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Medicine

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Liver & GIT

Question
1 out of 8
 

A patient is said to have chronic diarrhea if it is occurring for more than.. weeks?



A 3
B 4
C 5
D 6

Ans. B 4

Definition-It is defined according to symptoms as increase in liquidity, frequency and volume of stools; and according to sign as increase in stool weight of more than 200gm/day.

Pseudo diarrhea-it is the frequent passage of small volume of stools. It is seen in irritable bowel syndrome and proctitis.

Classification-It is classified according to duration as

Acute-Duration less than 2 weeks.

Persistent-Duration of 2-4 weeks.

Chronic-Duration of more than 4 weeks.

Acute Diarrhea-90% cases of acute diarrhea are due to infectious causes, rest 10% are due to noninfectious cause.

1. Infectious causes-

A. Toxin producer-

i. Preformed toxin-Staphylococcus aureus, Bacillus cereus, Clostridium perfringens.Q

ii. Enterotoxin-Vibrio cholerae, ETEC, Klebsiella pneumoniae, Aeromonas sp.Q

iii. Enteroadherent-

iv. E.coli,Giardia,cryptosporadium,helminths

v. Cytotoxin producers-

Clostridium difficile, hemorrhagic E. coli.

vi. Invasive organisms-

a. Minimal inflammation- Rotavirus, Norwalk virus

b. Moderate inflammation- Salmonella, Campylobacter, Yersinia, Vibrio parahaemolyticus

c. Severe inflammation- Shigella, enteroinvasive E. coli, Entamoeba histolytica. Q

2. Non-infectious causes-

i. Drug- Antibiotics, antiarrhythmic, laxatives, NSAIDs, antihypertensives, chemotherapeutic agents, antacids, Theophylline.

ii. Toxins-organophosphate insecticides, amanita mushroom, arsenic.

iii. Ischemia-Ischemic colitis.

iv. Diverticulitis-colonic diverticulitis.

v. Graft vs host reaction.

Investigations-The most cases of acute diarrhea are self limiting and do not require detailed investigations. The indications for evaluation are-

1. Profuse diarrhea with dehydration.

2. Grossly bloody stools.

3. Fever>38.5 C.

4. Duration >48 hrs without improvement.

5. Age>50 years with severe abdominal pain .

6. Immunocompromised pt.

7. New community outbreak

Examination of the stools-

1. Presence of WBCs in stools-bacteria, toxin, ischemic colitis.

2. Occult blood in stools-colonic neoplasm, ischemia, ameobiasis, severe mucosal inflammation causing bacteria.

3. Ova and cyst –for helminths

4. Viral antigen-Rota virus

5. Immunoassay for toxins-Clostridium difficile Q

6. Protozoal antigen-Giardia, E. histolytica. Q

Endoscopy-If stool studies are unrevealing, flexible sigmoidoscopy with biopsy and upper GI endoscopy with duodenal aspirate and biopsy are indicated.

Treatment-

1. Fluid and electrolyte replacement.

2. Antimotility agents should be avoided in infectious diarrhea. They can be given in moderately severe nonfebrile, non bloody diarrhea.

3. Antibiotics-The indications for the use of antibiotics are-

a. Fever>38.5 C b. Bloody stools

c. Increased in fecal WBCs d. Immunocompromised pt.