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41 Cards in this Set

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define diarrhea
stool wt >300 g/day
(normal= 100-300 g/day)
characterize small-bowel diarrhea
stools are voluminous, watery, and fatty
characterize large-bowel diarrhea
stools are smaller in volume but more frequent
what should you suspect when prominent vomiting occurs with diarrhea?
1. viral enteritis
2. staph aureas food poisoning
what are you concerned with in malabsorption diarrhea?
1. characterized by high-fat content of stools
2. can cause iron deficiency, megaloblastic anemia (B12 loss), and hypocalcemia
what is the tx for diarrhea?
1. oral rehydration
2. iv fluids
3. electrolytes
what is the #1 cause of acute diarrhea?
1. infectious diarrhea!!
2. causes include non-inflam (enterovirus spp. and norwalk virus)
3. inflam (campylobacter, E. coli, salmonella, shigella, clostr. diff)
4. parasites (giardia, entamoeba, cryptosporidium)
what are the main causes of noninflammatory diarrhea?
1. enterovirus spp.
2. Norwalk virus (cause of cruise-ship diarrhea)
what are the main causes of inflammatory diarrhea?
1. campylobacter
2. E.coli for traveler's diarrhea
3. Salmonella
4. Shigella
5. Clostridium difficile with antibiotic exposure
what si/sx suggest invasive diarrhea?
1. blood/mucus in stools
2. fevers/chills
3. vomiting
4. pain
what are dx tools for diarrhea?
1. stool leukocytes
2. gram stain and culture
3. Ova and parasites (O&P) for parasitic
4. C. difficile toxin test
what is tx for infectious diarrhea?
1. ciprofloxacin
2. metronidazole for C. difficile
What are parasitic causes of diarrhea?
1. Giardia
2. Entamoeba
3. cryptosporidium
What are causes of osmotic diarrhea?
1. lactose intolerance
2. oral Mg
3. sorbitol/mannitol
What are the dx and tx for osmotic diarrhea?
1. check for an increase in the osmotic gap
2. check for fecal fat
3. for tx: withdrwa the inciting agent
what are causes of secretory diarrhea?
1. toxins (cholera)
2. enteric viruses
3. increased dietary fat
what are the sx of secretory diarrhea?
1. will see normal osmotic gap
2. with fasting, will not see a change in diarrhea
3. supportive tx
what are the causes of exudative diarrhea?
1. mucosal inflammation from plasma and serum leakage
2. enteritis
3. TB
4. colon CA
5. inflammatory bowel dz
what are sx of exudative diarrhea?
1. increased ESR and CRP
2. radiologic imaging or colconscopy to visualize intestine
what is encopresis?
oozing around fecal impaction in children or sick elderly
"fecal soiling"
*seen with hx of constipation
*seen in kids who have been potty-trained
*leaking stool into underwear
how do you tx encopresis?
1. laxatives
2. fiber-rich diet
3. scheduling a time for going to the bathroom
what are si/sx of celiac sprue?
1. bluten allergy (wheat, barley, rye, oats containing gluten)
2. weakness
3. failure to thrive
4. growth retardation
5. dermatitis herpetiformis=pruritic, red papulovesicular lesions on shoulders, elbows and knees
what is the classic rash a/c celiac sprue?
dermatitis herpetiformis=pruritic, red papulovesicular lesions on shoulders, elbows and knees
what do 10-15% of celiac sprue pts develop?
intestinal lymphoma
what is the dx for celiac sprue?
1. positive for anti-endomysial, anti-tissue transglutaminase and antigliadin antibodies
2. dx confirmed by small bowel bx showing pathognomonic blunting of villi
4. tx is to avoid dietary gluten
what are si/sx of tropical sprue?
1. likely caused by a tropical infection
2. glossitis,
3. diarrhea
4. wt loss
5. steatorrhea
how do you tx tropical sprue?
1. tetracycline plus folate!!
what is Whipple's disease?
GI infection caused by Tropheryma whippelii
what are si/sx of Whipple's disease?
1. diarrhea
2. arthritis
3. rash
4. anemia
what is dx for whipple's disease?
intestinal bx PAS-positive macrophages in intestine
(p-aminosalicylic acid (PAS))
what is whipple's diease?
1. multisystmic disease
2. fever, lymphadenopathy, arthralgias
3. malabosrption
4. duodenal biopsy c/ periodic acid-schiff (PAS)-positive macrophages c/ characterisitic bacillus
describe lactase deficiency
1. most of world is lactase deficient as adults, losing the deficiency as they emerge from adolescence
2. abd pain
3. diarrhea
4. flatulence after ingestion of any lactose-containing product
what is intestinal lymphangiectasia?
1. seen in children, congenital or acquired dilation of intestinal lymphatics which leads to marked GI protein loss
what are si/sx of intestinal lymphangiectasia?
1. diarrhea
2. hypoproteninemia
3. edema
4. dx with jeunal bx
5. tx is supportive
what are si/sx of diarrhea seen in pancreatic dz?
1. typically seen in pancreatitis and cystic fibrosis d/t deficiency of pancreatic digestive nzs
2. foul-smelling steatorrhea
3. megaloblastic anemia (folate deficiency)
4. wt loss
what are bacterial infectious causes of diarrhea?
1. e. coli
2. shigella
3. salmonella
4. campylobacter jejuni
5. vibrio parahaemolyticus
6. vibrio cholera
7. yersinia enterocolitica
how do you tx barterial infectious causes of diarrhea?
1. ciprofloxacin (fluoroquinolone--inhibits DNA gyrase)
2. bactrim (sulfonamide--inhibits folic acid)
what are viral infectious causes of diarrhea?
1. rotavirus
2. norwalk virus
how do you tx viral infectious causes of diarrhea?
supportive
what are parasitic infectious causes of diarrhea?
1. giardia lamblia
2. cryptosporidium
3. entamoeba histolytica
how do you tx parasitic infectious causes of diarrhea?
metronidazole!!!!