Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| 8-10 L of total fluid load enters intestines for absorption every 24 hrs, only 1.5 – 2 L of that fluid is dietary |
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Definition
| all but approximately 100ml of that fluid |
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Term
| absorbed in the small intestine |
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Definition
| All nutrients (vitamins, minerals, fats, proteins, carbohydrates) |
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Definition
| limited to electrolytes and water |
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Term
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Definition
Due to abnormalities in absorption of electrolytes (and thus water)
Large volume, watery
No blood or pus
Persists despite fasting
Cholera is the prime example |
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Definition
due to the accumulation of poorly absorbed solutes in the gut
Typically stops when the patient fasts
Examples include magnesium ingestion (laxatives, antacids), disaccharidase deficiencies like lactose intolerance, and pancreatic insufficiency |
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Term
Exudative / Inflammatory
diarrhea |
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Definition
Destruction of mucosa
Pus, mucus, and blood found in stool
Examples include ulcerative colitis, shigellosis, c.diff |
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Term
| Abnormal Intestinal Motility |
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Definition
Peristalsis is increased or decreased from normal
Examples include thyrotoxicosis and irritable bowel syndrome |
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Term
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Definition
Large, voluminous stools
Frothy stools and increased flatulance suggest carbohydrate malabsorption
Greasy, foul-smelling stools suggest steatorrhea (fat malabsorption) |
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Term
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Definition
Small amounts of stool with frequent urges to defecate
Bloody stool suggests colonic mucosal inflammation |
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Term
| “Red Flag” History for diarrhea |
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Definition
Symptoms of profound dehydration, unable to take p.o.
Bloody diarrhea
Fever, especially greater than 100.4F
Weight loss
With Chronic diarrhea – is it nocturnal? |
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Term
| Specific Etiologies of Acute Diarrhea |
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Definition
-Infectious
-Inflammatory
-Ischemic
-Impaction |
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Term
| Acute Infectious Diarrhea - Viral |
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Definition
About 50-70% of infectious diarrhea cases
Adults generally not seen by provider
Four important viral causes
Rotavirus
Infants and small children, daycare, watery / voluminous
Norwalk Virus (Norovirus)
No age predilection, sporadic outbreaks of explosive V/D, lasts 24-48 hours
Adenovirus
Astrovirus |
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Term
Four important viral causes
of diarrhea |
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Definition
Rotavirus
Infants and small children, daycare, watery / voluminous
Norwalk Virus (Norovirus)
No age predilection, sporadic outbreaks of explosive V/D, lasts 24-48 hours
Adenovirus
Astrovirus |
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Term
| Acute Infectious Diarrhea- Bacterial |
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Definition
Campylobacter
Can invade both the small intestine or the colon, low grade fever, bloody diarrhea, and abdominal discomfort
Salmonella
Associated with contaminated meat, dairy, or poultry, invades distal ileum, fever, explosive & bloody diarrhea, nausea/ vomiting
Shigella
Fecally contaminated food or water, associated with daycare centers / institutionalized adults via person to person transmission, fever, bloody diarrhea |
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Term
| Can invade both the small intestine or the colon, low grade fever, bloody diarrhea, and abdominal discomfort |
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Definition
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| Associated with contaminated meat, dairy, or poultry, invades distal ileum, fever, explosive & bloody diarrhea, nausea/ vomiting |
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Definition
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Term
| Fecally contaminated food or water, associated with daycare centers / institutionalized adults via person to person transmission, fever, bloody diarrhea |
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Definition
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Term
| Enterohemorrhagic E. coli (EHEC) |
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Definition
strains capable of producing Shiga toxin
In the United States, most EHEC strains are serotype O157:H7
Generally foodborne – undercooked contaminated beef
Associated with hemolytic-uremic syndrome, esp. in children
Suspect especially in bloody diarrhea without fever |
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Term
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Definition
Undercooked pork products
Generally affects the young
“mesenteric adenitis” – mimics appendicitis |
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Term
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Definition
| Inadequately cooked shrimp/shellfish |
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Term
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Definition
Cholera characterized by severe, watery diarrhea (the “classic” secretory diarrhea
Endemic in the developing countries of Asia and Africa
Severe disease can present with diarrhea, vomiting, and massive volume loss within hours of illness
Clinical diagnostic tools include Gram stain/culture
Treatment consists primarily of rehydration , antibiotic therapy can shorten course
Infection control paramount to controlling epidemics |
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Term
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Definition
Colonizes the intestinal tract after the normal gut flora have been altered by antibiotic therapy
Fluoroquinolones, clindamycin, cephalosporins, and penicillins
watery diarrhea up to 10 or 15 times daily with lower abdominal pain and cramping, low grade fever, and leukocytosis
“Pseudomembraneous” appearance on sigmoidoscopy
Can check stool for C. difficile toxins A and B |
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Term
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Definition
Very short incubation period – within six hours of ingesting contaminated dairy, mayo, poultry – with high attack rates
cramping, prominent vomiting, no fever |
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Term
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Definition
| Similar to s.aureus, severe cramping, usually associated with contaminated rice |
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Term
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Definition
| Similar to s. aureus, usually contaminated meat or poultry |
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Term
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Definition
Acute or chronic
Camping, well water, travel
Multiply in small bowel and cause watery diarrhea
Clinical manifestations are variable.
