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Rosens > 80. Gastroenteritis > Flashcards

80. Gastroenteritis Flashcards

1
Q

Diarrhea defn

A

passage of 3 or more unformed stools per day, more than 250g/day or stool taking on form of container is its placed

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2
Q

Dysentery defn

A

inflamm of intestine typically causing blood and mucus - generally assooc with fever, abdo pain, rectal tenesmus

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3
Q

Gastroenteritis: what 2 infections typically cause diarrhea related death?

A

cdiff
norovirus

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4
Q

Diarrheal illness classification - acute vs prolonged vs persistent vs chronic

A

acute (<7 days), pro- longed (7 to 13 days), persistent (14 to 29 days), or chronic (>30 days). Acute and prolonged gastroenteritis (13 or fewer days)

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5
Q

Pathophysiology of gastroenteritis: 4 mechanisms:

A
  1. ingestion of preformed toxin
  2. adherence of infectious pathogen to intestinal cell walls
  3. invasion of mucosal wall
  4. production of enterotoxins and cytotoxins
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6
Q

GI sx after short period - bug?

A

1-6h
staph or bacillus

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7
Q

Diarrhea lasting more than 2 weeks - bug?

A

giardia

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8
Q

Traveller’s diarrhea cause

A

enterotoxigenic e choli

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9
Q

Travel to southeast asia - risk of diarrhea from what 2 bugs?

A

vibrio
campy

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10
Q

South America, Asia, Africa travel diarrhea - bug?

A

rotavirus

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11
Q

3 bugs/protozoa can get from recent camping

A

giardia
aeromonas
crypto

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12
Q

Recent abx - diarrhea - worry?

A

cdiff

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13
Q

Daycare exposure - 2 bugs risk?

A

rotavirus
noro

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14
Q

Exposure to raw seafood - worry which bug?

A

noncholera vibrio

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15
Q

Anal sex 4 possible bugs causing diarrhea?

A

shigella
campy
salmonella
entamoeba

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16
Q

HIV diarrhea causing bugs -4

A

MAC
microsporidia
CMV
giardia
salmonella
cdiff
shigella

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17
Q

Diarrhea outbreak on cruise ship bug?

A

norovirus

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18
Q

Diarrhea outbreak contaminated local water, food etc: bugs?

A

campy
salmonella
ecoli

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19
Q

Which bugs more commonly cause bloody diarrhea?

A

campy
shigella

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20
Q

What bug causing diarhea mimics appendicits?

A

yersinia

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21
Q

DDX gastroenteritis

A

SBO, diverticulitis, IBD, ischemic bowel disease, appendicitis, pancreatitis, hepatobiliary pathology, malabsorption, celiac disease, or irritable bowel syndrome.

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22
Q

Stool cultures for Salmonella, Shigella, Campylobacter, Yersinia, Shiga toxin–producing Escherichia coli (STEC), and C. diffi- cile may be considered for patients with what features?

A

severe illnes
fever >38.5
dysentery
immunocomprised state
recent hospital
recent abx

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23
Q

Shigella, salmonella typhi, vibrio noncholera - dx, tx

A

stool culture

ciprofloxacin 500mg PO BID x3d or azithro 500mg PO d for 3d

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24
Q

Salmonella enteritids - dx, regular vs severe tx

A

stool, PCR
no tx vs sev: fever, bloody diarrh, bacteremia - levo 500mg IV or PO 7-10d

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25
Q

Campylobacter jejuni dx, tx

A

stool culture
azithro 500mg PO d for 3d, or erythromycin 500mg PO BID x5d

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26
Q

Vibrio cholerae dx and tx

A

dx stool culture with salt containing media

doxy PO 4-6mg/kg up to 300mg once daily for 3d

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27
Q

ETEC dx tx

A

stool culture and assay for toxin

ciprofloxacin 750mg Po x1 or 500mg PO bid x3d,rifaxamin 200mg PO TID x3d, azithromycin 1g PO once daily

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28
Q

Ecoli O157:H7 - dx, tx

A

sorbitol maconckey and serotype

NONE - supportive, risk HUS with abx

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29
Q

Yersinia: dx, tx

A

cIN agar

supportive, if sev: septra 1 tab PO BID x3d, ciproflocacin500mg PO BID x3d

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30
Q

Cdiff dx and tx

A

stool for cdiff toxin, PCR

vanco 125mg PO qid for 10d or fidaxocicin 200mg PO bid x10d
alt flagyl 500mg PO TID for 10d

