Friday, October 21, 2022: Gastroenterology: Diarrhea is an Increased Volume or Frequency of Stool, Generally of a more Liquid Consistency; Ax: 1) Idiopathic (Most Common Cause), 2) Viral Infection; Fluid Assessment is Most Important in the Management of this Disease Process (Hypotension, Orthostasis, Severe Pain, Fever, Abdominal Pain/Tenderness warrant Admission) and Normal Saline (NS) Bolus is Mandatory therein; Diarrhea can be classified as: 1) Acute ( 2 Days) PO Vancomycin is Indicated. Complications possible are 1) Toxic Megacolon and 2) Perforation. In Lactose Intolerance (LI), a common Enzyme Deficiency Pathology, lactase is Absent or Deficient allowing Bacteria Metabolize Lactose to Glucose and Galactose effecting Flatulence and Diarrhea thereby. Dx: Elevated Stool Osmolar Gap on Stool Studies. Tx: 1) Avoidance of Dairy Products (with the Exception of Yogurt) will Treat the Problem and Diagnose the Pathology; 2) Lactase Supplementation; 3) Symptoms Abate within 1-2 Days. In 2) Persistent Diarrhea (> 2 Weeks) or 3) Chronic (=> 4 Weeks): 1) Irritable Bowel Syndrome (IBS) is a Painful Remitting (Night and with Bowel Movements) and Recurring Diarrhea of Chronic Presentation. 2) Inflammatory Bowel Disease (IBD) is a Systemic Pathology (Anemia [Anemia of Chronic Disease] on CBC and Dx via Colonoscopy) with Chronic Bloody Diarrhea (Positive Lactoferrin) and is characterized by Disease Processes like Ulcerative Colitis and Crohn's Disease (SSx: Diarrhea, Fever, Abdominal Pain, and Extraintestinal Manifestations). Arthritides and Dermatoses are Common IBD Pathology; 3) Lactose Intolerance (LI); 4) Malabsorption (MCC is Celiac Disease) manifests as Steatorrhea (Lipids in Feces) and a High Stool Osmotic Gap on Feces Investigations (Stool Study). Malnutrition (Due to Vitamin Deficiency) and Weight Loss are Possible Manifestations, Dx is via 1) Gluten-Free Diet Trial, 2) Anti-tissue Transglutaminase (Anti-tTG IgA) Antibodies or Anti-Gliadin (IgA/IgG Immunoglobulins) Antibodies, or 3) Small Bowel Biopsy via Endoscopy (Morphology of Inflammation/Infiltration [Intraepithelial Lymphocytes], Villi Atrophy, and Crypt Hyperplasia); 5) Carcinoid Syndrome (CS) has Chronic Diarrhea (CD) along with 1) Flushing, 2) Tachycardia (> 100 BPM), and 3) Hypotension (SBP < 90 mm/Hg or DBP < 60 mm/Hg where Normal Blood Pressure is 120/80) due to a Serotonin-Secreting Tumor commonly in the Appendix, Small Bowel and Bronchi (however any Tissue is Possible). The Diagnosis of CS is via the Urinary 5-Hydroxyindoleic Acid Test (5-HIAA), a Serotonin Metabolite. A High Level of 5-HIAA in the Serum is Excreted in the Urine and thereby indicating CS. The Tx is Octreotide Acetate (Sandostatin Tradename), a Short Bowel Syndrome (SBS) Agent/Somatostatic Agent, otherwise a Somatostatin Analog and the Mechanism of Action (MOA) is Serotonin Antagonism. Multiple Endocrine Neoplasia Type I (MEN-I; Pituitary Gland Tumor, Parathyroid Gland Tumor and Pancreatic Tumor Morphology) has a Positive Association with the Development of a Carcinoid Tumor in CS. It is useful to understand another possible Aetiologic Agent of Chronic Diarrhea is Hepatitis A Virus (HAV) Infection. Goodness, My first Dirrrhea Diagnosis on the Basis of Neoplasia. Just Kidding. The Subject simply went fishing too long and ate too many Crustacean Shrimps (Vibriosis due to Vibrio parahaemolyticus). MD Paul Bolin, Zu Essen gut ist aber zu Gesundheit Bauen, man muss essen mit der Macht (Macht geht vor Recht). Heil!

Sir any plans on making Dermatology playlist? It would be appreciated greatly by medical students. Thank you very much for everything!! :)

Thank you Dr. Bolin!

thanks for the update!

Thank you Dr. Bolin

thank you so much

nice video, thank you

Haha i like your excitement at 18:57 it felt me like as if i am talking with gamer friends on discord

thank you Dr.

Thank you so much sir😊..your videos are very helpful...

Who have taken notes of what the dr said?

I have had every test in the world. Even breath testing. I have had Diarrhea for 2 years. Help!

Dr. Paul, in reference to C. Difficile diarrhea, is it FIDAXOMYCIN used as Rx now or still Metronidazole? Just asking for exam purpose only.

@xDomglmao

4 жыл бұрын

First line Fidaxo, second line Vanco; in EU Metro is still considered to be an okay - good choice

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