Summary Lower GI Problems complete study guide (NEW) N410 chapter 42_Lower GI Problems.

Chapter 42: Lower GI Problems DIARRHEA - Passage of at least three loose or liquid stool per day - Acute: lasting 14 days or less - Persistent: lasting longer than 14 days - Chronic: lasts 30 days or longer Etiology and Patho - Primary cause of acute diarrhea is ingesting an infectious organism - Viruses are also a common cause in the US - E. coli is most common (can be bloody) - Undercooked chicken or beef and fruits and vegetables contaminated manure - Travelers diarrhea: Giardia lamblia, intestinal parasite - C. diff: impairs absorption by destroying cells, causing inflammation of the colon, and produces toxins that cause damage - Secretory diarrhea: common result of bacterial or viral infections - A person's age, gastric acidity, intestinal microflora, and immune status influence susceptibility to pathogenic organisms - Older adults are most at risk - if on proton pump inhibitors or H2 blockers decrease the stomach acid that would kill the organism - Antibiotics kill of the normal flora making a person more susceptible - Patients that are immunosuppressed are also very susceptible to organisms - Diarrhea is not always due to infection- large amounts of undigested carbs, lactose intolerance, and certain laxatives produce osmotic diarrhea - Osmotic diarrhea: results from rapid GI transit that prevents absorption of electrolytes - Diarrhea from celiac and short bowel syndrome results from malabsorption in the small intestine Clinical Manifestations - Large volume, watery stool, cramping and periumbilical pain - Low grade fever or none - Often experience nausea and vomiting before the diarrhea begins - Infections of the colon and distal small bowel produce fever and frequent bloody diarrhea - Severe diarrhea - life threatening dehydration , electrolyte disturbances (hypokalemia), acid base imbalance (metabolic acidosis) Diagnostic Studies - Stool cultures are only done on patients who are very ill, have a high fever, pr have had diarrhea longer than 3 days - Stools are examined for blood, mucus, WBCs, and parasites - Cultures are reliable - Testing for ova and parasites is reserved for people who have diarrhea more than 2 weeks