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Senior - ID 2 > 8 - Diarrhea And Food Borne > Flashcards

8 - Diarrhea And Food Borne Flashcards

1
Q

Acute vs chronic diarrhea?

A

Acute: <3 weeks

Chronic: > 3 weeks

The pt knows what is abnormal

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2
Q

Noninfectious diarrhea?

A 
Malabsorption
Milk protein/lactose intol
IBS
IBD
Laxative abuse
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3
Q

Infectious diarrhea

A

Virus
Bacteria
Fungi
Parasites

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4
Q

Non-invasive toxin mediated diarrhea tends to present?

A

Afebrile

Abdominal cramping with watery diarrhea

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5
Q

Diarrhea where bacteria invade the mucosa?

A

Febrile

RBC/WBC in stool

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6
Q

Acute gastroenteritis (AGE)

A

1-5 days of watery diarrhea with prominent N/V

Can be any number of infections, toxins, drugs, diseases

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7
Q

Food poisoning

A

Disease caused by toxin present in food

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8
Q

Food poisoning classifications?

A

Ultrashort - 1-2 hrs
- chemical

Short - 1-6 hrs
- toxin in food

Long - 8-16hrs

  • organism in food
  • toxin produced after consumption
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9
Q

Who is susceptible to AGE?

A

Everybody

Especially travelers to “developing” countries

Honestly whoever came up with that term has never been to the countries, they arent developing, they are stagnant at best

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10
Q

Questions for diarrhea

A
  • History
  • stool volume
  • stool characteristic
  • stool consistency
  • flatus
  • food history
  • travel history
  • systemic symptoms
  • day care
  • failure to thrive
  • malnutrition
  • water exposure
  • camping
  • animal exposure
  • onset and duration
    Borborygmi
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11
Q

Borborygmi?

A

Rumbling or gurgling noise made by the movement of fluid and gas in the intestines

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12
Q

Dairy is associated with?

A

Campylobacter and salmonella

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13
Q

Eggs are associated with?

A

Salmonella

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14
Q

Meats are associated with?

A

C. Perfringes
Aeromonas
Campylobacter
Salmonella

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15
Q

Ground beef are associated with?

A

Enterohemorrhagic E. Coli

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16
Q

Poultry are associated with?

A

Campylobcter species

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17
Q

Seafood are associated with?

A

Astrovirus
Aeromonas
Plesimonas
Vibro

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18
Q

Oysters are associated with?

A

Calicivirus
Plesiomonas
Vibro species

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19
Q

Vegetables are associated with?

A

Aeromonas species

C. Perfringins

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20
Q

Underdeveloped tropics are associated with?

A

C. Perfringes

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21
Q

Africa, S/C america, and India are associated with?

A

Entamoeba species

Vibro cholera

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22
Q

Mexico is associated with?

A

Aeromonas
Entamoeba
Plesimonas
Yersinia species

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23
Q

Asia is associated with?

A

Vibrio cholera

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24
Q

Australia, canada, europe are associated with?

A

Yersinia species

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25
Q

Japan is associated with?

A

V. Parahaemolyticus

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26
Q

New guinea is associated with?

A

Clostridium species

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27
Q

C. Difficile is associated with?

A

Hospitalization

Abx

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28
Q

Plesimonas species is associated with?

A

Liver disease

Malignancy

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29
Q

Salmonella species is associated with?

A 
Intestional dysmobility
Malnutrition
Achlorhydria
Hemolytic anemia
SCD
Immunosuppression
Malaria
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30
Q

Rotavirus is associated with?

A

Hospitalization

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31
Q

Giardia species is associated with?

A

Agammaglobulinemia
Chronic pancreatitis
Achlorhydria
Cystic fibrosis

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32
Q

Nonspecific diarrhea/food borne disease s/s?

A
  • Lethargy
  • depressed consciousness
  • dry mucous membranes
  • sunken eyes
  • poor skin turgor
  • delayed cap refil
  • drop in BP
  • nonfocal abdominal pain
  • cramping
  • borborygmi
  • perianal erythema
  • fever
  • wt loss
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33
Q

Tests to consider for diarrhea/food borne?

A 
O and P
Stool pH
CBC- diff
Gram stain
Bacterial culture
Blood culture
LFTs 
Fecal leukocytes
Hemoccult
Serum electrolytes
X-rays
Simoidoscopy
Upper endoscopy (EGD)
Intestinal biopsy
String
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34
Q

Non specific treatments?

A

Oral/IV rehydration
BRAT diet
Anti motility agents
Antimicrobial therapy

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35
Q

Most diarrhea organisms are?

A

Self limiting

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36
Q

When to suspect a virus with diarrhea?

A 
Vomiting is prominent
14hr + incubation
Short (<3 days)
No bacterial warning signs
No epidemiologic clues
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37
Q

Adenovirus?