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31
Q

Staph aureus as diarrhea cause: dx, tx

A

food may be cucltured but not routine

supportvie

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32
Q

Bacilus cereus: severe case tx

A

vancomycin 125 mg PO qid; or clindamycin 500 mg PO tid for 7–10 days

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33
Q

Giardia tx options

A

Tinidazole 2 g PO single dose
Metronidazole 500 mg PO bid or 250 mg tid for 5–7 days Nitazoxanide 500 mg PO bid for 3 days
Alternative agents
Albendazole 400 mg PO once daily for 5 days Mebendazole 200 mg PO tid for 5 days
Quinacrine 100 mg PO tid for 5 days
Paromomycin 10 mg/kg PO tid day for 5–10 days

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34
Q

Entamoeba histolytica: tx

A

Metronidazole 500–750 mg PO tid for 7–10 days; Tinidazole 2 g PO once a day for 3–5 days; Nitazoxanide 500 mg PO bid for 3 days Intraluminal infection
Paromomycin 25–35 mg/kg PO divided tid for 7 days. Iodoquinol 650 mg PO tid for 20 days for adults Diloxanide furoate 500 mg PO tid for 10 days for adults

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35
Q

Cryptosporidium tx

A

Nitazoxanide 500 mg PO bid for 3 days

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36
Q

Cyclospora cayetanensis: tx

A

Trimethoprim-sulfamethoxazole (TMP-SMX), one double-strength 160/800 mg tablet PO bid for 7–10 days

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37
Q

3 main types of ORT per WHO: what do these contain?

A

ORS (331 mOsm/kg), reduced osmolarity WHO ORS (245 mOsm/kg), and Pedialyte (oral electrolyte solution for children; 250 mOsm/kg).

Simple home remedies, such as diluted fruit drinks and chicken broth, or com- mercial solutions such as Gatorade will also suffice

38
Q

Initial dose of loperamide and dosing

A

initial dose of loperamide is 4 mg PO, followed by 2 mg after each unformed stool, up to a maximum of 16 mg/day for 48 hours

NOT for children <18y

39
Q

Invasive vs noninvasive bacterial gastroenteritis:

A

Invasive gastroenteritis is a clinical diagnosis made in the presence of signs or symptoms of intestinal mucosal invasion, such as fever, gross or occult blood in the stool, tenesmus (feeling of con- stantly needing to pass stool), or severe abdominal pain

Patients with noninvasive gastroenteritis generally do not exhibit fever, produce bloody stools, or experience significant abdominal pain. Noninvasive gastroenteritis likely suggests the presence of a viral pathogen or toxin-producing bacteria.

40
Q

Campylobacter clinical features

A

Most common bacteria; organism identified in stool cultures; acute watery diarrhea, fevers, dysenteric characteristics

41
Q

DDX of invasive bacterial gastroenteritis:

A

campy
salmonella nontyphoid and tyhpod
shigella
yersinia
vibrio noncholera
ecoli O157:H7

42
Q

Bacteria: Usually foodborne (e.g., poultry); acute watery diarrhea, often with fever; common in sickle cell and immunocompromised patients

A

salmonella nontyhpod
within 12-24h, lasting 2-7d

43
Q

Bacteria? Fever, abdominal pain, ileus, systemic effects; most infections acquired during international travel

A

salmonella typhoid

44
Q

Bacteria? Common worldwide; acute watery diarrhea, fever, dysenteric characteristics; toxigenic; high incidence in men who have sex with men

A

shigella

45
Q

Bacteria? Acute diarrhea, dehydration; rare in the United States but common with travel to Asia; can mimic appendicitis

A

Yesinia

46
Q

Bacteria? Associated with seafood, shellfish; watery diarrhea, dysentery

A

vibrio

47
Q

Bacteria? Watery, bloody diarrhea; foodborne—contaminated beef or produce; toxigenic; associated with HUS
and TTP

A

ecoli O157:H7

48
Q

DDX noninvasive toxigenic bacterial gastroenteritis

A

staph aureus
clostridium perfringens
bacillus cereus
vibrio cholerae
marine bacteria like scombroid
noncholera vibrio
Cigatera fish poisoning
ETEC
Cdiff

49
Q

Bacteria? Short incubation period, 2–7 h; preformed toxin; vomiting; lasts <24 h

A

staph aureus

50
Q

Bacteria: 6-24h, Watery diarrhea, seen in large foodborne outbreaks

A

clostridium perfringens

51
Q

Bacteria? Vomiting or diarrhea, typically from contaminated rice

A

bacillus cereus

52
Q

Bacteria?

