pts who should not take salicytates