Chapter 114: Diarrhea, Noninfectious Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient, who first developed acute diarrhea 2 weeks ago, presents to clinic reporting profuse watery, bloody diarrheal stools 6 to 8 times daily. The provider notes a toxic appearance with moderate dehydration. Which test is indicated to diagnose this problem?

a. Qualitative and quantitative fecal fat b. Stool collection for 24-hour stool pH c. Stool sample for C. difficile toxin d. Wright stain of stool for white blood cells

ANS: C a. A diet high in carbohydrates b. Avoiding liquids with meals c. Empirical antibiotic therapy d. Probiotic supplements

Patients with acute onset diarrhea lasting more than 2 weeks with profuse, watery, bloody stools of more than 6 times in a 24-hour period warrants testing for C. difficile toxin. Qualitative and quantitative fecal fat, 24-hour pH studies, and Wright stain for WBCs are performed when chronic diarrhea are present.

2. A patient who developed chronic diarrhea after gastric surgery asks what can be done to mitigate symptoms. What will the provider recommend initially?

ANS: B

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Initial suggestions for treating postoperative diarrhea will include avoiding fluids during meals and lying down after meals. Concentrated carbohydrates may trigger symptoms. Empirical antibiotic therapy is indicated for small intestinal bacterial overgrowth syndrome with specific symptoms and an association with an elevated folate level. Probiotic supplements may be used as adjunctive therapy.

Multiple Response

1. Which types of chronic noninfectious diarrhea will cause fatty stools? (Select all that apply.)

a. Celiac disease b. Cystic fibrosis c. Diabetes mellitus d. Lactose intolerance e. Pancreatic insufficiency

ANS: A, B, E

Celiac disease, cystic fibrosis, and pancreatic insufficiency all produce malabsorption of fats and will result in fatty stools. Diabetes results in glucose malabsorption, while lactose intolerance causes lactose malabsorption.