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Flashcards in Small bowel Deck (31):
1

Diarrhea important things to consider

Quality of stool, freq, duration, pt hx, diet, recent antibiotic use

2

Difference between acute, chronic and persistent

acute 14 days, chronic>30 days

3

Common causes of acute diarrhea

Viruses (norovirus, rotavirus, adenoviruses, astrovirus), Bacteria (salmonella, shigella, campylobacter, enterotoxigenic E coli, c. diff), Protozoan (Cryptosporium, giardia, cyclospora, entamoeba)

4

Assessment of acute diarrhea

Hx (travel, food, occupation), signs of dehydration, temperature, abdominal exam

5

Indications for further evaluation of acute diarrhea

watery diarrhea, hypovolemia, blood, fever, >6/24 hour, abd pain, elderly, recent antibiotic use, pregnant

6

Diagnostic test of acute diarrhea

fecal leukocyte in stool and occult blood, stool culture w/ gram stain, if bloody have plated on Macconkey-sorbitol agar to test for Ecoli

7

Indications for Ova or parasite testing in acute diarrhea

persistent, travellling, exposure to infants, MSM or AIDS pt, bloody w/ no fecal leukocytes

8

High risk pop that requires testing sooner of acute diarrhea

immunocompromised, comorbidities, severe inflammatory, IBS, pregnant women

9

Treatment of acute diarrhea

Hydration, rest bowel (BRAT diet), antibiotics (not in most cases), antidiarrheal agents

10

Antidiarrheal agents

Loperamide (Imodium), Diphenoxylate (Lomotil), bismuth subsalicylate (pepto bismol), avoid anticholinergics

11

Chronic diarrhea affects how many

5% of pop

12

Chronic diarrhea causes

medications, infections, functional disorder, malabsorption, IBS

13

Meds that can cause diarrhea

BB, ACEI, statins, furosemide, CNS meds: alprazolam, lithium, levodopa, fluoceine, Meformin, ibuprofen, naproxen, GI: PPI, Lactulose, magnesium, H2 receptor blockers

14

Whipple disease

rare, slow progression, tropheryma whippeli (bacillus), white men 40-60 yo

15

Symptoms of whipple disease

joint pain, Later: abd pain, diarrhea, fever, weight loss, lymphadenopathy, heart murmur

16

Diagnosis of whipple disease

EGD: duodenal biopsy, Acid schiff positive macrophages w/ bacillus

17

Treatment of whipple disease

Antibiotic: ceftriazone IV, bactrim bid for 1 year, dietary supplements, if untreated it's fatal

18

Lactase deficiency

lactase hydrolyzes the disaccharide lactose into glucose and galactose, not usually produced past 12 yo

19

Symptoms of lactase deficiency

Chronic diarrhea, bloating, flatulence, abd pain after milk products

20

Confirming lactase deficiency

hydrogen breath test, bacteria produces hydrogen in presence of undigested foods

21

Antibiotic associated diarrhea

acute or chronic, most cases not C. diff

22

C. diff

mild to moderate green, foul-smelling watery diarrhea 5-15 times per day, lower abd cramping, mild LLQ, stools contain mucus, occasionally blood

23

C. diff treatment

D/c antibiotic, treat with metronidazole (flagyl), or vancomycin, in severe cases WBC > 15 or creatinine>1.5 times baseline

24

Irritable bowel disease

Unknown pathology, maybe linked to pscyh, more common in females, late teens to 20 yo, most common cause of chronic diarrhea in US

25

Symptoms of IBS

abd pain, pain worsened w/ food and relieved w/ defecation, bowel distention, postprandial urgency, changes in stool frequency, dyspepsia, urinary frequency

26

Symptoms not associated with IBS

large volume diarrhea, blood, nocturnal diarrhea, greasy stool

27

Types of IBS

constipation, diarrhea, mixed or unsubtyped

28

Physical exam of IBS

tender, palpable sigmoid, hyperresonance on percussion over abdomen

29

Alarm symptoms of diarrhea

rectal bleeding, weight loss, nocturnal or progressive abd pain, anemia, electrolyte disturbances, elevated inflammatory markers

30

Non-pharm treatment of IBS

strong pt provider relationship, avoid triggers, dietary modification (Fodmap), increase physical activity

31

Pharm treatment of IBS

osmotic laxatives (PEG), Lubiprostone, linaclotide, for diarrhea: antidiarrheals, bile acid sequestrants, alosetron if severe, abd pain: antispasmodics, peppermint oil, antidepressants