A

Enterotoxin; acute “rice water” diarrhea, dehydrating. Rare in the United States but common with travel to Asia

53
Q

Bacteria? Enterotoxin. Acute diarrhea, occasional dysentery. Seen in Gulf coast in the United States. Can cause septic shock, wound infection

A

noncholera vibrio

54
Q

Scombroid presenting sx

A

histamine toxin
tachycardia
itching
flushing
cramping dizziness
meetaollic taste

within 5-60min **mahi mahi, tuna other dark meat

55
Q

Ciguatera fish - toxin sx?

A

pain, paresthesia, dyesthesia, vomiting, diarrhea

within 2-6h

coral reef fish

56
Q

Bacteria? Acute watery diarrhea. Common cause of traveler’s diarrhea, but in the United States increasing cause of foodborne disease

A

etec

57
Q

Recent PPI - bacteria?

A

cdiff

58
Q

Salmonella - when to use abx? what RF

A

severe colitis and infants younger than 3 months, adults older than 50 years, and those at risk for severe disease, including those who are immunocompromised, with sickle cell disease, or with prosthetic grafts.

59
Q

Salmonella prevention?

A

cooking meat internal greater than 160°F (71°C) and minimizing how long foods are allowed to remain at room temperature,

60
Q

Post infection complications of Yersinia

A

erythema nodosum, persistent polyarthritis, sacroiliitis, ankylosing spondylitis, Reiter syndrome, exudative pharyngitis, pneumonia, empyema, or lung abscess.

61
Q

How does Vibrio produce effect?

A

two thermostable direct hemolysin virulence factors - attach to colonic epithelium inducing secretory diarrhea, local cell lysis

62
Q

What temp allows staph aureus allow for proliferation of organism

A

Temperatures of 45°F to 140°F (7°C to 60°C) for only a few hours will allow the proliferation of the organism and production of sufficient enterotoxin to cause disease.

63
Q

How do Cholera and noncholera Vibrio strains work?

A

stimulate enterocyte adenylate cyclase, disrupting mucosal fluid absorption and leading to secretory diarrhea

64
Q

Complications of cdiff

A

none
, pseudomembranous colitis, toxic megacolon, intestinal perforation, and death

65
Q

Why are cdiff spores so hard to kill?

A

Difficile spores are highly resistant to heat, acid, and antibiotics, making them highly contagious for person-to-person or surface-to-person infections. C. difficile bacte- ria secrete toxins A and B that cause inflammation, mucosal injury, and secretory diarrhea.

66
Q

Cdiff wbc level common?

A

> 15

67
Q

Virus? Most common cause of gastroenteritis in the United States, and most common cause of US foodborne-disease outbreaks; fever, headache, myalgias, nausea, vomiting, abdominal pain, diarrhea; incubation period, 12–48 h

A

norovirus

68
Q

Virus? Fever, nausea, vomiting, diarrhea; usually causes mild illness

A

sapovirus

69
Q

Virus: Fever, nausea, vomiting, abdominal pain and watery diarrhea; incubation period ≅ 2 days

A

rotavirus

70
Q

Virus? Rare cause of serious illness; fever, diarrhea; can cause nongastrointestinal illness (e.g., bronchitis, pneumonia, conjunctivitis)

A

adneovirus

71
Q

Virus? Malaise, headache, abdominal pain, diarrhea; vomiting less common

A

astorvirus

72
Q

Parasite? Nausea, vomiting, abdominal cramping, flatulence, greasy stool that may float

A

giardia

73
Q

Parasite? Fever, anorexia, abdominal cramping, watery or bloody diarrhea; illness ranges from asymptomatic infection to fulminant colitis, peritonitis to extraintestinal amebiasis

A

entaemoeba histolytica

74
Q

Parasite? Abdominal cramping, diarrhea. One of the most frew causes of waterborne disease in US population

A

crystosporidium

75
Q

Parasite? Nausea, vomiting, loss of appetite, weight loss, bloating, abdominal cramping, diarrhea

A

cyclospora

76
Q

How does giardia work?

