Podcast
Questions and Answers
What is diarrhea defined as?
What is diarrhea defined as?
Increase in daily stool weight of more than 200 gm/24 hours.
What is the normal bowel frequency range?
What is the normal bowel frequency range?
Pseudodiarrhea is characterized by an increase in stool weight.
Pseudodiarrhea is characterized by an increase in stool weight.
False
What is the duration of acute diarrhea?
What is the duration of acute diarrhea?
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Which of the following is NOT a characteristic of non-inflammatory diarrhea?
Which of the following is NOT a characteristic of non-inflammatory diarrhea?
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What is a common source of Staphylococcus aureus food poisoning?
What is a common source of Staphylococcus aureus food poisoning?
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The incubation period for Clostridium perfringens is __ to __ hours.
The incubation period for Clostridium perfringens is __ to __ hours.
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What type of diarrhea is suggested by fever, abdominal pain, and hematochezia?
What type of diarrhea is suggested by fever, abdominal pain, and hematochezia?
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Which group of pathogens is known for producing chronic diarrhea?
Which group of pathogens is known for producing chronic diarrhea?
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Osmotic diarrhea is relieved by __.
Osmotic diarrhea is relieved by __.
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Study Notes
Diarrhea
- Increased daily stool weight of more than 200gm/24 hours.
- Normal bowel frequency ranges between 3times/day to 3times/week.
- Pseudodiarrhea: Increased frequency with normal weight.
- Incontinence: Involuntary release of rectal contents.
- Constipation refers to infrequent defecation (less than two bowel movements weekly)
- Patients may also complain of sensation of incomplete evacuation and either perianal or abdominal discomfort.
Diarrhea Classification
- Acute: 7-14 days. Occasionally less than 6 weeks.
- Persistent: 2-4 weeks
- Chronic: More than 4 weeks. Occasionally more than 6 weeks.
Acute Infectious Diarrhea
- Acute infectious causes are commonest.
- Non-inflammatory ( watery, non bloody, periumblical cramps, bloating, nausea, vomiting )
- Inflammatory ( fever, bloody, small in volume, left lower quadrant cramps, urgency & tenesmus)
Non-inflammatory Diarrhea
- Staphylococcus aureus: Shortest incubation period (1-6 hours), lasts for less than 12 hours. Infected human carriers are the source. Food left to cool slowly at room temperature allows organism to form toxins, outbreaks after picnics, potatoes, salads, mayonnaise, cream pastries.
- Bacillus cereus: Two types of illness: Emetic form (within 6 hours, stereotypically due to rice) and Diarrheal form (after 6 hours). If cooked rice is not refrigerated, heat resistant spores germinate and produce toxins. Frying before serving may not destroy these preformed heat stable toxins.
- Clostridium perferingens: Incubation period 8-14 hours. Heat resistant spores. Inadequately cooked meat, poultry or legumes. Self limiting up to 24 hours.
Inflammatory Diarrhea
- Viral: Noro virus (diarrhea & vomiting same time), Rota virus (workers in nursery care), watery.
- Protozoal: Entamoeba histolytica (Gradual onset bloody diarrhea, abdominal pain and tenderness that may last several weeks), Cryptosporidium (common in patients with HIV/ AIDS), Giardiasis (prolonged non bloody leads to malabsorption)
- Bacterial: Shigella (Bloody diarrhea, vomiting, abdominal pain), Compylobacter jejuni (A flu-like prodrome is usually followed by crampy abdominal pain, fever and diarrhea which may be bloody), E-coli (Commonest infectious agent amongst travelers, watery diarrhea with abdominal cramps and nausea).
Approach to Patient with Diarrhea
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HISTORY:
- Duration: May correlate with dehydration
- Fever: Infections outside the gut like Malaria.
- Frequency.
- Abdominal pain: Inflammatory nature, RIF Pain with yersina, Bloating with Giardiasis.
- Vomiting: Acute illness, Toxin, Systemic disease, Obstruction
- Tenesmes: Shigellosis
- Appearance of stools: Blood –shigellosis, Rice watery – Vibrio cholera, Bulky white – small intestine.
Chronic Diarrhea
- Diarrhea which persists for more than 4 weeks.
- Needs evaluation to exclude serious pathology.
- Most of the causes are noninfectious.
Classification of Chronic Diarrhea
- Osmotic
- Secretory
- Inflammatory
- Motility disorders
- Factitious
- Malabsorptive conditions
- Chronic infections
Osmotic Diarrhea
- Large volume stool results from lack of absorption of orally ingested solutes (food).
- Osmotic effect.
- Relieved with fasting.
- Clinical symptoms are usually because of malabsorption of fat or carbohydrates.
- Osmotic causes include lactase deficiency intolerant to dairy products, drugs like laxatives etc.
Secretory Diarrhea
- Watery painless excretion of large amounts (more than 1 litre/day).
- No effect with fasting (persist).
- Abnormal fluid and electrolyte transport, no pus, mucus or blood in stool.
- Hormones mediated.
- Causes may include Carcinoid, Zollinger-Ellison syndrome, Medullary carcinoma of thyroid and extensive gut resection.
Steatorrheal Diarrhea
- Intraluminal maldigestion: Chronic pancreatitis, Decreased bile salts, Bacterial overgrowth.
- Mucosal malabsorption: Celiac disease, Tropical sprue.
- The stools are large volume, fatty or greasy, pale yellow to grey colored, extremely smelly, sometimes frothy and float in the toilet bowl.
- Quantitatively, steatorrhea is defined as stool fat exceeding the normal 7 g/d; rapid-transit diarrhea may result in fecal fat up to 14 g/d; daily fecal fat averages 15–25 g with small intestinal diseases and is often >32 g with pancreatic exocrine insufficiency.
Inflammatory Diarrhea
- Fever
- Abdominal pain and tenderness.
- Hematochezia.
- Patients may have toxic looks.
- Extra intestinal manifestations may be present.
- Causes include IBD, malignancy, radiation enteritis and infectious diarrheal agents.
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Description
This quiz focuses on the classification of diarrhea, including acute, persistent, and chronic types. It explores infectious causes, both inflammatory and non-inflammatory, and provides insights into associated symptoms. Test your knowledge on this important gastrointestinal topic!
