Tratamentul diareei

Question 1

Diareea

Answer 1

cresterea anormala a frecventei, volumului sau lichiditatii scaunelor

Question 2

Diareea acuta

Answer 2

Scaune de consistenta scazuta si pierdere de apa si electroliti <14 zile

Question 3

Diaree cronica

Answer 3

scaune moi > 30 zile + scadere in greutate, slabiciune musculara, deshidratare, tulb h-e

Question 4

Cauze de diaree

Answer 4

Infectioasa
Medicamentoasa
Datorata SB
Gastroenterocolita cronica
SII, B Crohn
stres emotional
cresterea osm cont intestinal

Question 5

Diareea acuta simpla

Answer 5

Tratament simptomatic

Question 6

Semne de alarma - diaree acuta infectioasa

Answer 6

Temp > 38,5
stare generala alterata
scaune cu produse patologice
deshidratare accentuata
tara subtropicala/ focar endemic de holera

Question 7

Obiectivele tratamentului in diaree

Answer 7

Mentinerea ech h-e
Tratament antiinfectios
Tratament antidiareic simptomatic

Question 8

Reechilibrare h-e

Answer 8

Oral - saruri de rehidratare

Perfuzie

Question 9

Clase de medicamente pentru tratamentul simptomatic al diareei

Answer 9

Antispastice - opioide, anticolinergice

Adsorbante

Question 10

Opioidele - mecanism de actiune

Answer 10

R opioizi miu si delta -> scad activ propulsiva a intestinului, cresc tonusul sfincterului ileocecal si anal, cresc tonusul IG si scad secr digestive

Question 11

Opioide - RA

Answer 11

Potential de dependenta

Question 12

Opioide - CI

Answer 12

Colita ulcerativa -> megacolon toxic
Abdomen acut
Boli diareice cu germeni enteroinvazivi

Question 13

Loperamid - efecte

Answer 13

Scade motil intest, ef antidiareic intens si de lunga durata, creste tonusul sfincterului anal
Actiune antisecretorie pe tox holerei si ETEC

Question 14

Loperamid - indicatii

Answer 14

Diaree acuta nespecifica
Diaree cronica
Diareea calatorilor +/- antimicrobiene
Ileostomie

Question 15

Loperamid - RA

Answer 15

Greata, varsaturi
Deprimarea SNC
Ileus paralitic
Megacolon toxic (BII)

Question 16

Loperamid - CI

Answer 16

Ileus paralitic
Copii < 2 ani
Sarcina, alaptare
Diaree febrila
Scaune cu sg

Question 17

Difenoxilat

Answer 17

Opioid cu potential adictiv > loperamid
Asoc cu atropina
RA: ef atropinice, SNC, constipatie, megacolon toxic

Question 18

Racecadotril

Answer 18

Inhibitor de enkefalinaza -> previne degradare enkefalinelor (opioide endogene) cu rol de inhibitie a secretiei intestinale

Question 19

Adsorbante - mecanism de actiune

Answer 19

formeaza complexe cu subst iritante pe care le elimina prin fecale
formeaza complexe cu vitamine si minerale, medicamente -> previn abs

Question 20

Adsorbante - reprezentanti

Answer 20

argile (caolin)
disilicat de Al si Mg
Diosmectita
Subcitratul de Bi
Carbune medicinal

Question 21

Clonidina - mecanism de actiune

Answer 21

Agonist alfa2 adrenergic -> + reabs H20 si electroliti

Question 22

Clonidina - indicatii

Answer 22

Diaree cronica DZ, sdr de abstinenta la opioide, SII

Question 23

Clonidina - RA

Answer 23

hTA, depresie, oboseala

Question 24

Octreotid

Answer 24

Analog de somatostatina

I: tu carcinoide pancreatice si GI, sdr dumping, chimioterapie, DZ, SIDA

Question 25

Colestiramina si colestipol

Answer 25

Rasini schimbatoare de ioni - leaga SB si unele toxine bact ! in rezectii ileale extinse pot agrava diareea ! NU in diareea infectioasa

Question 26

Alosetron

Answer 26

Antagonist specific al R 5HT3 -> scade peristaltismul, creste absorbtia apei, amelioreaza durerea I: SII

Question 27

Probioticele

Answer 27

suplimente alimentare - stimuleaza tranzitul, cresterea florei saprofite impiedica popularea colonului cu flora patogena, favorizeaza rasp imun, efect antiinflamator

Question 28

Prebioticele

Answer 28

alimente nedigestibile care stimuleaza dezv spp saprofite ale gazdei (oligozaharide din ceapa, praz, usturoi, banane, inulina)

Question 29

Simbioticele

Answer 29

amestecuri de probiotice si prebiotice

Question 30

Tratamentul antiinfectios in diaree (empiric)

Answer 30

Ciprofloxacina (sau alte quinolone) | Co-trimoxazol

Question 31

Tratamentul infectiei cu C diff

Answer 31

Vancomicina/metronidazol

Question 32

Tratamentul diareei acute necomplicate

Answer 32

``` Mentinerea balantei h-e Rehidratare orala/pe Regim alimentar Adsorbante (carbune, diosmectita) Crampe accentuate - butilscopolamina ```

Question 33

Tratament diaree acuta severa

Answer 33

ATB - quinolone, rifamixina, co-trimoxazol !coprocultura Rehidratare pe + monitoriz - Ht, ech h-e si AB

Question 34

Tratament diaree cronica

Answer 34

Tratarea cauzei Dieta, lq si electroliti Smecta, Loperamid, Butilscopolamina

Question 35

Tratamentul diareei calatorilor

Answer 35

(ag etiologic EPEC) Co-trimoxazol 2x2 cpr/zi

Question 36

Profilaxia diareei calatorilor

Answer 36

Alimente pregatite termic, apa imbuteliata