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Rosens > 27. Diarrhea > Flashcards

27. Diarrhea Flashcards

1
Q

Acute diarrheal illness defn

A

> /=3 liquid/water stools in 24h up to 14d

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2
Q

Epidemiology: who associated with?

A

ext of age
hiv can present
food vs water are RF

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3
Q

Defn osmotic diarrhea

A

presence of poorly absorbed solutes in gut

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4
Q

Defn secretory diarrhea

A

toxin producing infectious agent

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5
Q

Exudative diarrhea

A

infectious/inflamm conditions

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6
Q

Malabsoprtive diarrhea

A

infectious agent vs lactose intol vs celiac vs pancreatic insuff

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7
Q

Motility related diarrhea

A

db or scleroderma
or prokinetic agents

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8
Q

Dysentery defn

A

infectious diarrhea in which enteropathogens and toxic metabolites had invaded intestinal mucosa –> fever, abdo pain, visible blood

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9
Q

Name 5 causes of acute diarrhea - viral

A

Cytomegalovirus
Enteric adenovirus
Human immunodeficiency virus (HIV) enteropathy Norovirus
Rotavirus

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10
Q

Name 5 causes of acute diarrhea - bacterial - Invasive

A

Campylobacter species Clostridioides difficile Enteroinvasive Escherichia coli Salmonella species
Shigella species Vibrio vulnificus Yersinia enterocolitica

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11
Q

Name 2 causes of acute diarrhea - toxigenic

A

bacillus cereus
staph aureus

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12
Q

Name 4 causes of acute diarrhea - toxin formation after coloonization

A

Shiga toxin–producing E. coli 0157:H7 (STEC) [also known as enterohemor- rhagic E. coli (EHEC) or verocytotoxin-producing E. coli (VTEC)]
Enterotoxigenic E. coli
Shigella species
Vibrio cholerae

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13
Q

Name 4 causes of acute diarrhea - protozoa

A

cryptosporidium
cyclospora
entamoeba histolytica
giardia

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14
Q

Key questions on hx

A

-onset
-duration
-character: est vol, blood or mucous,
- fever, abdo pain, n/v
- oral hydration
- food consumption
-etoh/substance use
-travel
-abx use 8-12 weeks. prior
-ill contacts
-meds, dietary suppl
- cormorbitidies: db, collagen vasc disease, immune deficiency, malignancy, transplant

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15
Q

First key question in determining diarrhea cause

A

infx or not

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16
Q

Travellers diarrhea culprit

A

ETEC

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17
Q

PPI risk for which type of diarrhea

A

cdiff

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18
Q

Which 2 bacteria causing diarrhea can mimic appendicitis?

A

yersinia
campy

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19
Q

Which type of vibrio causes diarhea vs septicemia

A

cholera
vulnificus

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20
Q

Name 5 categories of noninfectious diarrhea

A

pharamcy/meds
dietetic suppl
seafood assoc
plant/herbs
GI path
endocrine related
ssytemic illness cause
miscellaneous

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21
Q

Name 8 pharmaceuticals known to cause diarrhea

A

Antacids (magnesium) Antimicrobials
Antiretrovirals Chemotherapeutic agents Cholinergic agents Cholinesterase inhibitors Colchicine
Lactulose
Laxatives/Cathartics Prostaglandins

