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x. ID > 3/21 Ch 13 Gastroenteritis > Flashcards

3/21 Ch 13 Gastroenteritis Flashcards

RA = rapid associations ∆ = difference

1
Q

RA: mayo, custards, ham, poultry

A

staph aureus

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2
Q

RA: fried rice, meat, vegetables, dried beans, cereals

A

bacillus cereus

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3
Q

RA: beef, poultry, legumes, gravy

A

clostridium perfringens

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4
Q

RA: shellfish

A

vibrio cholera

vibrio parahemolyticus

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5
Q

RA: oysters, shellfish

A

vibrio parahemolyticus

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6
Q

RA: salad, cheese, meat, water

A

ETEC

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7
Q

RA: beef, poultry, eggs, dairy

A

salmonella

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8
Q

RA: potato or egg salad, lettuce, raw veggies

A

shigella

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9
Q

RA: improperly canned foods – bulging cans

A

c. botulinum

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10
Q

RA: reheated meat dishes

A

c. perfringens

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11
Q

RA: antibiotics

A

clostridium difficile

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12
Q

RA: MSM

A

shigella (also giardia)

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13
Q

RA: reptiles and amphibians

A

salmonella

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14
Q

RA: turtles

A

salmonella enterica

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15
Q

RA: proctitis

A

chylamydia, gonorrhea, syphilis, HSV

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16
Q

RA: travel

A

ETEC

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17
Q

∆ btwn acute, persistent, and chronic diarrhea?

A

diarrhea: 3 loose stools/24 hrs

acute: 10-14d
persistent: >14d
chronic: >30d

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18
Q

RA: fever, severe abd pain

A

invasive disease

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19
Q

RA: vomiting

A

toxin-mediated

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20
Q

RA: abdominal bloating

A

outdoor exposures

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21
Q

RA: dizziness

A

severe dehydration or chronicity

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22
Q

RA: tenesmus

A

rectal inflammation (shigella, STDs)

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23
Q

General etiology of non-inflammatory, inflammatory diarrhea and penetrating diarrhea?

A

Non-inflammatory (enterotoxin)

Inflammatory (invasion or cytotoxin)

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24
Q

General etiology of non-inflammatory, inflammatory and penetrating diarrhea?

A

Non-inflammatory (enterotoxin)

Inflammatory (invasion or cytotoxin)

Penetrating - they didn’t really give a MoA…

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25
Q

location of non-inflammatory, inflammatory and penetrating diarrhea?

A

Non-inflammatory: Proximal small bowel

Inflammatory: Terminal Ileum, Colon

Penetrating: Distal small bowel

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26
Q

sx of non-inflammatory, inflammatory and penetrating diarrhea?

A

Non-inflammatory: watery (secretory)

Inflammatory: bloody or mucoid (dysentery)

Penetrating: Enteric fever (fever, chills, signs of bacteremia)

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27
Q

stool features of non-inflammatory, inflammatory and penetrating diarrhea?

A

Non-inflammatory Ø WBC

Inflammatory WBC (+), lactoferrin (+)

Penetrating WBC (+)

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28
Q

culprits of non-inflammatory diarrhea?

A 
C. difficile 
C.perfringens
ETEC
Giardia
Cryptosporidium 
Vibrio cholera
Rotavirus
Norovirus 
Bacillus cereus
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29
Q

culprits of inflammatory diarrhea?

A 
Campylobacter
Entamoeba histolytica EHEC
EIEC
Salmonella (non-typhi)
Shigella
Y. enterocolitica 
Vibrio parahemolyticus
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30
Q

culprits of penetrating diarrhea?

A

Salmonella typhi

Yersinia enterocolitica

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31
Q

when should you evaluate diarrhea complaints?ww

A 
bloody 
profuse w/ evidence of hypovolemia
small volume stools w/ blood and mucus
hospitalized patients 
immunocompromised patients
pregnant patients
fever >38.5 (or evidence of systemic disease) 
duration >48hrs or >6 stools/24hrs
diarrhea in the setting of recent antibiotic exposure
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32
Q

what test helps you differentiate between bloody and non-bloody diarrhea?

A

(+) Lactoferrin test (high sensitivity/specificity) = inflammatory diarrhea (indicates invasion or cytotoxin)

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33
Q

what tests can you run on a stool to determine the etiology of diarrhea?

A 
Lactoferrin
Fecal WBC
stool cultures 
Ova and Parasite (O+P) 
PCR/Antigen test
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34
Q

When is endoscopy indicated?

A
  • immunocompromised patients with ongoing sx and no clear etiology
  • IBD suspicion
  • ischemic bowel suspicion
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35
Q

is treatment indicated for regular diarrhea?

