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Lower Gastrointestinal Problems (Inflammatory Disorders (Appendicitis,…

- - - - Persists for at least 2 weeks
      - Subsides & returns more than 2 to 4
        weeks after the initial episode
      - Severe dehydration (water and sodium loss) & electrolyte disturbances (hypokalemia)
        
        Malabsorption & Malnutrition
  - - - Viral
        
        Rotavirus: O(18-24hr), D(3-8 days), fever, vomiting, and profuse watery diarrhea
        
        Norwalk virus: O(18-24hr), D(24-48hr), nausea, vomiting, diarrhea, stomach cramping
      - Bacterial
        
        Escherichia coli: O(4-24hr), D(3-4 days), Four or five loose stools per day, nausea, malaise, low-grade
        fever
        
        Enterohemorrhagic E. coli (0157:H7): O (4-24hr), D(4-9 days), Bloody diarrhea, severe cramping, fever
        
        Shigella: O (24hr), D(7 days), Watery stools containing blood and mucus; tenesmus, urgency,
        severe cramping, fever
        
        Salmonella: O (6-48hr), D(2-5 days), Watery diarrhea, nausea, vomiting, abdominal cramps, fever
        
        Campylobacter species: O (24hr), D(<7 days), Profuse, watery diarrhea; malaise, nausea, abdominal cramps,
        low-grade fever
        
        Clostridium perfringens: O (8-12hr), D(24hr), Watery diarrhea, abdominal cramps, vomiting
        
        Clostridium difficile: O (4-9 days after start of antibiotics), D(24hr), Associated with antibiotic treatment; symptoms range from mild, watery diarrhea to severe abdominal pain, fever,
        leukocytosis, leukocytes in stool
      - Parasitic
        
        Giardia lamblia: O (1-3 wk), D(Few days to 3 mo), Sudden onset; malodorous, explosive, watery diarrhea;
        flatulence, epigastric pain and cramping, nausea
        
        Entamoeba histolytica: O (4 days), D (Weeks to months), Frequent soft stools with blood and mucus (in severe cases,
        watery stools), flatulence, distension, abdominal cramps, fever,
        leukocytes in stool
        
        Cryptosporidium: O (2-10 days), D (1-6 mo), Watery diarrhea, nausea, vomiting, abdominal cramps, weight
        loss in AIDS
    - - Decreased Fluid Absorption
        
        Oral intake of poorly absorbable solutes (e.g., laxatives)
        
        Maldigestion and malabsorption
        
        Mucosal damage: celiac disease, inflammatory bowel disease, radiation injury, ischemic bowel
        
        Pancreatic insufficiency (e.g., cystic fibrosis)
        
        Intestinal enzyme deficiencies (e.g., lactase)
        
        Bile salt deficiency
        
        Decreased surface area (e.g., intestinal resection, short gut syndrome)
      - Increased Fluid Secretion
        
        Infectious: bacterial endotoxins (e.g., cholera, Escherichia coli, Shigella, Salmonella, Staphylococcus,
        Clostridium difficile, viral agents [rotavirus], and parasitic agents [Giardia lamblia])
        
        Drugs: laxatives, antibiotics, suspensions, or elixirs containing sorbitol
        
        Foods: candy, gum, and mints containing sorbitol
        
        Hormonal: vasoactive intestinal polypeptide secretion from adenoma of the pancreas; gastrin secretion
        caused by Zollinger-Ellison syndrome; calcitonin secretion from carcinoma of the thyroid
        
        Tumour: villous adenoma
      - Motility Disturbances
        
        Irritable bowel syndrome: ↑ visceral sensitivity and transit
        
        Diabetic enteropathy: ↑ transit secondary to autonomic neuropathy
        
        Gastrectomy: ↑ transit as a result of dumping syndrome
  - - - Blood tests
        
        Anemia, elevated white blood cell (WBC) count, iron and folate deficiencies, elevated liver enzyme levels, and electrolyte disturbances
      - Examine stools
        
        Measure stool electrolytes, pH, & osmolality
        
        Elevated serum levels of GI hormones such as vasoactive intestinal polypeptide and gastrin
        
        Measure stool fat & undigested muscle fibre
        
        Fat & protein malabsorption conditions,
        including pancreatic insufficiency?
        
        Decreased fluid absorption? increased fluid secretion (secretory diarrhea)?
        
        Presence of blood, mucus, WBCs, ova, parasites, & infectious organisms
      - Endoscopy may be used to examine the mucosa
        and to obtain specimens via biopsy for examination.
      - Upper and lower radiographic studies w/ barium contrast
        
        Mucosal disease? Structural abnormalities?