A

trophozoite (active form) and cyst (inactive form).

Trophozoites attach to the mucosal lining of the small intestine and cause symptoms.

This active form of the parasite is unable to survive outside the body for an extended period of time and hence cannot spread infection to others. However, the cystic form is viable outside of the body for prolonged periods and, once ingested, changes into the trophozoite form. Trophozoites generate the cysts that exit the body via the feces.

77
Q

DDX food borne illnesses

A

staph
b cereus
scombroid
ciguaeteria fish poisoning

slight longer at 16h: etec, stec, shigella, vibrio

78
Q

What fish cause scombroid?

A

Scombridae (e.g., tuna, mackerel, skipjack, bonito, and related species) but results from the ingestion of a wide variety of dark meat fish, including nonscombroid species such as herring, bluefish, anchovy, sardine, amberjack, black marlin, and mahi mahi.

79
Q

Traveller’s diarrhea: mild?

A

tolerable, not distressing, does not interfere with planned activities
no abx

80
Q

Traveller’s diarrhea: mod

A

distressing, interfers with activities
abx if immunosuppressed, solid organ transplant, elderly

81
Q

Traveller’s diarrhea: severe

A

Diarrhea that is incapacitating or prevents planned activities; all dysentery (passage of grossly bloody stools) is considered severe. Antibiotics are indicated for severe traveler’s diarrhea

82
Q

Organisms causative of traveller’s diarrhea?

A

ETEC
Enteroaggregate ecoli
campy
salmonella
shigella
noro
rotavirus
giardia

83
Q

Indications for bismuth subsalicylate traveller’s diarrhea

A

The antacid bismuth subsalicylate decreases the incidence of trav- eler’s diarrhea by 65% due to its antibacterial and antisecretory effects. The recommended dose is two tablets PO qid or one fluid ounce PO qid. Bismuth subsalicylate should be avoided in those who are allergic to aspirin because it contains salicylate. Potential side effects include blackening of the tongue or stool. It should not be taken for more than 3 weeks.

84
Q

Traveller’s diarrhea prevention options?

A

rifaximin 200mg PO d or bid duration of tx
or bismuth

85
Q

After eating undercooked ground beef, a patient develops fever, abdominal pain, bloody diarrhea, and rectal tenesmus. Local health authorities are investigating a common source from a local diner, as 10 other patrons have presented with the same symptoms. Which of the following organism is likely to produce this dysentery outbreak? a. Giardia
b. Norovirus
c. Shigatoxin–producingEscherichiacoli(O157:H17) d. Staphylococcus aureus

A

c

86
Q

A patient from a resource-rich country has traveled to a resource-
poor developing country. He develops diarrhea, up to four times a day, with yellow watery stools. There is no fever or abdominal pain. Which of the following organism is most commonly the etiology of Traveler’s Diarrhea?
a. EnterotoxigenicEscherichiacoli(ETEC) b. Giardia
c. Shigella
d. Vibrio noncholera

A

a

87
Q

A patient comes to the emergency department (ED) with a com- plaint of abdominal cramping and vomiting twice; the first time was the food ingested from a buffet 8 hours ago and the second time yellowish vomitus. There is no diarrhea or fever. There is contin- ued retching intermittently in the ED. What is the likely causative organism?
a. Clostridium perfringens
b. Escherichia coli O157:H7—Shiga-producing toxin c. Norovirus
d. Salmonella enteritidus

A

a

88
Q

A 5-year-old patient with a likely viral gastroenteritis for 3 days is determined to be dehydrated. What is optimum mode of rehydra- tion therapy in this patient?
a. High-glucose solution (e.g., apple juice)
b. IV normal saline (0.9%)
c. Oral hydration with clean water
d. Reduced osmolarity (245 mOsmol/kg) oral rehydration solution

A

d

89
Q

A patient presents with non-bloody diarrhea for 5 days, crampy abdominal pain, and bloating. The white blood cell (WBC) is 16,000/mL. Which of the following types of patient and scenario is most likely to put the patient at high risk for Clostridium difficile? a. A 3-year-old toddler in daycare
b. Elderly nursing home patient
c. Nurse who works in the emergency department d. Traveler on vacation returning from Mexico

A

b

90
Q
A

Rosens (40 decks)

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