Giardia cysts can be seen on stool for O and P, also can antigen in stool |
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Term
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Definition
most common parasitic cause of acute food or water-borne diarrhea in US
Self-limited in normal host, chronic and severe with HIV |
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Term
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Definition
parasitic
Clinical manifestations of intestinal amebiasisare variable, worst is bloody diarrhea, fever, abdominal pain,
Contaminated food or water, or person to person transmission
Very rare in US, Canada, Western Europe |
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Term
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Definition
More than 90 % travel –associated diarrhea is caused by bacteria; most common organism is enterotoxigenic Escherichia coli (ETEC)
High risk (>30 percent) — Asia (with the exception of Singapore), Africa (outside of South Africa), South and Central America, and Mexico
Travelers canbe given a prescription for antibiotics to fill and take with them in case diarrhea develops |
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Term
| Acute Diarrhea Management |
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Definition
Replace Fluids & Electrolytes
Clear liquids at room temperature
Non-caffeine carbonated beverages
Gatorade/ Powerade
Most can be managed with oral fluid replacement, IV fluids if unable to take p.o.
Allow BRAT diet (Broth/Rice/Applesauce/Toast)
Clear soup, rice, crackers, toast/ bread, popsicles, jello
Baked potatos, noodles, bananas, poultry, applesauce
Avoid coffee, alcohol, red meat, dairy |
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Term
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Definition
(Broth/Rice/Applesauce/Toast)
Clear soup, rice, crackers, toast/ bread, popsicles, jello
Baked potatos, noodles, bananas, poultry, applesauce |
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Term
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Definition
Viral agents
Salmonella if mild/mod
A aureus
B cereus
C perfringes
Enterohemorrhagic E. coli (EHEC) |
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Term
| Giardia and E histolytica treatment |
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Definition
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Definition
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Definition
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Term
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Definition
| Metronidazole / oral vancomycin |
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Term
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Definition
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Term
| Acute Inflammatory Diarrhea |
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Definition
Crohn’s Disease
Ulcerative Colitis |
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Term
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Definition
Acute colonic ischemia usually presents with rapid onset of mild abdominal pain and tenderness over the affected bowel, most often involving the left side.
Mild to moderate rectal bleeding or bloody diarrhea usually develops within 24 hrs of abdominal pain
Majority of patients are elderly with multiple medical problems
Dx is somewhat “via exclusion” and treatment is supportive |
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Term
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Definition
Common cause of fecal incontinence in the elderly or the hospitalized / bedbound – leakage of liquid stool around the impaction
Treatment strategies may include stool softeners, manual disimpaction, laxatives, or enemas – avoidance of continued constipation
Yet another reason to do the rectal exam! |
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Term
| Medication-related Diarrhea |
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Definition
Any new medication is suspect!
Antibiotics
Antacids
Metformin (Glucophage)
Proton Pump Inhibitors (e.g. omeprazole)
Colchicine
Digoxin |
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Term
| Specific Etiologies of Chronic Diarrhea |
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Definition
-Infectious (Giardia, Entamoeba )
Inflammatory (Crohns Disease and Ulcerative Colitis)
- Malabsorption (Celiac Disease/Lactose Intolerance/Pancreatic Insufficiency )
- Irritable Bowel Syndrome |
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Term
| Chronic Differentials – Celiac Disease |
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Definition
AKA gluten-sensitive enteropathy and nontropical sprue
Chronic immune-mediated malabsorption disorder with a strong genetic component
Gluten intolerance - protein found in wheat/barley/rye
Gluten exposure causes inflammation of small intestine, loss of intestinal villi (“villous atrophy”), and decreased nutrient absorption |
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Term
| Chronic Differentials – Celiac Disease sx |
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Definition
Typically detected in infancy or young adulthood (20s/30s
Adults may have a wide variety of symptoms
Classic GI symptoms are diarrhea, flatulence, abdominal distention, weight loss , steatorrha
Anemia is common (due to small bowel malabsorption of folate/B12/iron), premature osteoporosis can occur (due to malabsorption of calcium) |
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Term
| Chronic Differentials – Lactose Intolerance |
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Definition
Decreased amounts of the brush border enzyme lactase
Decreased ability to break down lactose (the sugar in dairy products)
Bloating, cramping, flatulence, diarrhea associated with diary intake
More common in African Americans and Asians
Can diagnose with Lactose breath hydrogen test |
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Term
| Chronic Differentials- Chronic Pancreatic Exocrine Insufficiency |
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Definition
Chronic Pancreatitis (end-stage pancreatic disease) can result in pancreatic exocrine insufficiency – the pancreas cannot produce enough enzymes that help break down fats (lipases) and proteins (proteases)
Steatorrhea is classic symptom - loose, pale, greasy, foul smelling stools that are difficult to flush
Pancreatic calcifications on plain film or abdominal CT strongly suggest diagnosis
Tx is with pancreatic replacement enzymes |
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Term
| Chronic Differentials - Irritable Bowel Syndrome |
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Definition
S/S include abdominal cramping and distention, diarrhea, constipation, or both
Usually Female / Caucasian
Diagnosis of exclusion - should NOT be associated with weight loss, rectal bleeding, anemia, and should NOT be nocturnal or progressive |
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