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ACUTE DIARRHEA Flashcards

1
Q

what is the definition of diarrhea?

A

> 3 loose stools

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2
Q

what is characterized by acute diarrhea?

A

<2 weeks duration

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3
Q

what is characterized by chronic diarrhea?

A

> 3 weeks duration

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4
Q

what is gastroenteritis?

A

diarrhea w/nausea and vomiting

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5
Q

what is dysentery?

A

diarrhea w/ BLOOD, mucus, pus

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6
Q

what is osmotic diarrhea? (sorbitol)

A

solutes in lumen draw/keep water in lumen

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7
Q

what is secretory diarrhea? (Cholera)

A

intestinal secretions of solutes and water into lumen

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8
Q

what sx are see in non-infectious diarrhea?

A

lack of constitutional symptoms (fever, fatigue, night sweats)

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9
Q

what are sx seen in infectious diarrhea?

A

large volume (often watery) stool, constitutional sx, N/V/abd cramps (gastroenteritis)

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10
Q

what sx are seen in infectious colitis?

A

fever, tenesmus, and dysentery

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11
Q

is non-inflammatory diarrhea usually viral or bacterial?

A

usually VIRAL! (some bacterial, parasitic)

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12
Q

what is going on with the mucosa in non-inflammatory diarrhea?

A

intestinal secretion, mucosa INTACT

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13
Q

what kind of diarrhea presents with a fever, and bloody stool?

A

inflammatory

non-inflammatory DOES NOT have either of these sx for the most part (etec-low grade fever)!!!!

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14
Q

what type of diarrhea has fecal leukocytes?

A

inflammatory

non-inflammatory DOES NOT have this sx!!!!

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15
Q

is inflammatory diarrhea usually viral or bacterial?

A

usually invasive, toxin-producing bacteria

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16
Q

what is going on with the mucosa in inflammatory diarrhea?

A

shes DAMAGED** huge thing

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17
Q

what are some examples of non-inflammatory diarrhea?

A

-norovirus
-rotavirus
-cholera
-enterotoxigenic E. coli
-staph aureus
-giardia

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18
Q

what are some examples of inflammatory diarrhea?

A

-shigella
-campylobacter
-c. diff
-some salmonella
-shiga toxin E. coli

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19
Q

what pathogen is most common in daycare?

A

rotavirus

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20
Q

what pathogen is most common with foods being eggs and dairy?

A

salmonella

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21
Q

what pathogen is most common with water (CAMPING)?

A

streams= giardia

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22
Q

what pathogen is most commonly associated with travel?

A
  1. enterotoxigenic E. Coli
  2. norovirus outbreaks on cruise ships (and locally)
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23
Q

what pathogen is most commonly associated with animals being turtles and reptiles?

A

salmonella

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24
Q

what is toxin-mediated “food poisoning” ?

A

bacterial toxin that has abrupt onset (1-8 hours after ingestion) that has vomiting that is PROMINENT (diarrhea minimal) and resolves in <24 hours

