Diarrhea 2
Terms
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- define diarrhea
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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?
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1. viral enteritis
2. staph aureas food poisoning - what are you concerned with in malabsorption diarrhea?
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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?
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1. oral rehydration
2. iv fluids
3. electrolytes - what is the #1 cause of acute diarrhea?
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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?
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1. enterovirus spp.
2. Norwalk virus (cause of cruise-ship diarrhea) - what are the main causes of inflammatory diarrhea?
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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?
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1. blood/mucus in stools
2. fevers/chills
3. vomiting
4. pain - what are dx tools for diarrhea?
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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?
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1. ciprofloxacin
2. metronidazole for C. difficile - What are parasitic causes of diarrhea?
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1. Giardia
2. Entamoeba
3. cryptosporidium - What are causes of osmotic diarrhea?
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1. lactose intolerance
2. oral Mg
3. sorbitol/mannitol - What are the dx and tx for osmotic diarrhea?
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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?
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1. toxins (cholera)
2. enteric viruses
3. increased dietary fat - what are the sx of secretory diarrhea?
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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?
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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?
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1. increased ESR and CRP
2. radiologic imaging or colconscopy to visualize intestine - what is encopresis?
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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?
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1. laxatives
2. fiber-rich diet
3. scheduling a time for going to the bathroom - what are si/sx of celiac sprue?
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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?
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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?
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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?
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1. diarrhea
2. arthritis
3. rash
4. anemia - what is dx for whipple's disease?
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intestinal bx PAS-positive macrophages in intestine
(p-aminosalicylic acid (PAS)) - what is whipple's diease?
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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
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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?
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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?
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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?
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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?
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1. ciprofloxacin (fluoroquinolone--inhibits DNA gyrase)
2. bactrim (sulfonamide--inhibits folic acid) - what are viral infectious causes of diarrhea?
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1. rotavirus
2. norwalk virus - how do you tx viral infectious causes of diarrhea?
- supportive
- what are parasitic infectious causes of diarrhea?
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1. giardia lamblia
2. cryptosporidium
3. entamoeba histolytica - how do you tx parasitic infectious causes of diarrhea?
- metronidazole!!!!