acute Diarrhea Flashcards
what is the most common pathogen for viral gastroeneritis?
Norovirus-
מונו מונו אני “לבד” וטוב לי- הפוכה, בתי ספר, קרוזים , בתי אבות.
חשיפה – אחרי יומיים הקאות ושלשולים – עובר אחרי 72 שעות
מה הפתוגנזה של רוטה וירוס
Duedonum + proximal jeujonum»_space; villi blunting, prolifration of crypts cells and loss of brush border enzymes
no fecal luekocytes
what Administration of moderate to severe dehydration in childrens?
which fluid and how
Bolus IV istotonic fluids
whats the pathogen?
Raw /prepared food (potato salad)»_space; 3 hrs later»_space; VOMITING + wattery stool
vomiting > diarrhea
S.aureus
what is the DDx for vomiting dominant gastroenteritis?
2
S. aureus
Bacillus Cereus
whats the pathogen?
Vomiting dominant Gastroenteritis after reheating rice
Bacillus cereus
סיראוס- סיר אוז
Enterotoxin
Whats the pathogens?
return from india w/acute onset od diarrhea and abdominal pain
Traveler’s diarrhea = ETEC E.coli (Exterotoxigenic)
what are the 2 types of ETEC toxin
Heat-labile = activation of adenylate cyclase = increase cAMP
Heat stable = activation oc Gunelate cyclase = increase cGMP
Whats the most common causeses (3) of acute onset bloody diarrhea?
- E.coli O157:H7
- Compylobacter
- Shigella
whats the diagnosis?
31 yr old»_space; 7 days of lower abdominal pain + bloody diarrhea (wakes at night). Hb 8. MCV 67, PLT 55K, WBC 11K, Cr 2.4, coombs negetive, schistocyts on blood smear
what cause it
Hemolytic Uremic Syndrome = HUS
Thrombocytopenia - around 40-60K
Diagnosis- E.coli O157:17 (STEC- shiga toxin) or Shigella dysenteriae
who have the greater risk for HUS
children < 10
E.coli (STEC O157:H7) or Shigella dysentheria
What the patogenesis of O157:H7 EHEC + Shigella dysenteriae
inhibition of 60S»_space; block protein synthesis»_space; cell death»_space; watery diarrhea that may become bloody
True / False
pt with EHEC will always present with fever
False
will not have fever
how to EHEC transmitted
Contaminated / undercook foood
How to destinguisah Inflammatory diarrhea with non inflammatory?
preseance of fecal blood and leukocytes
which medicaiton can cause diarrhea
- Metformin
- allopurinol- prevent gout, lower uric acid levels
- orlistat- for loosing weight
- SSRI
- cholinesterase inhibitor
- PPI
- NSAIDS
MOCA PAN
How can we resolve osmotic diarrhea comapre to secretory diarrhea
osmotic diarrhea- can be resolved by fasting
what do Shigella cuease to the intestital epithelium
Invade and enter enterocytes»_space; cell death of epithelium»_space; ulcerationd and bloody / mucoid diarrhea
whare are the 2 classic symptoms of shigella infection?
- High fever
- Left side abdominal pain (rectosigmoid)
Which complecation can shigella cause in pediatrics?
Siezures
why shigella species rq low infection dose to cause disease?
survive in acidic enviroment of the GI tract
What are the characterstic of shigella on labratory:
1. lactose fermantation
2. which agar
- Non lactose fermentation
- Non hydrogen sulfide on triple sugar iron agar
What cause Campylobacter gastroeneritis?
2
Poultry (fram chickens) and domasticated animals (dogs..)
whats the diagnosis?
Diarrhea mucoid / bloody + fever + pseudoappendecitis (oliocetis) in a pt that have a dog
Compylocabter
which pathogs are the 2 most common cuase of
psuadoappendicitis
in USMLE
- Yersinisa enterolitica
- Campulobacter jejuni
whats the diagnosis
trip to india»_space; eat local food»_space; 2 weeks later»_space; fever 1 week»_space; severe abdominal pain + distenaion + salomon colur (rose spots) circular lesions
also, who is the pathogen and how transmitted
- Thypoid fever
- Slamonella Thypi
- Feco-oral transmittion
Which pathogen associated with contaminated food and water can cause Hemorrhagic enteritis (Bowl perforation)
Salmonella Thypi
How Slamonella thypi invade the immune sys?
Via capsular antigen»_space; inhibit nuetophils»_space;replication in macrophages
Which Hematological disease can present with Non-typhoidal salmonella osteomoylietis
Sickle cell
What the presentation of Non typpoidal salmonella?
bloody diarrhea after eating a lot of eggs / contact with turtules/pets
which pathogen cause a foul smelling amniotic fluid + gram positive bacilli
Listeria monocytogenes
Which pathogen is presented with “ Thumnling motility in room Tm”
Listeria monocytogenes
facultative anaerobe
Listeria monocytogenes:
in adult
in pregnent women
what the presentation?
Story of expose to deli meet / cheeses
adults- Self limiting Gastroenteritis
Pregnant- Intrauntrine fetal demise = death (Hepatic abcess)
When we will give Abx for acute diarrhea?
- Severe with systemic symptoms > 7 days
- immunocompromised
How to diagnosed C.difficle
**stool PCR analysis or enzyme Immunoassay **
for C.diff toxins
or
Glutamtate dheydrogenase antigen
Whats the diagnosis?
inpatint stay / use of antiontics in pat 12 wks , on day 3 on hospital present with fever, Watery diarrhea with trace of mucus and blood
C.difficile
All the following are major risk factor for ___________
Abx use, PPI, cytotoxic Chemotherapy, age >65, recent hospitalization
C. difficile
Whats C.difficle typical finding on colonoscopy
psuedomembranes
Fibrin & inflammatory cells
how so psuadomembranous form?
Ingestion of pores»_space; Toxin A &Toxin B»_space; inflammatory reaction»_space; actin cytoskeletal structre disrapture
C. difficile (gram positivie)
Tx for C.difficile?
Vanco or Fidaxomicin (macrolide)
What is the mechanism of aciton of macrolide?
inhibit RNA polymerase»_space; Bactericial
Tx for toxic mega colon after C.difficle
Bowl rest + NG tube + PO and rectal fidaxomicin / vanco and consider Metronidazole + Stop antinotility agents
if severe = consider colectomy
Which of the following wont prevent/ kill bacterial spoers of C.difficile?
1. handwashing
2. Alcohol
3. Nonsterile gloves + Gown
Alcohol woldn’t kill bacterial spores
Watery diarrhea after return from trip
ETEC
Watery diarrhea with “rice water stool”
Vibrio cholera
Watery diarrhea on cruise ship
Norovirous/ Norwalk virus
Watery diarrhea in HIV
Cryptospardium parvum
Bloddy diarrhea + consuming meat
Shigella
(or maybe EHEC, Compylobacter)
Bloddy diarrhea + lactose ferment
EHEC
Most common cause of bloddy diarrhea in usa
c. jujuni
Diarrhea that feels like Appendicitis
Yersiniea enterolitica
Protozoal cause bloody diarrhea
Entamoeba hystolitica
Blodody diarrhea + HUS
EHEC or Shigella
Diarrhea after consuming oysters / seafood
Vibrio parahemolyticus
Diarrhea after consuming oyster / seafood + elevated liver enzymes
Vibrio vulnificus
Diarrhea after sweimming in fresh water- (also aquarium association)
Aeromonas
Diarrhea after reheat rice
Bacillus cereus
Diarrhea 6-15 hrs after meat/ poultry left out long
Clostirdium Perfingens
Rash + slapped cheeks apprerance
parvo B12