A

Prolonged diarrhea (compared to rotavirus)

Multiple viral illness (“the cold”)

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38
Q

Calicivirus

A

Common cause of pediatric diarrhea

Possible association with intussuception

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39
Q

Norovirus

A

Norwalk / norwalk-like

Cruise ships

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40
Q

Rotavirus

A

AGE in kids

URT infections

Vaccine available (not widely used)

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41
Q

Cytomegalovirus

A

Immunocompromised pts

Possible dysentary

Bennefits from antivirals

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42
Q

Yersinia entercolitica

A

Sever cramping

Misdiagnosed as appendicitis

Associated with polyarticular arthritis

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43
Q

Staphylococcus aureus

A

Toxin in food

No organism in body

“I want to die” gastroenteritis

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44
Q

Bacillus cereus

A

Contaminated rice

Systematic movement through GI tract

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45
Q

Clostridium perfringens

A

Known for causing gas gangrene

Mild gastrointestinal symptoms

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46
Q

General info for campylobacter jejuni

A

Community acquired inflammatory enteritis

Fecal/oral

Food borne (chickens 50-70%)

Sick pets

Unpasteurized milk

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47
Q

Campylobacter jejuni s/s?

A 
Acutely ill
Diffusely Tender abdomen 
Abdominal pain 
Fever (104)
HA
Myalgias

10+ watery BM/day

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48
Q

Differentiator for campylobacter jejuni?

A

Abdominal pain

Salmonella/shigella has minimal/no pain

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49
Q

Campylobacter jejuni diagnosis?

A

Stool exam

  • microscopic
  • culture (slow)
50
Q

Treatment for campylobacter jejuni?

A

Azithromycin

51
Q

Salmonellosis groups?

A

2,300 salmonella serovars exist

But they are all grouped into one species

Most of which are pathogenic

52
Q

Another name for salmonella?

A

Nontyphoidal salmonellae

53
Q

Sources of salmonella?

A

Pets:

  • reptiles
  • birds

Food borne illness (95%)

  • eggs
  • poultry
  • vegetables
  • cheese
  • unpeeled fruit
54
Q

Common crawly things that spread salmonella?

A 
Turtles
Lizards
Iguana
Snakes
Salamanders
Frogs and amphibians
55
Q

S/S of salmonellosis?

A
  • Non blood loose stool or watery diarrhea
  • N/V
  • Vomiting
  • mild abd cramping
  • rare symptoms
    — choleralike diarrhea
    — tenesmus
56
Q

How long after eating food do you get salmonellosis?

57
Q

How is salmonellosis diagnosed?

A
  • macConkey agar
58
Q

Tx for salmonellosis?

A

Ciprofloxacin

59
Q

Typhoid fever?

A

Salmonella infection that is a systemic bacterial infection

60
Q

Enteric fever?

A

Typhoid fever

61
Q

What organisms cause typhoid fever?

A

Salmonella typhi (typhoid fever)

Salmonella paratyphi (paratyphoid fever)

62
Q

MC typhoid fever strain?

A

Salmonella typhi

Also the more severe

63
Q

70% of typhoid pts have a hx of?

64
Q

How is typhoid fever spread?

A

Food borne transmission w feces and urine

65
Q

Hallmark of typhoid fever?

A

Invasion/multiplication

Mononuclear phagocytic cells

66
Q

Where are the mononuclear phagocytic cells of typhoid fever found?

A

Liver
Lymph
Spleen
Peyer patches of the ileum

67
Q

Typhoid fever prevention?

A

Besides not eating from street venders (or outside your bubble if you are Ms Booker)

Vaccine

68
Q

Systemic infection of typhoid fever?

A

Bacteremia

69
Q

Phases of typhoid fever?

A
  • Incubation
  • first week
  • days 7-12
  • third week (mortality week)
  • 4th week

3-60 days
- Average 7-14 days

70
Q

Incubation phase of typhoid fever?

A

Usually asymptomatic but can also have transient diarrhea or constipation

71
Q

First week of typhoid fever infection?

A

HA
Malaise
Remittent Fever (103-104*F)

72
Q

Days 7-12 s/s

A

2-4mm diameter pink papules

  • rose spots
  • fade with pressure
  • upper abdomen and lower chest
Relative bradycardia
Dicoratic pulse (double beat)
73
Q

Third week s/s

A 
Increased toxicity
Wt loss
Pyrexia
Delirious state 
Pronounced abdominal distention
Pea soup diarrhea
Weak thready pulse
Tachypnea

This is when they may die

74
Q

What is the delirious state of typhoid fever aka?

A

Typhoid state

75
Q

Fourth week s/s?

A

If they survive (50% mortality)

Symptoms resolve slowly

  • fever
  • mental state changes
  • abdominal distention

Still have intestinal complications
Relapses

76
Q

Typhoid mary?

A

Typhoid fever has a carrier state that some pts get and they can spread it around like a dirty little salamander

77
Q

What lab findings come with typhoid fever?

A 
Anemia
H ESR
Thrombocytopenia
H LFT
Lymphopenia
\+ culture
78
Q

Tx for typhoid fever?

A

Regular:
Ciprofloxin

From Asia:
Ceftriaxone or azithromycin

79
Q

90% of shigellosis are?

A

Shigella sonnei

Shigella flexneri

80
Q

What is bacillary dysentery?

