1 / 16

diarrhea

diarrhea. intro. Generally > 3 stools per day daily stool weight exceeding 200 grams Up to 5% of ER visits Four mechanisms: increased intestinal secretion decreased intestinal absorption increased osmotic load abnormal intestinal motility . Clinical features. History Camping Travel

moswen
Download Presentation

diarrhea

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. diarrhea

  2. intro • Generally > 3 stools per day • daily stool weight exceeding 200 grams • Up to 5% of ER visits • Four mechanisms: • increased intestinal secretion • decreased intestinal absorption • increased osmotic load • abnormal intestinal motility

  3. Clinical features • History • Camping • Travel • Recently hospitalized • Abdominal pain • Physical exam • Rectal • Stool cultures if febrile, toxic

  4. treatment • Mild diarrhea: 30 to 50 mL/kg over the next 4 hours • Moderate diarrhea: 100 mL/kg over the next 4 hours • Soup and crackers • BRAT diet

  5. Traveler’s diarrhea • Most common causes depend on region travelled to • Fever and bloody stools: Salmonella, Shigella, Campylobacter, and E coli O157:H7 • Persistant diarrhea: E. histolytica antigen, G. intestinalis antigen, and Cryptosporidium parvum antigen

  6. treatment • Cipro is indicated for all patient with presumed infectious diarrhea • Can also use bactrim • Avoid anti-motility agents in bloody diarrhea

  7. C. diff • Most common cause of infectious diarrhea in hospitalized patients • anaerobic bacillus that causes infection ranging from diarrhea to pseudomembranous colitis • clindamycin, cephalosporins, ampicillin/amoxicillin, and, recently, fluoroquinolones

  8. C. diff • profuse diarrhea (20 to 30 stools per day), crampy abdominal pain, fever, leukocytosis, dehydration, and hypovolemia • Stools for c diff toxins • colonoscopy

  9. treatment • Oral metronidazole, 500 milligrams every 6 hours for 10 to 14 days for moderate disease • Oral vancomycin, 125 to 250 milligrams four times a day for 10 days for severe disease

  10. Crohn’s disease • chronic granulomatous inflammatory disease affecting anywhere mouth to anus • Affects one million in U.S. • Women > men • Family history in 10-15%

  11. Crohn’s • Involves all layers of bowel • Is discontinuous “skip lesions” • fissures, fistulas, and abscesses

  12. Clinical features • Abdominal pain, anorexia, diarrhea, and weight loss • Extraintestinal features • Arthritis • Ocular • Hepatobiliary • anemia

  13. treatment • Sulfasalazine, 3 to 5 grams per day • Mesalamine (Asacol®, Claversal®, Salofalk®, Lialda®), 2 to 4 grams per day • prednisone (40 to 60 milligrams per day) provides relief but does not shorten course • Ciprofloxacin (1.0 to 1.5 milligrams/kg/d) induces remission in percentages equal with mesalamine.

More Related