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20 Cards in this Set
- Front
- Back
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Is Diarrhea a sx or a sign?
What is the difference between acute diarrhea and chronic diarrhea? |
both.
acute: - most commonly infectious - usually self limiting - <2-3wks duration chronic: - >3wks - may be non-infectious; (could still be parasitic tho', or some other kind of long-lasting infection) |
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Which diarrhea-causing organism is common, especially in hospital pts that have been tx'ed with antibiotics?
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C. Difficile
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What are the usual mechanisms of infectious diarrhea?
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- direct tissue destruction
- toxin mediated secretion |
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Think of some common and less common causes of chronic diarrhea.
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common:
Chronic or recurrent infection Inflammatory Bowel Disease Irritable Bowel Syndrome (motility) Carbohydrate Malabsorption Drug Induced - Laxative abuse Pancreatic insufficiency Endocrine: thyroid, diabetes Ischemia Celiac disease less common: Hormone producing tumors - Gastrinoma - VIPoma - Carcinoid Infiltrative Disease - Amyloid - Sarcoidosis - Diffuse lymphoma Eosinophilic Gastroenteritis Food Allergy |
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What are the four main classifications of diarrhea?
which is cholera the classic example of? |
osmotic/malabsorption: osmotic load in lumen --> H20 retention
secretory: excess secretion of electrolytes and water into the intestinal lumen inflammatory: exudation of fluid and protein from the intestinal mucosa motility: rapid transit through the colon Secretory. |
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Which absorbs more water and electrolytes, the sm intestine or the colon?
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80% sm. intestine
20% colon |
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What effect will fasting have on osmotic diarrhea?
What is steatorrhea? Empirical finding about it? |
decrease or resolve it.
fat malabsorption; smells REALLY bad. |
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Which two theoretical etiologies can cause osmotic/malabsorptive diarrhea?
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Small Bowel Can’t absorb due to disease of the lining of the small intestine
Or Too many osmoles in the lumen of the small intestine that can’t be absorbed |
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Celiac Dz, Tropical Sprue, Whipple Dz, and IBD all can cause which type of diarrhea by which etiology?
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mucosal destruction --> osmotic
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Pts with pancreatic insufficiency are at risk of which type of diarrhea?
At what % of damage does this occur? Clinical sx? |
malabsorption (osmotic)
~90% decrease in exocrine secretions Fat malabsorption - decrease in DEAK |
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When you hear "osmotic diarrhea" think... (3)
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- pancreatic insufficiency
- small intestinal wall problems - too many osmoles that cannot be absorbed. |
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How might you differentiate Bacterial Overgrowth osmotic diarrhea from other causes of osmotic diarrhea?
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SBFT
Hydrogen breath test Empiric trial of appropiate antibiotic |
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What usually characterizes secretory diarrhea?
Possible causes? |
substantially elevated stool volumes and associated hypokalemia
This continues despite fasting Bacterial stuff: vibrio cholerae, c. difficile, 0157:H7, shigella VIPoma, gastrinoma, carcinoid Inflammatory cell products |
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What is the equation for the stool osmotic gap?
- >60, what does it suggest? Is stool osmolality used to calculate this value? - high values? - low values? |
290 mosm/kg H20 minus 2 x (stool Na + stool K) = osmotic gap
- osmotic diarrhea no. <290 contamination of stool with water or dilute urine, etc. >290 seen w/ bacterial metabolism of stool contents. |
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White blood cells in the stool
Blood in the stool Systemic symptoms such as fever With rectal inflammation, tenesmus or urgency occurs ... what type of diarrhea are these sx associated with? |
inflammatory diarrhea
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If we were concerned about c.diff in a pt, what might we run?
Can c.diff, shigella, e.coli, etc. only cause one type of diarrhea? |
C.diff toxin test
no, some can do either, depending on the infection/strain. |
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Why does a hydrogen breath test work?
- what does it assess? |
bacterial are the only cells in the body that make hydrogen.
- lactose intolerance as well as small bowel bacterial overgrowth |
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Ulcerative colitis/Crohn’s colitis
Radiation colitis Ischemic colitis Infectious colitis: CMV Collagenous or Microscopic colitis Pseudomembranous colitis ... how can these be dx'ed? |
Combination of endoscopic and histologic findings.
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Celiac Disease
Whipple’s Disease Giardia Cryptosporidiosis/Microsporidiosis Eosinophilic Gastroenteritis MAI/Tuberculosis ... how must these be dx'ed? |
histologically
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HLA DR and DQ can help dx what?
Anti-endomysial ab, Anti TTG? ESR, CRP? |
Celiac dz
Celiac Dz non-specific inflammation |
