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  #1  
Old 05-31-2012
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Question post chemo diarrhea...what is most app test?

A 64-year-old woman is evaluated for 2 weeks of nonbloody diarrhea. She was recently
diagnosed with stage IV rectal cancer and underwent treatment with chemotherapy and
radiation therapy 4 weeks ago. She has 10 small, loose bowel movements daily associated
with tenesmus. She has no nausea, vomiting, abdominal pain, fever, or weight loss.
On physical examination, vital signs are normal. The abdomen is soft, and no evidence of
rectal fissures or fistulas is seen.
Which is the following is the most appropriate diagnostic test?
(A) Abdominal/pelvic CT scan
(B) Flexible sigmoidoscopy
(C) Stool culture
(D) Stool osmolality
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Old 05-31-2012
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stool culture may be needed to see if antibiotic associated diarrhea
cl difficle may be causative org.
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Quote:
Originally Posted by tyagee View Post
A 64-year-old woman is evaluated for 2 weeks of nonbloody diarrhea. She was recently
diagnosed with stage IV rectal cancer and underwent treatment with chemotherapy and
radiation therapy 4 weeks ago. She has 10 small, loose bowel movements daily associated
with tenesmus. She has no nausea, vomiting, abdominal pain, fever, or weight loss.
On physical examination, vital signs are normal. The abdomen is soft, and no evidence of
rectal fissures or fistulas is seen.
Which is the following is the most appropriate diagnostic test?
(A) Abdominal/pelvic CT scan
(B) Flexible sigmoidoscopy
(C) Stool culture
(D) Stool osmolality
i'm thinking of radiation colitis (idon't know if its occur after 4 wks, and if there are acute & chronic form), pt dont show other signs consistent with infection (E.g. fever, N/V, weight loss...)

check this https://en.wikipedia.org/wiki/Radiation_proctitis
there are actually acute & chronic forms

Last edited by bisho; 05-31-2012 at 08:50 AM.
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Old 05-31-2012
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Quote:
Originally Posted by tyagee View Post
a 64-year-old woman is evaluated for 2 weeks of nonbloody diarrhea. She was recently
diagnosed with stage iv rectal cancer and underwent treatment with chemotherapy and
radiation therapy 4 weeks ago. She has 10 small, loose bowel movements daily associated
with tenesmus. She has no nausea, vomiting, abdominal pain, fever, or weight loss.
On physical examination, vital signs are normal. The abdomen is soft, and no evidence of
rectal fissures or fistulas is seen.
Which is the following is the most appropriate diagnostic test?
(a) abdominal/pelvic ct scan
(b) flexible sigmoidoscopy
(c) stool culture
(d) stool osmolality
- (b).flexable sigmoidoscopy
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Old 05-31-2012
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I will go for B too, due to tenesmus.

C Diff colitis isnt associated with this (or if it is, i dont know about it haha)
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Quote:
Originally Posted by salem View Post
stool culture may be needed to see if antibiotic associated diarrhea
cl difficle may be causative org.
clostridium is bloody diarrhea



but according to this article it is still stool work up.
http://www.ncbi.nlm.nih.gov/pmc/arti...8834009355164/

confused.
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Quote:
Originally Posted by salem View Post
stool culture may be needed to see if antibiotic associated diarrhea
cl difficle may be causative org.
Its easier to just look for c diff toxin with a rapid test than to culture i think
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(D) Stool osmolality

Diarrhea Workup

Quote:
Because the pathogenesis of diarrhea can be either osmolar (due to the presence of an excess of unabsorbed substrates in the gut lumen) or secretory (due to active anion secretion from the enterocytes), the anion gap in the stools is occasionally used to ascertain the nature of the diarrhea. The stool anion gap is calculated according to the formula: 290 - [(Na+K) X 2]. If the value is more than 100, osmolar diarrhea can be assumed to be present. If the value is less than 100, the diarrhea has a secretory origin.

Last edited by Novobiocin; 05-31-2012 at 02:42 PM.
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my 2 cents, you wanna do the least invasive test first so do stool culture, all that chemo may have killed his wbc and he cannot fight infections so it can be anything from parasite to baceria causing his diarrhea, pls what is the answer, thanks
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Flexible sigmoidoscopy is the most appropriate next diagnostic test. The most likely cause of
diarrhea in this patient is radiation proctitis, which occurs commonly in patients receiving
pelvic radiation.
Acute radiation proctitis usually manifests within 6 weeks of therapy with
symptoms of diarrhea and tenesmus. The proctitis is due to direct radiation injury to the
rectal mucosal and usually resolves soon after radiation is discontinued. Diagnosis is
established by endoscopic findings of mucosal telangiectasia, with biopsy showing submucosal


The temporal relationship between the patient's radiation therapy and onset of her diarrheal
symptoms within 6 weeks most strongly suggests radiation proctitis. Evaluation for an
infectious cause of diarrhea is unlikely to establish a diagnosis, because the pretest probability
of an infectious cause of diarrhea is low.


Measuring stool osmolality may occasionally be helpful in distinguishing osmotic diarrhea from
secretory diarrhea and in those few patients suspected of having factitious diarrhea (low stool
osmolality). This test will not be helpful in a patient with a history compatible with radiation
proctitis.
fibrosis and arteriole endarteritis.
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  #11  
Old 05-31-2012
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btw, can clostridium diarrhea occur post chemo ? i learned only post antibiotics...i ruled it out that way...
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