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Questions and Answers
What is diarrhea?
What is diarrhea?
An increased frequency of bowel evacuation by the passage of three or more loose or liquid stools per day.
Which of the following is the most common cause of diarrhea in children under 2 years old?
Which of the following is the most common cause of diarrhea in children under 2 years old?
What is a less common viral cause of acute diarrhea?
What is a less common viral cause of acute diarrhea?
Bacterial infections
Bacterial infections are the most common causes of diarrhea.
Bacterial infections are the most common causes of diarrhea.
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Which pathogen is associated with contaminated chicken and eggs?
Which pathogen is associated with contaminated chicken and eggs?
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What is a common protozoan pathogen responsible for diarrheal disease?
What is a common protozoan pathogen responsible for diarrheal disease?
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What is the first-line treatment for infections caused by Entamoeba histolytica?
What is the first-line treatment for infections caused by Entamoeba histolytica?
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___ is the most common cause of chronic diarrhea.
___ is the most common cause of chronic diarrhea.
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Young children are at greater risk of dehydration due to diarrhea.
Young children are at greater risk of dehydration due to diarrhea.
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What type of fluids should patients with diarrhea avoid?
What type of fluids should patients with diarrhea avoid?
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For how long is zinc typically recommended to be given for diarrhea in developing countries?
For how long is zinc typically recommended to be given for diarrhea in developing countries?
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Study Notes
Diarrhea
- Diarrhea is defined as an increased frequency of bowel evacuation, with three or more loose or liquid stools per day.
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Infectious causes are the most common source of diarrhea.
- Viral causes are the most prevalent.
- Bacterial causes are less common.
- Protozoan causes are even less common.
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Rotavirus is the most common cause of diarrhea, especially in children under 2 years old, and is most prevalent during the winter months.
- The virus is highly contagious and spreads via the fecal-oral route.
- Oral vaccination against the virus has been available since 2006, and now significantly reduces the spread and effects of the virus
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Common bacterial pathogens causing diarrhea include:
- Campylobacter, often associated with contaminated chicken and eggs rather than beef.
- Salmonella, commonly associated with recooked rice that has been kept warm or reheated.
- B. cereus spp.
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Common Protozoan pathogens causing diarrhea include:
- Entamoeba histolytica (amoebic dysentery).
- Giardia lamblia (giardiasis).
- Stool samples are needed for diagnosis.
- Common treatments include metronidazole and tinidazole.
Diarrhea Causes (Non-Infectious)
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Drugs can contribute to diarrhea.
- Common culprits include laxatives, antacids containing magnesium, antineoplastic drugs such as:
- Clindamycin
- Tetracyclines
- Sulfonamides
- Misoprostol (cytotec)
- PPIs
- Digoxin at toxic levels
- Common culprits include laxatives, antacids containing magnesium, antineoplastic drugs such as:
Clinical Features of Acute Diarrhea
- Symptoms typically appear rapidly.
- Nausea and vomiting may precede or accompany onset.
- Abdominal cramping, flatulence, and tenderness may occur.
- Cough and cold may present if rotavirus is the cause.
- Stools are usually watery.
Chronic Diarrhea
- Irritable bowel syndrome (IBS) is the most common cause of chronic diarrhea.
- Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is another common cause.
- Malabsorption syndromes, such as celiac disease or lactose intolerance, can also contribute.
Patient Assessment with Diarrhea
- Age: Young children and individuals over 65 are at higher risk of dehydration.
- Duration: Diarrhea lasting more than 1 day in children and more than 2-3 days in adults should be evaluated.
- Severity: Dehydration requires immediate medical attention.
- Underlying Conditions: Individuals with current or prior conditions such as inflammatory diseases, diabetes, or cancer may require special considerations.
Treatment Recommendations for Diarrhea
- Oral Rehydration Solution (ORS): For dehydration, especially in children.
- Loperamide: May be used for adults and children over 12 years old.
- Zinc: Zinc supplementation with ORS can significantly improve the severity and duration of acute diarrhea in developing countries.
Miscellaneous Products with Weak Evidence-Based Medicine (EBM)
- Adsorbents: Such as Pectokaolin® (pectin + kaolin). Effectiveness unproven and questionable.
- Probiotics: Used to replace colonic microflora. Efficacy in preventing antibiotic-associated diarrhea (AAD) remains controversial.
Additional Advice for Patients with Diarrhea
- Drink plenty of clear fluids: Water and rice water are effective remedies.
- Avoid sugary drinks: Can prolong diarrhea.
- Avoid milk and milky drinks: Temporary lactose intolerance may occur due to damage to the intestinal lining caused by organisms.
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Description
This quiz explores the various causes and implications of diarrhea. It covers infectious sources, including viral, bacterial, and protozoan pathogens, and highlights the significance of rotavirus in young children. Test your knowledge on the common organisms responsible for diarrhea and their modes of transmission.
