27. Diarrhea Flashcards
Acute diarrheal illness defn
> /=3 liquid/water stools in 24h up to 14d
Epidemiology: who associated with?
ext of age
hiv can present
food vs water are RF
Defn osmotic diarrhea
presence of poorly absorbed solutes in gut
Defn secretory diarrhea
toxin producing infectious agent
Exudative diarrhea
infectious/inflamm conditions
Malabsoprtive diarrhea
infectious agent vs lactose intol vs celiac vs pancreatic insuff
Motility related diarrhea
db or scleroderma
or prokinetic agents
Dysentery defn
infectious diarrhea in which enteropathogens and toxic metabolites had invaded intestinal mucosa –> fever, abdo pain, visible blood
Name 5 causes of acute diarrhea - viral
Cytomegalovirus
Enteric adenovirus
Human immunodeficiency virus (HIV) enteropathy Norovirus
Rotavirus
Name 5 causes of acute diarrhea - bacterial - Invasive
Campylobacter species Clostridioides difficile Enteroinvasive Escherichia coli Salmonella species
Shigella species Vibrio vulnificus Yersinia enterocolitica
Name 2 causes of acute diarrhea - toxigenic
bacillus cereus
staph aureus
Name 4 causes of acute diarrhea - toxin formation after coloonization
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
Name 4 causes of acute diarrhea - protozoa
cryptosporidium
cyclospora
entamoeba histolytica
giardia
Key questions on hx
-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
First key question in determining diarrhea cause
infx or not
Travellers diarrhea culprit
ETEC
PPI risk for which type of diarrhea
cdiff
Which 2 bacteria causing diarrhea can mimic appendicitis?
yersinia
campy
Which type of vibrio causes diarhea vs septicemia
cholera
vulnificus
Name 5 categories of noninfectious diarrhea
pharamcy/meds
dietetic suppl
seafood assoc
plant/herbs
GI path
endocrine related
ssytemic illness cause
miscellaneous
Name 8 pharmaceuticals known to cause diarrhea
Antacids (magnesium) Antimicrobials
Antiretrovirals Chemotherapeutic agents Cholinergic agents Cholinesterase inhibitors Colchicine
Lactulose
Laxatives/Cathartics Prostaglandins
Name 3 dietetic supplements that can cause diarhea
caffeine
sorbitol
xyitol
Name 3 seafood associated toxins causing diarrhea
ciguatera
paralytic shellfish poisoning
scromboid
Name 4 plants or herbs that can cause diarrhea
aloe vera juice
senna
pokeweed
tumeric
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
Name 4 endocrine related conditions causing diarrhea
carcinoid syndrome
adrenal insuff
diabetic enteropathy
pancreatic insuff
Name 4 systemic ilness/other causes of diarrhea per Rosen’s box 27.2
alcoholism
ctd/scleroderma
CF
runners diarrhea
What additional findings may a Strongyloides stercoralis infection cause?
urticaria
bronchospasm - ie histamine associated
What do stool cultures typically test for - (ie which bacteria)
campy
salmonella
sigella
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)
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
What does a stool o and p test for?
entaemoeba histolytica
cyrptosporidium
giardia
cyclospora
Who should get a s
nic diarrhea
hx travel or recent immigration from dev countries
HIV infection/other immunocompromised state
Considerations for testing/tx in a patient with abnormal vital signs and concern for critical dx
IVF
cr
hbg
lactate
cbc
LFT, LE
Name that pathogen - “travel hx”
Especially foreign travel or to endemic areas of dysenteric disease
Name that pathogen - recent hospitalization
cdiff
Name that pathogen - Day care attendance
rotavirus
shigella
giardia
Name that pathogen - nursing home
cdiff
meds SE
tube feeding
ischemic colitis
fecal impaction with overflow
Name that pathogen - wilderness or untreated water exposure
giardia
cryptosporidium
Name that pathogen - abx therapy
cdiff
abx assoc diarrhea
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
Name that pathogen - epidemic of mult pt within short onset
norovirus
less common campy , salmonella, or cryptosporidium
Name that pathogen - epidemic sev gastroenteritis traced to eggs, poultry, meat or dairy
campy
salmonella
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
Name that pathogen - diarrhea >7-14d
protozoa or microsporidia
cdiff
campy
shiga toxin producing e coli
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
Name that pathogen - HIV/ other immunodeficiency
Severe illness from common bacteria, spore-forming protozoa, or microsporidia Increased frequency of Cytomegalovirus or Mycobacterium avium complex
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
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
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
Who for sure DOES NOT get abx with diarrhea
if its bloody
Empiric tx for travellers diarrhea: what is this?
single dose of azithromycin 1000 mg by mouth
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.
How to dose loperamide
4mg oral then 2mg (not exceeding 16mg in 24 hours total)
What disease can you get with severe colonic inflammation and loperamide?
toxic megacolon
Use loperamide in peds? why or why not
no - increased risk toxic megacolon and HUS
Antimotlity agents in a person high risk for obstruction - yes or no?
no
what kind of medication is loperamide?
bowel selective opioid agonist