What treatments are generally used?

A

GENERALLY NOT INDICATED SINCE ITS SELF-LIMITED

but if you have to

  • supportive (rehydration)
  • antibiotics
  • peptobismol
  • loperamide
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36
Q

When are antibiotics indicated for diarrhea? which antibiotics are generally used?

A

fluoroquinolone or azithromycin

indicated for

  • severe diarrhea (>8 episodes/day)
  • prolonged diarrhea (>7 d)
  • hospitalized patients
  • immunocompromised patients
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37
Q

what is loperamide? MoA? When is it usually given?

A

µ opioid agonist that acts on the µ opioid receptors in the myenteric plexus of the large intestines only; decrease motility to allow for more H2O to be absorbed out of the fecal matter

given only when major infections have been ruled out

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38
Q

pathophysiology of Norovirus?

A

“viral gastroenteritis” Damages brush border and prevents reabsorption of H2O and nutrients

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39
Q

epidemiology and clinical presentation of Norovirus?

A

Epi: usually kids

Acute onset of vomiting (esp. in kids), low grade fever (30%)
abdominal cramps and/or non-bloody diarrhea (esp. in adults) within (10-48 hrs of exposure)

40
Q

how to diagnose Norovirus?

41
Q

treatment of Norovirus?

A

supportive

42
Q

pathophysiology of rotavirus?

A

“viral gastroenteritis” Activated by proteolysis to infectious sub-viral particle that cause villous destruction and atrophy, leading to decr. absorption and incr. absorption of K

43
Q

epidemiology and clinical presentation of rotavirus?

A

Main cause of pediatric diarrhea (3-15mo)

2 day incubation followed by watery diarrhea for 3-8. can be associated with fever and abdominal pain

44
Q

how to diagnose rotavirus?

A

Rapid antigen test of stool

45
Q

treatment of rotavirus?

A

Supportive

Vaccine available

46
Q

pathophysiology of Shigella?

A

Invades and damages intestinal mucosa and causes PMN infiltration; resulting in superficial ulcerations, colitis with crypt abscesses

produces shiga toxin that inactivates 60S ribosome and enhances HUS.

47
Q

epidemiology and clinical presentation of Shigella?

A 
Children*
Fecal-oral
Daycare 
Poor sanitation
MSM 
(has human reservoir only)

12-72hr incubation, followed by dysentery, moderate to severe illness with fever and blood flecks in stool. lasts 1-2 weeks. Children can develop HUS due to Shigatoxin

48
Q

how to diagnose Shigella?

A

Stool culture

49
Q

treatment of Shigella?

A

Ampicillin
TMP/SMX and Ciprofloxacin for resistant strains
AVOID anti-motility agents

50
Q

pathophysiology of Salmonella

enteritidis, typhimurium

A

Pili adheres to small intestines where enterotoxin stimulates fluid secretion and also stimulates a monocytic infiltration

51
Q

epidemiology and clinical presentation of Salmonella

enteritidis, typhimurium

A

Eggs, poultry

12-26hr incubation: gastroenteritis with sudden onset of nausea, crampy abd. pain, diarrhea, and fever

52
Q

how to diagnose Salmonella

enteritidis, typhimurium

A

Stool culture

Lactose (-)

53
Q

treatment of Salmonella

enteritidis, typhimurium

A

Mild cases: supportive since abx may prolong fecal excretion of organism

Severe cases, immunocompromised, or extreme ages: TMP/SMX or ciprofloxacin

54
Q

pathophysiology of Salmonella typhi (typhoid fever)

A

Penetrates mucosa of small bowel, carried to LN and blood with 2˚ excretion into intestines from bile

55
Q

epidemiology and clinical presentation of Salmonella typhi (typhoid fever)

complications?

A

Found only in humans

10 d incubation; systemic illness with insidious onset of malaise, myalgias, HA, and high fever.
Classic rose spots on abdomen, diarrhea, temperature/pulse dissociation

Complications: intestinal perforation and chronic carriage in gallbladder

56
Q

how to diagnose Salmonella typhi (typhoid fever)

A

Stool culture (only 80% diagnostic in early stage)

57
Q

treatment of Salmonella typhi (typhoid fever)

A

Ampicillin
TMP/SMX
Ciprofloxacin
Vaccine - Live

58
Q

pathophysiology of Campylobacter jejuni

A

Invasion of ileum and colon with inflammatory diarrhea

59
Q

epidemiology and clinical presentation of Campylobacter jejuni

A

Animal reservoirs, poultry, unpasteurized milk

12-24 hr prodrome HA, myalgias, and fever, followed by acute diarrhea with >10 loose, non-bloody BM/day that lasts 5-7d

