8B. Diarrhea Treatment Overview

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following laxatives is specifically recommended for women with chronic constipation who have not responded to other treatments?

Methylcellulose

Prucalopride (correct)

Bisacodyl

Polyethylene glycol

What is the mechanism of action of bulk-forming laxatives like psyllium?

Activating chloride channels and increasing intestinal fluid secretion

Stimulating the release of acetylcholine

Increasing water content in the stool and lubricating the intestines (correct)

Hydrolyzing into an active metabolite that directly stimulates colonic peristalsis

Which of these laxatives is considered a rescue treatment for patients who have not responded to other laxatives?

Polyethylene glycol

Lubiprostone

Bisacodyl (correct)

Senosides A and B

How do prebiotics and probiotics differ in their mechanism of action on the intestinal ecosystem?

Prebiotics primarily target bacterial populations, while probiotics also directly influence mucosal immune mechanisms. (D) Signup and view all the answers

Which of the following is NOT a pharmacological measure for treating constipation?

High fiber intake (C) Signup and view all the answers

Which laxative works by activating CIC-2 chloride channels, leading to increased intestinal fluid secretion?

Lubiprostone (C) Signup and view all the answers

Which of the following statements is TRUE regarding chronic idiopathic constipation?

It involves persistent difficulty with bowel movements and other associated symptoms. (D) Signup and view all the answers

What is the mechanism of action of senosides A and B, a common over-the-counter treatment for constipation?

They increase cyclooxygenase 2 (COX2) expression in macrophage cells, leading to increased PGE2 production. (A) Signup and view all the answers

Which of the following is NOT a disease associated with chronic constipation?

Irritable bowel syndrome (B) Signup and view all the answers

What is the primary way that prokinetic laxatives like prucalopride work to alleviate constipation?

By stimulating the 5-HT4 receptors in the GI tract (D) Signup and view all the answers

Which of the following is NOT a symptom associated with acute diarrhea?

Constipation (A) Signup and view all the answers

What is the first-line treatment for acute diarrhea?

Oral rehydration (B) Signup and view all the answers

Which of the following is NOT recommended for the treatment of acute diarrhea in adults?

Probiotics (A) Signup and view all the answers

Which of the following is a fluoroquinolone antibiotic used to treat traveler's diarrhea?

Ciprofloxacin (C), Levofloxacin (D) Signup and view all the answers

What is the most common enteric pathogen causing diarrhea in children?

Rotavirus (D) Signup and view all the answers

Which of the following is a sign of dehydration in a child with diarrhea?

Sunken eyes (B) Signup and view all the answers

Which of the following is NOT a component of oral rehydration solution (ORS)?

Calcium (D) Signup and view all the answers

What is the mechanism of action of oral rehydration solution (ORS)?

It helps the body absorb fluids and electrolytes by using the sodium-glucose transporter (SGLT1). (C) Signup and view all the answers

Which of the following is NOT recommended for the prevention of traveler's diarrhea?

Probiotics (A) Signup and view all the answers

Which of the following is NOT a contraindication for the use of loperamide in children with diarrhea?

Constipation (D) Signup and view all the answers

Which of the following is a potential side effect of antibiotic therapy for diarrhea?

Increased risk of developing antibiotic-resistant bacteria (D) Signup and view all the answers

Study Notes

Diarrhea

Acute Diarrhea: Passage of many loose or liquid stools (3 or more in 24 hours) for less than 13 days. Abrupt onset.
Symptoms: Nausea, vomiting, abdominal pain, bloating, flatulence, fever, bloody stools, tenesmus, fecal urgency.
Persistent Diarrhea: Lasting between 14 and 30 days.
Chronic Diarrhea: Lasting longer than 30 days.

Treatment of Diarrhea

First Line: Oral rehydration (balanced electrolyte solution).
Probiotics/Prebiotics: Not recommended for routine acute diarrhea in adults, but may help post-antibiotic illness.
Non-antibiotic Therapies:
- Bismuth subsalicylates (BSS): Moderate effectiveness in controlling stool passage; may help travelers with mild to moderate illness.
- Adjunctive loperamide: May decrease duration and improve chance of cure, particularly in travelers with antibiotic-associated diarrhea.
Antibiotic Therapy: Not routinely used for community-acquired diarrhea (often viral), except in travelers' diarrhea with high bacterial pathogen likelihood.
Specific Treatment for Travelers' Diarrhea: Levofloxacin or Ciprofloxacin (fluoroquinolones).

Acute Diarrhea in Children

Common Causes: Rotavirus, norovirus, astrovirus, enteroaggregative E. coli, atypical E. coli, Giardia, Cryptosporidium, and Entamoeba histolytica.
Symptoms: Loss of appetite, fever, vomiting, mucus in stools. Systemic symptoms like fever, severe dehydration, and lethargy.

Dehydration Assessment

Evaluation: Skin turgor, eye sunkeness, general appearance, capillary refill time, mucous membranes.

Rehydration

Oral Rehydration Solution (ORS): First-line treatment.
Mechanism of Action: SGLT1 (sodium-glucose cotransporter) mediates glucose absorption, drawing sodium and chloride into the cells with water following to maintain balance.
Enteral Rehydration: Preferred over intravenous method for most children.
Intravenous Fluids: For severe dehydration with or without shock.

Prevention of Diarrhea

Handwashing: Crucial for preventing most traveler's diarrhea.
Pretravel Counseling: Importance of avoiding high-risk food/beverage.
Prophylactic Medications:
- Bismuth subsalicylates: Moderate effectiveness.
- Probiotics/prebiotics/synbiotics: Not recommended.
- Antibiotic chemoprophylaxis: Moderate to good effectiveness; may be used in high-risk individuals for short-term use.

Constipation

Definition: Difficult or infrequent bowel movements, often with straining and sensation of incomplete evacuation.
Chronic Idiopathic Constipation: 2 or more of the following for 3+ months: lumpy or hard stools, straining, sensation of obstruction/blockage, sensation of incomplete evacuation, need for manual maneuvers, fewer than 3 bowel movements per week.
Associated Diseases: Neoplasia, intestinal stenosis, rectal prolapse, diabetes, hypothyroidism, chronic renal failure. More prevalent in women.

Treatment of Constipation

Non-Pharmacological: High fiber intake, water intake, physical exercise.
Pharmacological:
- Bulk-Forming: Psyllium, methylcellulose (increase water content in stool).
- Osmotic: Polyethylene glycol, lactulose (increase water in stool).
- Emollient/Lubricant: Bisacodyl (stimulates peristalsis), Senosides A & B (increase fecal water content).
- Prokinetic: Prucalopride (stimulates GI motility).
- Secretory: Lubiprostone (increases intestinal fluid secretion).

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the different types of diarrhea, including acute, persistent, and chronic forms, along with their symptoms. It also explores treatment options ranging from oral rehydration to various medications. Test your knowledge on the best practices for managing diarrhea.