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Acute Diarrhea Open

Johnson case opening acute diarrhea

QuestionAnswer
Definition of Diarrhea - >200-250 gm/day of stool - Decrease in fecal consistency - Abnormal frequency and liquidity of stool with greater than 3 loose/watery stools in 24 hours
Acute diarrhea duration <14 days
Chronic diarrhea duration >30 days
Persistent diarrhea duration >14 days but <30 days
Paradoxical diarrhea Stool oozing around an impaction
Dysentery -Frequent watery stools, often with blood/pus/mucus -Clinically characterized by pain, tenesmus, dehydration -Bacillary: Shigella ssp -Amebic: Entamoeba histolytica
Enteritis Inflammation of small intestine
Gastritis Inflammation of stomach
Gastroenteritis Inflammation of both stomach and intestine
Colitis Inflammation of colon
Enterocolitis Inflammation of both large and small intestine
Tenesumus Painful spasm of urogenital diaphragm accompanied by an urgent desire to evacuate the bowel or bladder and involuntary straining that results in the passage of little to no matter
Osmotic Diarrhea -d/t increased osmotic load -watery -often volume of stool produced <1 L/d -Stops during fast or removal of offending substance
Secretory Diarrhea -Watery -Occurs when secretion of electrolytes and water into the lumen exceeds absorption -Often produces stool volume >1 L/d -Usually doesn't resolve with 2-3 day fast
Inflammatory Diarrhea -Exudative -Mucosal lining inflamed, damage to the mucosal lining or brush border -Structural damage to the mucosa impairs absorption and stimulates secretion -Stool positive for WBCs
Malabsorption/Maldigestion Fatty diarrhea
Motility-related Diarrhea Functional diarrhea, irritable bowel syndrome
Organisms causing viral infection -Rotavirus -Norovirus -Adenovirus
Organisms causing bacterial infections -Salmonella -E. coli -Shigella -Bacillus cereus -Clostridium perfringes -Staphylococcus aureus -Vibrio cholera -Vibrio parahaemolyticus -Yersinia enterocolitica -Campylobacter jejuni -Clostridium difficile -Listeria monocytogenes
Organsims causing parasitic infections -Giardia lamblia -Entamoeba histolytica -Cryptosporidium -Cyclosporoa cayetanensis -Microsporidia -Isospora -Balantidium
N/V predominant acute diarrhea -Bacillus cereus -Staphylococcus aureus
Diarrhea predominant small bowel acute diarrhea Viruses, bacteria, parasites
Diarrhea predominant large bowel acute diarrhea bacteria, parasites
Inflammatory bloody acute diarrhea -Crohn's ileitis -Crohn's colitis -Villous adenoma
Inflammatory non-blood acute diarrhea -Ulcerative colitis -Crohn's colitis -Radiation colitis
Drugs/toxins acute diarrhea -Laxative abuse -Antibiotics -Heavy metals -many more
Dietary acute diarrhea -Food allergy/hypersensitivity -Osmotic causes (lactase deficiency, sugars, sugar alcohols)
What situations warrant stool culture collection? -Immunocompromised patients -Co-morbidites -Severe, inflammatory diarrhea (including bloody diarrhea) -Patients with underlying inflammatory bowel disease in whom the distinction between a flare and superimposed infection is critical -Food handlers
Medically significant diarrhea -Profuse watery diarrhea w/ hypovolemia -Passage of many small volume stools w/ blood and mucus -Blood -Temp >101.3 F -Pass >6 unformed stools/24 h -Severe ab pain -Hospitalized/elderly/antibiotics/immunocompromised -Pregnant
Basic treatment of acute diarrhea -Rehydration: oral, IV -Antibiotics -Symptomatic: antidiarrheals, antinausea meds
Contraindication for antidiarrheals Never use antidiarrheals in patients with bloody diarrhea!
Created by: 1334850283
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