11. Infectious Diarrheas And Intussusception

Question 1

Clinical definition of diarrhea.

Answer 1

Abrupt onset of 3 or more loose stools/day, no longer than 14 days.

Question 2

Mechanism of NON-INFLAMMATORY

Answer 2

Enterotoxin

Question 3

Location of NON-INFLAMMATORY

Answer 3

Proximal small bowel

Question 4

Stool findings in NON-INFLAMMATORY

Answer 4

No fecal leukocytes or fecal lactoferrin

Question 5

Mechanism of INFLAMMATORY

Answer 5

Invasion or cytotoxic

Question 6

Location of INFLAMMATORY

Answer 6

Colon or distal small bowel

Question 7

Stool findings in INFLAMMATORY

Answer 7

Fecal leukocytes and elevated fecal lactoferrin

Question 8

Mechanism of PENETRATING

Answer 8

Systemic invasion

Question 9

Location of PENETRATING

Answer 9

Distal small bowel

Question 10

Illness of PENETRATING

Answer 10

Enteric Fever

Question 11

Stool findings in PENETRATING

Answer 11

Fecal Leukocytes

Question 12

Pathogens causing PENETRATING

Answer 12

Salmonella typhi (typhoid fever)

Y. Enterocolitica

Question 13

People w/ blood group _____show inc. susceptibility so specific diarrheal diseases

Answer 13

O

Question 14

Stool pH of ______suggest viral etiology for acute diarrhea.

Answer 14

<5.5

Question 15

Fecal leukocytes in acute diarrhea suggest______

Answer 15

Enteroinvasive etiology

Question 16

What lab test would you use for Rotavirus or Adenovirus?

Answer 16

Enzyme immunoassay and latex agglutination assay

Question 17

What test would you use for C. diff?

Answer 17

Rapid enzyme immunoassay, latex agglutination tests, or PCR

Question 18

What antibiotics might you give for inflammatory diarrhea?

Answer 18

Fluoroquinolone or macrolide

Question 19

Two exceptions to giving antibiotics in inflammatory diarrhea

Answer 19

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

Question 20

When should infants get their first dose of the RotaVirus Vaccine?

Answer 20

Before 15 weeks

Question 21

What vaccine is recommended for travels in high risk areas?

Answer 21

Salmonella typhi

Question 22

A major complication of acute diarrhea.

Answer 22

Hemolytic Uremic Syndrome

Question 23

Hemolytic uremic syndrome is damage to the vascular endothelial cells by __________, released by enterohemorrhagic _____and _______organisms.

Answer 23

Verotoxin

E. Coli

Shigella

Question 24

The most common pathogens of bacterial food poisoning:

Answer 24

E. Coli
Salmonella
C. Perfringens
Campylobacter
Staphylococcus aureus

Question 25

Main care objective for bacterial food poisoning.

Answer 25

Hydration and Electroylte supplementation

Question 26

To prevent bacterial food poisoning keep refrigerated food ______and hot items______.

Answer 26

<40 | >140

Question 27

Where is E.coli found?

Answer 27

Leafy green vegetables and sprouts

Question 28

If dysentery is absent in E. Coli what should you do?

Answer 28

DO NOT ADMINISTER ANTIBIOTICS until microbiologic diagnosis confirmed. E.coli 0157: H7 is ruled out.

Question 29

Where could you find salmonella?

Answer 29

Poultry, peanut butter, sprouts

Question 30

What is a complication of Campylobacter?

Answer 30

Guillain-Barre

Question 31

This results from a disturbance of the normal bacterial flora of the colon> releasing toxins that cause mucosal inflammation and damage.

Answer 31

C. Did

Question 32

The most commonly diagnosed diarrheal illness acquired in the hospital.

Answer 32

C. Dif

Question 33

Clinical criteria for C. Dif:

Answer 33

Diarrhea Toxin A or B in stool Toxin-producing C Dif

Question 34

C. Dif is a gram (+ or -),_______-forming bacillus that is an ________anaerobe.

Answer 34

Positive. Spore Obligate

Question 35

A patient has diarrhea and was recently hospitalized and on strong antibiotics, what should you suspect?

Answer 35

C. Dif

Question 36

Sx of C. Dif

Answer 36

Diarrhea-rarely bloody *Characteristic odor

Question 37

Gold standard test for C. Dif.

Answer 37

Stool Culture: * Toxins A and B * C. Dif gene toxin * EIA-enzyme made by C. Dif

Question 38

Imaging of choice for C. Dif colitis?

Answer 38

CT *used when complications suspected

Question 39

Definition of pseudomembranes:

Answer 39

Raised, yellow white, 2 to 10 mm plaques overlying and erythematous and edematous colonic mucosa

Question 40

Tx for mild,antibiotic associated diarrhea WITHOUT fever etc.

Answer 40

Stop antibiotics

Question 41

Tx for mild to moderate diarrhea or colitis:

Answer 41

Metronidazole 500mg P.O. TID OR Vancomycin (oral) for 10 days

Question 42

Tx for SEVERE C. Dif

Answer 42

Vancomycin-faster symptom resolution

Question 43

Once a pt. has 1 C. Dif relapse _____% chance for a second.

Answer 43

45%

Question 44

Tx for 1st relapse of C. Dif

Answer 44

Antibiotic based on severity

Question 45

Tx for 2nd+ relapse of C. Dif

Answer 45

Vancomycin or Fidaxomicin

Question 46

Do pt’s have diarrhea in fulminant colitis?

Answer 46

No-have acute surgical abdomen, lieu’s, fever, and leukocytosis.

Question 47

An acute toxic colitis with dilation of the colon.

Answer 47

Toxic megacolon

Question 48

The most common location for intussusception is _______

Answer 48

Ileocolic

Question 49

Males are ______more likely to get intussecption than females.

Answer 49

3X

Question 50

The most common cause of bowel obstruction in the first 2 years of life.

Answer 50

Intussusception

Question 51

“Currant jelly” stool

Answer 51

Intussusception

Question 52

A 2 year presents with lethargy and palpable abdominal mass.

Answer 52

Intussusception

Question 53

What is the “dance sign”?

Answer 53

Sausage-shaped mass that is drawn cephalad and leaves the RLQ looking empty and flat

Question 54

The most sensitive and specific diagnostic tool for intussusception.

Answer 54

Abdominal Ultrasonogrphy

Question 55

The most reliable way to make a diagnosis of intussusception in children.

Answer 55

Barium and Air enema

Question 56

When should you not use a barium enema?

Answer 56

Signs of strangulated bowel, perforation, or toxicity.