Johnson case opening acute diarrhea
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| 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
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| Acute diarrhea duration | <14 days
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| Chronic diarrhea duration | >30 days
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| Persistent diarrhea duration | >14 days but <30 days
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| Paradoxical diarrhea | Stool oozing around an impaction
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| Dysentery | -Frequent watery stools, often with blood/pus/mucus
-Clinically characterized by pain, tenesmus, dehydration
-Bacillary: Shigella ssp
-Amebic: Entamoeba histolytica
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| Enteritis | Inflammation of small intestine
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| Gastritis | Inflammation of stomach
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| Gastroenteritis | Inflammation of both stomach and intestine
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| Colitis | Inflammation of colon
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| Enterocolitis | Inflammation of both large and small intestine
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| 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
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| Osmotic Diarrhea | -d/t increased osmotic load
-watery
-often volume of stool produced <1 L/d
-Stops during fast or removal of offending substance
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| 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
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| 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
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| Malabsorption/Maldigestion | Fatty diarrhea
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| Motility-related Diarrhea | Functional diarrhea, irritable bowel syndrome
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| Organisms causing viral infection | -Rotavirus
-Norovirus
-Adenovirus
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| 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
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| Organsims causing parasitic infections | -Giardia lamblia
-Entamoeba histolytica
-Cryptosporidium
-Cyclosporoa cayetanensis
-Microsporidia
-Isospora
-Balantidium
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| N/V predominant acute diarrhea | -Bacillus cereus
-Staphylococcus aureus
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| Diarrhea predominant small bowel acute diarrhea | Viruses, bacteria, parasites
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| Diarrhea predominant large bowel acute diarrhea | bacteria, parasites
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| Inflammatory bloody acute diarrhea | -Crohn's ileitis
-Crohn's colitis
-Villous adenoma
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| Inflammatory non-blood acute diarrhea | -Ulcerative colitis
-Crohn's colitis
-Radiation colitis
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| Drugs/toxins acute diarrhea | -Laxative abuse
-Antibiotics
-Heavy metals
-many more
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| Dietary acute diarrhea | -Food allergy/hypersensitivity
-Osmotic causes (lactase deficiency, sugars, sugar alcohols)
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| 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
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| 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
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| Basic treatment of acute diarrhea | -Rehydration: oral, IV
-Antibiotics
-Symptomatic: antidiarrheals, antinausea meds
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| Contraindication for antidiarrheals | Never use antidiarrheals in patients with bloody diarrhea!
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