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Diarrhea
1
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exclude infection with STOOL for white cells, culture, giardia antigen, ova and parasite
...
after that we see if there is blood and fever it cant be lactose intolerance (just get rid of
milk)
4
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also after that: only the fat malabsorptions give u diminished Vitamins A D E K
6
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coli 015787 ( associated with hemolytic uremic syndrome)
with HUS we don’t give
antibiotics since as they die they release more shiga like toxin
causing worsening of HUS
platelets as much as the platelet count goes low since it makes the
clot worse
Vibrio Parahemolyticus (seen in shellfish)
Vibrio Vulmifigus associated with
Liver disease
hemochromatosis
iron overload
bullous skin lesions
we can never know the exact bacteria without culture
NO: Non invasive diarrhea (Blood won’t ever appear soon, in these cases it takes so
much time)
Viral
Giardia
unfiltered water, fishing, gay men, campers
stool Giardia antigen for testing
...
difficile)
if it’s CHRONIC:
Lactose intolerance:
complete absence of blood, fever and anything that looks like an infection
diagnose by removing dairy and checking if diarrhea heals
Irritable Bowel Syndrome
it is a diagnosis of exclusion
presents with Diarrhea alternating with Constipation
it is a PAIN syndrome (abdominal)
it sometimes gets better with bowel movement
symptoms are not at night!
everybody should be treated with
Fiber/Bulking agents
Antispasmodics hyoscyamine and Dicyclomine
TCAs because
they are anti cholinergic so they relax the bowel
since 40% have depression
they are analgesics
if diarrhea is dominant:
take Alosetron (5-HT3 antagonist)
if constipation is dominant:
take Tegaserod (5-HT4 antagonist)
Carcinoid syndrome:
it is intermittent
flushing
wheezing
cardiac problem (tricuspid insufficiency and pulmonic stenosis)
it causes chronic fibrosis of the the Right side of the heart
test with 5 HIAA hydroxyindolacetic acid in the urine (unique to carcinoid)
treat with octreotide (somatostatin analog)
the only ones presenting with STETORRHEA (tested with a Sudan black test) with very
significant WEIGHT LOSS due to fat malabsorption
...
we dont use it anymore
can be diagnosed with Xrays and CT scans but only 50% show the calcifications
it is diagnosed by repeated history of pancreatitis with addition to fat malabsorption
BY THE TIME WE DEVELOP CHRONIC PANCREATITIS THE AMYLASE AND LIPASE
ARE NORMAL since the pancreas has been juiced off the amylase and lipase
Secretin stimulation test is the most accurate test since it makes the pancreas release
HCO3
...
Tropical sprue:
better than Celiac since it can be diagnosed with Biopsy
and treated with Bactrin or Doxycycline
unlike Celiac that can’t be cured
Secretory diarrhea is usually the result of some medication use or hormonal
disturbances
...
There is little to no structural damage
Osmotic diarrhea is caused by the ingestion of osmotically active, poorly absorbable
substances
...
occurs when too much water is drawn into the
bowels
...
Factitial diarrhea is typically associated with psychiatric disturbances
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Blood/leukocyte-positive stool is another important finding