11. Infectious Diarrheas And Intussusception Flashcards
Clinical definition of diarrhea.
Abrupt onset of 3 or more loose stools/day, no longer than 14 days.
Mechanism of NON-INFLAMMATORY
Enterotoxin
Location of NON-INFLAMMATORY
Proximal small bowel
Stool findings in NON-INFLAMMATORY
No fecal leukocytes or fecal lactoferrin
Mechanism of INFLAMMATORY
Invasion or cytotoxic
Location of INFLAMMATORY
Colon or distal small bowel
Stool findings in INFLAMMATORY
Fecal leukocytes and elevated fecal lactoferrin
Mechanism of PENETRATING
Systemic invasion
Location of PENETRATING
Distal small bowel
Illness of PENETRATING
Enteric Fever
Stool findings in PENETRATING
Fecal Leukocytes
Pathogens causing PENETRATING
Salmonella typhi (typhoid fever)
Y. Enterocolitica
People w/ blood group _____show inc. susceptibility so specific diarrheal diseases
O
Stool pH of ______suggest viral etiology for acute diarrhea.
<5.5
Fecal leukocytes in acute diarrhea suggest______
Enteroinvasive etiology
What lab test would you use for Rotavirus or Adenovirus?
Enzyme immunoassay and latex agglutination assay
What test would you use for C. diff?
Rapid enzyme immunoassay, latex agglutination tests, or PCR
What antibiotics might you give for inflammatory diarrhea?
Fluoroquinolone or macrolide
Two exceptions to giving antibiotics in inflammatory diarrhea
1) Salmonellosis-can prolong intestinal prolongation
2) Enterohemorrhagic E. coli infection-many antibiotics cause inc. toxin production, may lead to hemolytic-uremic syndrome and renal failure
When should infants get their first dose of the RotaVirus Vaccine?
Before 15 weeks
What vaccine is recommended for travels in high risk areas?
Salmonella typhi
A major complication of acute diarrhea.
Hemolytic Uremic Syndrome
Hemolytic uremic syndrome is damage to the vascular endothelial cells by __________, released by enterohemorrhagic _____and _______organisms.
Verotoxin
E. Coli
Shigella
The most common pathogens of bacterial food poisoning:
E. Coli Salmonella C. Perfringens Campylobacter Staphylococcus aureus
Main care objective for bacterial food poisoning.
Hydration and Electroylte supplementation
To prevent bacterial food poisoning keep refrigerated food ______and hot items______.
<40
>140
Where is E.coli found?
Leafy green vegetables and sprouts
If dysentery is absent in E. Coli what should you do?
DO NOT ADMINISTER ANTIBIOTICS until microbiologic diagnosis confirmed.
E.coli 0157: H7 is ruled out.
Where could you find salmonella?
Poultry, peanut butter, sprouts
What is a complication of Campylobacter?
Guillain-Barre
This results from a disturbance of the normal bacterial flora of the colon> releasing toxins that cause mucosal inflammation and damage.
C. Did
The most commonly diagnosed diarrheal illness acquired in the hospital.
C. Dif
Clinical criteria for C. Dif:
Diarrhea
Toxin A or B in stool
Toxin-producing C Dif
C. Dif is a gram (+ or -),_______-forming bacillus that is an ________anaerobe.
Positive.
Spore
Obligate
A patient has diarrhea and was recently hospitalized and on strong antibiotics, what should you suspect?
C. Dif
Sx of C. Dif
Diarrhea-rarely bloody
*Characteristic odor
Gold standard test for C. Dif.
Stool Culture:
- Toxins A and B
- C. Dif gene toxin
- EIA-enzyme made by C. Dif
Imaging of choice for C. Dif colitis?
CT
*used when complications suspected
Definition of pseudomembranes:
Raised, yellow white, 2 to 10 mm plaques overlying and erythematous and edematous colonic mucosa
Tx for mild,antibiotic associated diarrhea WITHOUT fever etc.
Stop antibiotics
Tx for mild to moderate diarrhea or colitis:
Metronidazole 500mg P.O. TID
OR
Vancomycin (oral) for 10 days
Tx for SEVERE C. Dif
Vancomycin-faster symptom resolution
Once a pt. has 1 C. Dif relapse _____% chance for a second.
45%
Tx for 1st relapse of C. Dif
Antibiotic based on severity
Tx for 2nd+ relapse of C. Dif
Vancomycin or Fidaxomicin
Do pt’s have diarrhea in fulminant colitis?
No-have acute surgical abdomen, lieu’s, fever, and leukocytosis.
An acute toxic colitis with dilation of the colon.
Toxic megacolon
The most common location for intussusception is _______
Ileocolic
Males are ______more likely to get intussecption than females.
3X
The most common cause of bowel obstruction in the first 2 years of life.
Intussusception
“Currant jelly” stool
Intussusception
A 2 year presents with lethargy and palpable abdominal mass.
Intussusception
What is the “dance sign”?
Sausage-shaped mass that is drawn cephalad and leaves the RLQ looking empty and flat
The most sensitive and specific diagnostic tool for intussusception.
Abdominal Ultrasonogrphy
The most reliable way to make a diagnosis of intussusception in children.
Barium and Air enema
When should you not use a barium enema?
Signs of strangulated bowel, perforation, or toxicity.