60
Q

how to diagnose Campylobacter jejuni

A

Stool culture, grows at 42˚C

Oxidase +

61
Q

treatment of Campylobacter jejuni

A

Controversial, but ciprofloxacin is effective in vitro

62
Q

pathophysiology of EIEC

A

invade and cause cell destruction in the colon

63
Q

epidemiology and clinical presentation of EIEC

A

Humans

Shigella-like diarrhea w/ fever; inflammatory

64
Q

how to diagnose EIEC

A

Lactose fermentation (to differentiate from shigella)

65
Q

pathophysiology of ETEC

A

colonization and production of enterotoxins that cause loss of H2O
LT  cAMP
ST  cGMP

66
Q

epidemiology and clinical presentation of ETEC

A

Travelers and infants in developing countries or regions of poor sanitation

Milder, cholera-like watery diarrhea w/o fever

67
Q

treatment of ETEC

A

Loperamide
fluoroquinolones
azithromycin (macrolide), rifaximin

68
Q

pathophysiology of EPEC

A

adheres to intestinal mucosa and causes microvilli effacement; prevents absorption

69
Q

epidemiology and clinical presentation of EPEC

A

Children in developing countries

Profuse, watery (sometimes bloody) diarrhea

70
Q

diagnosis of EPEC

A

Toxins are not detectable in stool

71
Q

treatment of EPEC

A

Antibiotics, resistance testing useful, possibly

72
Q

pathophysiology of EHEC (0157:H7)

A

production of shiga-like toxin (Stx) that can cause HUS (anemia, thrombocytopenia, and acute renal failure)

73
Q

epidemiology and clinical presentation of EHEC (0157:H7)

A

Poorly cooked beef,

Intense inflammatory response + necrosis, resulting in bloody diarrhea (hemorrhagic colitis); may progress to HUS

74
Q

how to diagnose EHEC (0157:H7)

A

Agglutination test or immunoassay for shiga-like toxin

75
Q

treatment of EHEC (0157:H7)

A

supportive care (antibiotics are contraindicated because it causes them to make more toxins; may lead to HUS)

76
Q

what is EHEC (0157:H7) also known as

77
Q

pathophysiology of Clostridium difficile

A

Anerotic toxin-producing bacteria

78
Q

epidemiology and clinical presentation of Clostridium difficile

A

Pts on lots of antibiotics

4-9d incubation; Diarrhea + pseudomembranous colitis

79
Q

treatment of Clostridium difficile

A

Metronidazole

Vancomycin for severe cases

80
Q

pathophysiology of Yersinia enterocolitica

A

intracellular pathogen that cause mucosal ulcerations and mesenteric adenitis (inflammation of LN; causes attachment to abd wall)

81
Q

epidemiology and clinical presentation of Yersinia enterocolitica

A

Animal reservoir with outbreaks from food and H2O, esp in daycare

Pseudo-appendicitis, diarrhea, and fever

82
Q

how to diagnose Yersinia enterocolitica

A

Fecal isolation

slow growth makes this difficult

83
Q

treatment of Yersinia enterocolitica

A

Tetracycline

TMP/SMX

84
Q

pathophysiology of Vibrio parahemolyticus

A

Invasion + toxin formation

85
Q

epidemiology and clinical presentation of Vibrio parahemolyticus

A

Undercooked seafood

24hr incubation; mild tissue damage with explosive watery diarrhea and low-grade fever

86
Q

how to diagnose Vibrio parahemolyticus

A

Stool culture w. special media

87
Q

treatment of Vibrio parahemolyticus

A

Supportive

88
Q

pathophysiology of Vibrio cholera

A

Non-inflammatory toxin permanently activates Gs -> incr. cAMP -> incr. Cl secretion and H2O efflux in the gut

89
Q

epidemiology and clinical presentation of Vibrio cholera

A

Food/water borne, seafood

1-2 d incubation; “rice-water diarrhea”, dehydration w/o fever

90
Q

how to diagnose Vibrio cholera

A

1-2 d incubation; “rice-water diarrhea”, dehydration w/o fever

91
Q

treatment of Vibrio cholera

A

Supportive

Tetracycline

92
Q

pathophysiology of Listeria monocytogenes

A

Intracellular pathogens that pass through the intestines into macrophages and causes disseminated infection

93
Q

epidemiology and clinical presentation of Listeria monocytogenes

A

Coleslaw, dairy, cold processed meats

Immunocompromised, extreme ages, pregnant women

94
Q

how to diagnose Listeria monocytogenes

A

2-6 wk incubation: fever, myalgias, bacteremia, meningitis

95
Q

treatment of Listeria monocytogenes

A

Blood or CSF culture

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