Diarrhea and Constipation

what are the mechanisms of diarrhea?

osmotic/indigestion and secretory/bacterial

what are examples of osmotic/indigestion diarrhea?

lactose and sorbitol, undigested material

what bacteria is enteriovasive?

C. jejuni, Salmonella, Shigella sonnei

what bacteria are enterotoxic?

S. aureus, E. coli (must report), C. difficile

what does presence of fecal leukocytes suggest?

enteroinvasive

what is true viral diarrhea?

usually resolves in 48 hours

what are causes of viral diarrhea?

adenovirus and rotavirus

what type of parasite cause diarrhea commonly if they have been hiking or rafting 1-3 weeks earlier?

G.lamblia 

what will the stool contain in a patient with G.lamblia?

cysts and trophozoites

how is G.lamblia treated?

metronidazole

if a patient has blood in stool, what conditions should be be thinking?

IBD like UC or Crohn’s

if a patient has a recent onset of diarrhea with blood and a high fever, what should we be suspecting?

C. jejuni, salmonella and shigella sonnei 

if a patient has a recent onset of diarrhea with no blood, nausea and vomiting, and increased peristalsis, what should we be suspecting?

giradia (hiking and rafting), E.coli (traveling outside US)

if a patient has recurrent diarrhea that is bloody, what should we suspect?

sigmoid polyps/carcinoma (>50 yrs), UC (stress), Crohn’s (weight loss)

if a patient has recurrent diarrhea that is not bloody, what should we suspect?

IBS (mucus and constipation) lactose intolerance

what are causes of gastroenteritis with diarrhea that lasts minutes to hours?

monosodium glutamate, fish toxins, heavy metals, mushrooms 

how will monosodium glutamate gastroenteritis present?

burning sensation in the head, trunk and extremities

what are causes of gastroenteritis with diarrhea that lasts 2-8 hours?

S. aureus, bacillus cereus and c. perfringens 

how will patients with gastroenteritis caused by S. aureus present?

vomiting, no fver, duration less than 24 hours

what foods commonly cause S.aureus gastroenteritis?

ham, poultry and mixed salads

how will patients with gastroenteritis caused by bacillus cereus present?

no fever, cramping, duration less than 2 days 

what foods commonly cause bacillus cereus gastroenteritis?

fried rice, mac n cheese

how will patients with gastroenteritis caused by c.perfringens present?

no fever, vomiting, duration less than 24 hours 

what foods commonly cause c.perfringens gastroenteritis?

meat and pultry 

what are causes of gastroenteritis with diarrhea that lasts 12 hours to days?

E. Coli, Vibrio cholerae, Shigella sonnei, Salmonella typhi, Vibrio parahaemolyticus, C. jejuni, C. botulinum

how does salmonella typhi present?

dysentery and prolonged fever 

how does C. boutlinum present?

CN palsies, paralysis and respiratory failure

what should we be suspecting if an infant has constipation at birth?

hirschsprung’s

what should we be suspecting if a patient has painful constipation?

dehydration or hemorrhoids

what should we be suspecting if an adult has constipation with abdominal pain?

colorectal cancer or IBS 

what medications can cause constipation?

codeine, iron supplements, diuretics and antidepressants

what are the six symptoms of IBS?

pain relief with pooping, more frequent stools with onset of pain, constipation/firm stool in the morning, loser poop, passage of mucus, sensation of not done pooping, and abdominal distention

how does IBS present?

late tessn or younger than 30, abdominal pain (LLQ or suprapubic) that is relieved with defectaion 

what will rectal and stool exam show with IBS?

non bloody stool free of leukocytes, parasites and ova

what will be present in a rectal/stool exam in a patient with IBS?

mucus and steatorrhea

what is the treatment for IBS?

stress reduction and dietary factors, intestinal Ca-channel blockers

what medication is an intestinal Ca channel blocker used is IBS?

dicetel 

what is the presentation of celiac disease?

younger patient with abdominal cramping, explosive flatulence, weight loss, diarrhea and a rash on their elbows knees butt and back

what is the name of the rash seen in patients with celiac disease?

dermatitis herpetiformis

what will examination reveal in patients with celiac disease?

abdominal distention, aphlous stomatitis, dermatitis herpetiformis

what labs need to be checkin in patients with celiac?

iron status, liver function, d-xylose for malabsorption, vitamins A,D,C, folate and B12, cholesterol and natural fats 

what is used to diagnosis celiac?

anti-tTG, AGA, IgG and IgA

what is the treatment for celiac disease?

predisone for refractive CD (autoimmune), substitute with corn, rice and soybeans

how does lactase deficiency present?

bloating, abdominal cramps and flatulence

what is the lab test for lactase deficency?

hydrogen breath test

what is the treatment for lactase deficiency?

achieve patient comfort by finding their tolerable range, lactaid