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25
what is ETEC also known as?
traveler's diarrhea or montezuma's revenge
26
what are the sx of ETEC
anorexia, cramps, watery diarrhea, low grade fever may be nausea& vomiting - not prominent NO PUS OR BLOODY STOOLS
27
what is ETEC/travelers diarrhea due to?
contaminated food/water
28
what is a common cause of acute diarrhea hospitalizations in children?
rotavirus
29
in what season is rotavirus more prevalent?
winter
30
how long is viral shedding in rotavirus?
21 days
31
What kind of onset does rotavirus have?
acute onset, may be fever
32
what is a common cause of diarrheal epidemics?
norovirus - HIGHLY CONTAGIOUS
33
what kind of onset does norovirus have?
acute onset
34
what are the sx of norovirus?
N/V watery diarrhea abdominal cramps lasts 1-3 days
35
what are the types of acute bacterial diarrhea specifically?
campylobacter salmonella shigella e. coli ALL OF THESE ARE SEEN ON STOOL CULTURE
36
what is campylobacter seen in?
contaminated food (poultry) or d/t contact with fecal material/animal-to-person
37
what are the s/sx of campylobacter?
diarrhea +/- BLOOD abd cramps/pain fever usually self-limited -> may not require abx
38
what age population is salmonella seen in?
children <4 years old
39
what is salmonella d/t?
contaminated food (poultry) infected animals (turtles)
40
what are the s/sx of salmonella?
fever diarrhea +/-blood abdominal cramping/pain usually self-limited -> usually does not require abx
41
what is shigella?
"shiga toxin" - toxic to enterocytes
42
what are the sx of shigella?
fever abdominal cramps/pain TENESMUS--mucoid stools +/- blood abx shorten duration of illness, limit fecal shedding
43
what is E. coli (shiga toxin) d/t?
d/t contaminated food/water
44
what are the sx of E. coli (shiga toxin)?
BLOODY DIARRHEA-- not typical traveler's diarrhea SEVERE abdominal cramps high fever >101.3 DO NOT USE ABX-> THEY INC RISK OF HUS
45
what is c. diff associated with?
antibiotic use
46
what is c. diff?
major diarrhea cause in pts hospitalized >3 days (consider in all hospitalized patients w/ unexplained leukocytosis)
47
what type of diarrhea is seen with c. diff?
greenish, foul, watery diarrhea 5-15x daily, rarely bloody
48
what will you see on PE of c. diff?
normal or mild LLQ tenderness
49
what does it mean if diarrhea of c.diff is severe or fulminant?
This means theres profuse diarrhea (> or equal to 30 stools/day)
50
what will you see on PE of severe/fulminant diarrhea of c. diff?
fever, hemodynamic instability (shock), abdominal distention, pain, tenderness
51
what labs suggest severe/fulminant diarrhea of c. diff?
wbc >30k, albumin <2.5 d/t protein-losing enteropathy, elevated serum lactate, rising Cr
52
if there is severe/fulminant diarrhea of c.diff, what is the imaging of choice?
noncontrast abdominal CT to look for colonic dilation and wall thickening
53
what other lab should be done for c. diff (Severe/fulminant diarrhea)?
stool toxin/antigen assay
54
what is the number one med assoc. w/ c.diff?
clindamycin
55
what are the indications for surgical consultation in management of C. Diff?
1. hypotension w/ or w/o vasopressors 2. fever > or equal to 38.5 3. ileus of significant abdominal distention 4. peritonitis or significant abdominal tenderness 5. mental status changes 6. WBC > or equal to 20k 7. serum lactate levels >2.2 8. admission to intensive care unit for C. diff 9. end organ failure (mechanical ventilation, renal failure) 10. failure to improve after 3-5 days or max medical therapy
56
why do we want to prevent abx use for c. diff?
we don't want to suppress gastric acid
57
what are the sx of parasites as well as the types?
- d/t contaminated food, water, person - gradual onset/can be chronic - watery, persistent, NON-BLOODY diarrhea - vomiting is not prominent - malabsorption TYPES: #1=GIARDIA, ENTAMOEBA HISTOLYTICA, CRYPTOSPORIDIUM
58
what will you see in malabsoprtion d/t parasites?
weight loss and foul smelling stool
59
WHAT ARE SIGNS OF DEHYDRATION YOU WILL SEE ON PE?
1. dry mucus membrane 2. poor skin turgor 3. orthostatic changes: DECREASE IN BP > 20/10
60
do you usually do a diagnostic workup for acute diarrhea?
usually not
61
when would you do a diagnostic workup for diarrhea (What are the exceptions)?
1. wt. loss/ dehydration 2. bloody diarrhea 3. severe abdominal pain 4. recent abx use 5. immune suppressed/ associated illness/ elderly 6. high fever > or equal to 101.3
62
if a dx workup for acute diarrhea is needed, what is entailed?
1. stool culture, Giardia antigen testing, O&P 2. fecal leukocytes/fecal lactoferrin 3. c. diff testing 4. electrolytes 5. renal function testing
63
what abx therapy does shigella. campylobacter, c diff, severe travelers diarrhea, or prtozoal infections get?
NONE BITCH YOULL KILL THEM
64
in what cases do you give abx therapy?
bloody diarrhea high fever > or equal to 101.3 elderly or if severe comorbidities immune compromised
65
what is the tx for acute diarrhea?
1. oral rehydration therapy/early refeeding for dehydration 2. IV fluids PRN 3. avoid antimotility agents if bloody diarrhea 4. probiotics? may shorten duration of sx
66
when would anti-motility agents work for sx relief?
in pts w/ no significant fever non-bloody stools
67
what are ther anti-motility agents?
loperamide pepto-bismol kaopectate lomotil- rx because narcotic+atropine (opiate)
68
when do you admit for diarrhea?
1. severe dehydration/ unstable VS 2. bloody diarrhea w/ anemia 3. severe abdominal pain & recent abx use 4. significant comorbidities
69
what is the most common endocrine cuase of nausea that you should consider in any women of childbearing age?
pregnancy
70
what are acute symptoms usually?
INFECTIOUS, INFLAMMATORY , OR IATROGENIC
71
what can chronic GI sx usually indicate?
obstruction, fxnal disorders, organic diseases
72
whats the number one cause of GI obstruction?
surgery
73
what do you do when the cause of N/V is unknown/ you are uncertain?
empiric therapy with antiemetics
74
what kind of sx will a gastric outlet obstruction have?
intermittent sx that also cause n/v
75
what kind of sx will intestinal obstruction have?
acute sx and severe pain that can lead to n/v
76
what are acute sx that can cause n/v?
appendicitis, cholecystitis, pancreatitis
77
what kind of sx do motility disorders have?
insidious onset of sx w/ inability to move food through GI tract
78
do GERD, PUD, IBS have n/v?
may have, but not primary sx
79
COLIC
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GI (22 decks)

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