Diarrhea

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Author:
jcu1
ID:
203020
Filename:
Diarrhea
Updated:
2013-02-24 15:13:18
Tags:
GI Exam
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Description:
Exam 1
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  1. diarrhea definitions
    • acute >14 days (self-limiting)
    • persistent 14 - 4 weeks
    • chronic >4 weeks
  2. rotavirus vs. norovirus
    • norovirus: 24 hour flu; duration 12-60 hours
    • rotavirus: infection in toddlers and infants; duration 5-8 days; vaccine prevents 75% cases
  3. clinical diarrhea groups
    • secretory/watery
    • osmotic
    • inflammatory
    • altered intestinal motility
  4. cause of secretory diarrhea
    • stimulation of crypt cells
    • produces influx of electrolytes and water into the lumen

    can happen with bacterial and viral enterotoxins and laxatives
  5. cause of osmotic diarrhea
    unabsorbed solutes in the intestine that inhibit fluid absorption

    stops in fasted state
  6. cause of inflammatory diarrhea
    inflammation of intestinal mucosa --> dec absorption of fluid, leakage of blood and pus into lumen
  7. cause of altered intestinal motility diarrhea
    premature emptying of intestinal tract b/c too rapid intestinal transit time

    usually chronic
  8. pts that get altered intestinal motility diarrhea
    • diabetic neuropathy
    • intestinal resection
    • gastric bypass surgery
    • IBS
  9. Phase 1 treatment for dehydration
    rehydration

    • for moderate - severe dehydration
    • severe: IV fluids
    • moderate: ORT
    • 6 months - 5 years: 50-100 mL/kg over 3-4 hrs
    • > 5 yo: 2-4 liters over 3-4 hrs
  10. phase 2 treatment for dehydration
    • for mild dehydration
    • give about 10 mL/kg for each stool or emesis

    • <10 kg: 60-120 mL
    • >10 kg: 120-240 mL
  11. pharmacologic treatment categories for diarrhea treatment
    • anti-motility agents (opiates or opioid derivatives)
    • anti-secretory agents
    • antibiotics
    • adsorbents
    • digestive enzymes
    • intestinal microflora
  12. Loperamide MOA
    peripherally acting anti-secretary agent
  13. used to prevent abuse of difenoxin
    atropine added
  14. difenoxin MOA
    peripherally and centrally acting anti-secretary agent
  15. bismuth subsalicylate MOA
    • dec freq of unformed stools
    • inc stool consistency
    • dec abdominal cramping
    • direct antimicrobial effects
  16. bismuth subsalicylate AEs
    • tongue discoloration
    • dark stools
    • salicylate toxicity/Reye's syndrome
  17. polycarbophil MOA
    • adsorbent
    • absorbs nutrients, drugs, toxins, digestive juices

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