A

The disease caused by shigellosis

81
Q

2 mechanisms of bacillary dysentary from shigellosis?

A

Invasion of the colonic epithelium

Production of enterotoxin

82
Q

Production of enterotoxin for shigellosis?

A

Not essential for colitis but enhances virulence

83
Q

How is shigellosis spread?

A

Fecal oral
From
Water and food

84
Q

Shigella is invasive, that means?

85
Q

S/S of shigellosis?

A 
Acute blood diarrhea
Tenesmus
Mucus poo
Fever (1-3 days later)
Lower abdominal tenderness
Normal/increased bowel sounds
86
Q

Shigellosis timeline?

A

Often self-limited

3d - 1 week
- occasionally last up to 1 month

87
Q

Diagnosis for shigellosis?

A

+stool culture

Fecal leukocytes and erythrocytes

Leukocytosis (rare)

88
Q

Tx for shigellosis?

A

Usually self limited

Ciprofloxacin (cipro)

89
Q

Dont give ___ to shigellosis

A

Narcotic-related antidiarrheals

90
Q

Types of excherichia coli?

A

There are 6 but 4 matter now

  1. ETEC - Enterotoxigenic E Coli
  2. EPEC - enteropathogenic E coli
  3. EIEC - enteroinvasive E coli
  4. EHEC - Enterohemoryhagic E coli
91
Q

Travelers diarrhea is aka

92
Q

Childhood diarrhea is aka?

93
Q

Shigella-like dysentery is aka?

94
Q

Hemolytic uremic syndrome (HUS) is aka?

95
Q

Travelers diarrhea general S/S?

A

Abdominal cramping
EXPLOSIVE BM
Tenesmus
N/V

96
Q

Tx for travelers diarrhea?

A

Loperamide
+
Ciprofloxacin

97
Q

O157:H7

A

EHEC

Produces shiga toxin

98
Q

S/s of O157:H7?

A

Early - Watery diarrhea
Later - grossly bloody
HUS

99
Q

HUS?

A

Hemolysis
Thrombocytopenia
URemia (dialysis)
Death

100
Q

Pathoghnomic of O157:H7 or EHEC?

A

Watery diarrhea that has a sudden switch to grossly bloody

101
Q

Diagnosis of EHEC?

A

Stool culture
- MacConkey

Must request this test specially

102
Q

Tx for EHEC?

A

Typically self limiting

NO ANTIBIOTICS
NO antidiarrheals

Treat the HUS

103
Q

Why no ABX with EHEC?

A

Renal complications

- the HUS kills the kidneys

104
Q

Cholera is NBD right?

A

If only

It can kill you w/in hours from massive dehydration

105
Q

S/S of cholera?

A 
Painless watery diarrhea
Voluminous diarrhea
Vomiting
Abd cramps (maybe)
NO FEVER
hypovolemic shock
106
Q

Cholera poop?

A

Rice water stools

Fishy odor

107
Q

Tx for cholera?

A

Fluid replacement is primary

Abx can shorten the course

108
Q

Abx for cholera?

A
  • doxycycline

- azithromycin

109
Q

Prevention of cholera?

A

oral vaccine

Vaxchora for 18-64 y/o for O1 serogroup

110
Q

This disease is uncommon and not that bad for most people but it is bad for preggos

A

Listeria monocytogenes

111
Q

Listeria monocytogenes and preggo?

A

25% result in fetal loss

112
Q

What is listeria spread through?

A

Food

  • dairy (unpasterurized)
  • soft cheese
  • ice cream
  • raw fruit
  • vegetables/produce
  • hot dogs
  • cold cuts
  • deli meats
113
Q

Typical presentation of listeria?

114
Q

Uncommon presentation of listeria?

A 
Meningitis
Meningoencephalitis
Abscess formation
Endocardidits
Arthritis/osteomyelitis
Pneumonia
115
Q

S/s of listera

A 
Non invasive diarrhea (1-3 days)
Poss bacteremia
- fever
- myalgias
- arthritis
- back pain
- HA
116
Q

Types of Neonatal listeria?

A

Early-onset sepsis (w/in 6 days)
(Transplacental transmission)

Late onset - 7-28 days after birth
(Vaginal transmission)

117
Q

Effects of transplacental transmission of listeria?

A

Premature birth
Abortion
Stillbirth
Intrauterine infection

Abscess and/or granulomas

118
Q

S/S of neonatal listeria?

A

CNS: brain parenchyma

  • mental status changes
  • seizure
  • cranial nerve deficits
  • strokelike syndrome
  • hemiplegia
  • movement disorders
  • encephalitis
  • meningitis
  • ventriculitis
119
Q

What labs for listeria?

A 
Blood culture
CSF culture
Wet mounts - motile
Serologic (not reliable)
Stool cultures (not good)
120
Q

Tx for listeria for at risk populations?

A

Empiric abx

  • ampicillin
  • gentamicin
  • trimethoprim-sulfamethoxazole
121
Q

Have you see the sequel, Diarrhea?

A

It leaked so they had to release it early

Senior - ID 2 (6 decks)

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