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22
Q

Name 3 dietetic supplements that can cause diarhea

A

caffeine
sorbitol
xyitol

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23
Q

Name 3 seafood associated toxins causing diarrhea

A

ciguatera
paralytic shellfish poisoning
scromboid

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24
Q

Name 4 plants or herbs that can cause diarrhea

A

aloe vera juice
senna
pokeweed
tumeric

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25
Name 5 GI pathology diseases causing diarrhea
Celiac disease Irritable bowel syndrome with diarrhea Lactose intolerance Malabsorption syndromes Post vagotomy Radiation enteritis Short gut syndrome
26
Name 4 endocrine related conditions causing diarrhea
carcinoid syndrome adrenal insuff diabetic enteropathy pancreatic insuff
27
Name 4 systemic ilness/other causes of diarrhea per Rosen's box 27.2
alcoholism ctd/scleroderma CF runners diarrhea
28
What additional findings may a Strongyloides stercoralis infection cause?
urticaria bronchospasm - ie histamine associated
29
What do stool cultures typically test for - (ie which bacteria)
campy salmonella sigella
30
RF for cdiff
immunocompromised or reports antibiotic use during the preceding 3 months, recent hospitalization, nursing home residence, employment in a health care setting, or significant diarrhea (>5/day) for several days (generally without vomiting)
31
32
When to send off a shiga toxin/E coli O157:H7 toxin assay?
known outbreak endemic area suspected HUS --> consider it: anemia, thrombocytopenia, renal dysfunction
32
33
What does a stool o and p test for?
entaemoeba histolytica cyrptosporidium giardia cyclospora
34
Who should get a s
nic diarrhea hx travel or recent immigration from dev countries HIV infection/other immunocompromised state
35
Considerations for testing/tx in a patient with abnormal vital signs and concern for critical dx
IVF cr hbg lactate cbc LFT, LE
36
Name that pathogen - "travel hx"
Especially foreign travel or to endemic areas of dysenteric disease
37
Name that pathogen - recent hospitalization
cdiff
38
Name that pathogen - Day care attendance
rotavirus shigella giardia
39
Name that pathogen - nursing home
cdiff meds SE tube feeding ischemic colitis fecal impaction with overflow
40
Name that pathogen - wilderness or untreated water exposure
giardia cryptosporidium
41
Name that pathogen - abx therapy
cdiff abx assoc diarrhea
42
Name that pathogen - raw shellfish, farm animals or livestock, pet reptile or amphibian, petting zoo
Salmonella species, Escherichia coli O157:H7, and non-O157 Shiga toxin–produc- ing E. coli, Vibrio species
43
Name that pathogen - epidemic of mult pt within short onset
norovirus less common campy , salmonella, or cryptosporidium
44
Name that pathogen - epidemic sev gastroenteritis traced to eggs, poultry, meat or dairy
campy salmonella
45
Name that pathogen - abdo pain + blood stool + fever + rectal pain + tenesmus
severe bacterial infection: salmonella, campy, shigella, EPEC, yersinia or vibrio also can be surgical abdo, GIB, IBD
46
Name that pathogen - diarrhea >7-14d
protozoa or microsporidia cdiff campy shiga toxin producing e coli
47
Name that pathogen - organ transplant/immunosuppressed
Abnormally severe illness from rotavirus or adenovirus Increased frequency of Cytomegalovirus Severe illness from dysenteric diarrhea Spore-forming protozoa or microsporidia
48
Name that pathogen - HIV/ other immunodeficiency
Severe illness from common bacteria, spore-forming protozoa, or microsporidia Increased frequency of Cytomegalovirus or Mycobacterium avium complex
49
Name the components of the WHO oral rehydration solution
dissolv- ing the following in 1 L of clean water: 3.5 g of sodium chloride, 2.9 g of trisodium citrate or 2.5 g of sodium bicarbonate, 1.5 g of potassium chloride, and 20 g of glucose or 40 g of sucrose
50
What is the BRAT diet consistent of ?
some pathogens cause lactase deficiency where you can get more diarrhea. - recommend bananas, rice, apples toast diet as relatively constipating
51
Who can get abx for diarrhea, and which abx?
immunocomp or demonstrating signs of sepsis: cipro 500mg PO BID or levo 500mg PO daily 3-5d or azithro 500mg PO daily x3d
52
Who for sure DOES NOT get abx with diarrhea
if its bloody
53
Empiric tx for travellers diarrhea: what is this?
single dose of azithromycin 1000 mg by mouth
54
Cdiff tx
fidaxomicin (200 mg by mouth twice daily for 10 days) Vancomycin (125 mg by mouth four times daily for 10 days) is still an acceptable first line option if fidaxomicin is not available.
55
How to dose loperamide
4mg oral then 2mg (not exceeding 16mg in 24 hours total)
56
57
What disease can you get with severe colonic inflammation and loperamide?
toxic megacolon
58
Use loperamide in peds? why or why not
no - increased risk toxic megacolon and HUS
59
Antimotlity agents in a person high risk for obstruction - yes or no?
no
60
what kind of medication is loperamide?
bowel selective opioid agonist

Rosens (77 decks)

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