Acute Diarrhea

Question 1

What causes 90% of acute diarrhea?

Answer 1

INFECTION

remainedr due to medications, ischemia, or toxins

Question 2

Campers

Answer 2

giardia

Question 3

travelers to Mexico

Answer 3

enterotoxigenic E coli

Question 4

undercooked chicken

Answer 4

salmonella or shigella

Question 5

raw seafood

Answer 5

vibrio, salmonella, hepA

Question 6

Say you ate a salad with maynonnaise and got symptoms within 6 hours? 8-12 hours? 12-14 hours?

Answer 6

6 - s aureus
8-12 - clostridium perfringens
12-14 hours E coli

Question 7

Daycare

Answer 7

shigella, giardia, rotavirus

Question 8

patient in a nursing home or who were recently hospitalized, recently took antibiotics

Answer 8

C diff

Question 9

Cold meats, raw milk, soft cheese

Answer 9

listeria

Question 10

T/F: It is imperative to thoroughly work up any patient with acute diarrhea, as left untreated may become deadly

Answer 10

FALSE most patients with acute diarrhea have self limiting processes that don’t require much workup

Question 11

Red flags for COMPLICATED diarrhea

Answer 11

bloody diarrhea, severe abdominal pain, fever greater than 100.4, diarrhea more than 48 hours, children, elderly, immunocompromised

Question 12

Questions to ask patient with diarrhea

Answer 12

• exposure history (food, travel, others with similar symptoms, medications
• can you tolerate PO? (if not, more prone to dehydration)…may need hospitalization

Question 13

When to use stool cultures?

Answer 13

bloody diarrhea, diarrhea lasting for more than 3-7 days, immunocompromised patients, evidence of systemic disease/severe dehydration

Question 14

Antibiotic often associated with pseudomembranous colitis

Answer 14

clindamycin

BUT ANY ANTIBIOTIC CAN CAUSE THIS

Question 15

How to treat most cases of diarrhea

Answer 15

REHYDRATION
mild - gatorade, pedialyte, encourage PO intake
severe - hospitalization for IV rehydration

may try antimotility agents like loperamide or zinc supplementation (in children)

Question 16

Most common infectious cause of diarrhea

Answer 16

viral

Question 17

How to prevent spread of viral diarrhea

Answer 17

HANDWASHING

• pasteurized dairy food
• eat hot and well cooked foods if traveliing to endemic areas, bottled water and soda, avoid ice

Question 18

travelers diarrhea

Answer 18

more than 3 loose stools in a 24 hours period accompanied by abdominal cramping, nausea, vomiting, fever, or tenesmus. Most cases occur within 2 weeks of travel

Question 19

What has been shown to reduce incidence of traveler’s diarrhea

Answer 19

bismuth subsalicylate

Question 20

When to initiate antibiotics for traveler’s diarrhea and which class

Answer 20

as soon as diarrhea begins
use a quinolone or azithromycin for pregnant women and children

CIPRO 500 mg twice daily 3 times a day
AZITHRO single 100- mg dose adults

Question 21

When can you use rifaximin?

Answer 21

TD caused by non invasive E coli (not effective in fever or bloody stool)

Question 22

treatment for c diff

Answer 22

metronidazole or oral vanc