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What is the primary pathophysiological difference between acute non-inflammatory and acute inflammatory diarrhea?
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Acute non-inflammatory affects the small bowel and involves massive decrease in absorption without mucosal damage, whereas acute inflammatory affects the colon and involves direct mucosal damage.
What defines acute diarrhea?
At least three or more loose stools per day for less than two weeks.
Name some of the common pathogens that cause acute inflammatory diarrhea.
Salmonella, Shigella, Campylobacter, EHEC O157:H7, C. difficile, Entamoeba histolytica.
List some causes of chronic secretory diarrhea.
VIPoma, Gastrinoma, Carcinoid Syndrome, stimulant laxatives like Senna and Docusate.
What laboratory findings would suggest hypovolemia as a complication of acute diarrhea?
Low electrolytes and metabolic acidosis (non-anion gap).
What is a major diagnostic indicator for acute inflammatory diarrhea?
Presence of fecal WBCs, fecal calprotectin, blood in stool.
Which pathogens are typically associated with acute non-inflammatory (secretory) diarrhea?
S. aureus, B. cereus, ETEC, Vibrio cholerae, Norovirus, Rotavirus, Giardia, Cryptosporidium.
Identify common causes of chronic osmotic diarrhea.
Celiac disease, EPI (Exocrine Pancreatic Insufficiency), Tropical Sprue, Whipple's disease, Lactose intolerance, osmotic laxatives.
How should one determine whether chronic diarrhea is inflammatory, secretory, or osmotic?
For inflammatory: test fecal WBCs, calprotectin, and occult blood. For secretory or osmotic: test stool osmotic gap, followed by specific tests for VIP/gastrin/serotonin levels (secretory) or fecal fat/hydrogen breath test (osmotic).
What distinguishes chronic inflammatory diarrhea from other types of chronic diarrhea?
Presence of chronic inflammation that damages the mucosa, leading to symptoms like bloody, mucous-containing stools, and the presence of fecal WBCs and calprotectin.
Which complications are frequently associated with acute diarrhea?
Hypovolemia, colitis, Hemolytic Uremic Syndrome (HUS).
What are the diagnostic indicators of chronic secretory diarrhea?
Watery diarrhea, low stool osmotic gap.
What are the diagnostic indicators for acute non-inflammatory diarrhea?
No fecal WBCs, no fecal calprotectin, no blood in stool.
Describe the typical symptom triad of Hemolytic Uremic Syndrome (HUS).
Hemolytic anemia, thrombocytopenia, acute kidney injury.
What initial diagnostic tests should be performed for acute diarrhea and why?
CBC and BMP to identify complications like HUS, hypovolemia, and metabolic acidosis; stool analysis if high-risk (fecal WBCs, fecal calprotectin, stool cultures, O&P, norovirus/rotavirus testing).
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