Acute Diarrhea Flashcards
Diarrhea, or greater than 200grams/day of stool weight typically presents as 3 or more loose/watery stools and is associated with loss of
____ and ____
Bicarbonate and potassium
Frequent passage of small volumes of stool associated with rectal urgency and tenesmus
Accompanies IBS or proctitis
Pseudo-diarrhea
5 risk groups of diarrhea in the us
Travelers Immunocompromised Daycare workers/attendees and family Institutionalized persons Consumers of certain foods
Non infectious causes of diarrhea often manifest as LONGER THAN 14 DAYS include what kind of medications/food sweeteners
Antibiotics, cardiac anti-dysrhythmics, NSAIDS
Sorbitol
Chronic illness
Ischemic colitis
Indications to work up acute diarrhea include
6+ episodes a day with dehydration Hypotension and tachycardia not responsive to initial volume depletion Dysentery (leukocytes present) Fever Duration >48h without improvement New antibiotic use Community outbreak Severe abdominal pain Elderly, immunocompormised Creating 1.5x higher Peripheral leukocytes
Labs to order when working up acute diarrhea
CBC, ELECTROLYTES, BUN, CREATININE, BLOOD CULTURE STOOL CULTURES OVA AND PARASITES Micro analysis of stool Immune assays for toxins, Ag
Undercooked hamburger == \_\_\_\_\_\_\_\_\_ Fried rice == \_\_\_\_\_\_\_\_\_ Potato salad == \_\_\_\_\_\_\_\_\_\_ Eggs == \_\_\_\_\_\_\_\_ Lunch meats == \_\_\_\_\_\_\_\_\_\_ Seafood == \_\_\_\_\_\_\_\_\_
Hamburger - E. coli Fried rice = b. Cereus Potato salad = s. Aureus Eggs = salmonella Lunch meat = listeria Seafood = vibrio
Gram positive cocci
Preformed enterotoxins —> rapid onset
N/v, watery diarrhea
Eggs, potato salad, mayonnaise
Staph aureus
Gram positive rod
Preformed enterotoxin - 6h onset
Vomiting, watery diarrhea
Fried rice.
B cereus
Gram positive, spore forming (heat resistant), preformed enterotoxin Watery diarrhea, no fever or vomiting Crampy abdominal pain 8-16h onset Beef, ham, poultry
C perrfringens
Gram negative rod, nonmotile , acid resistant
Enterotoxin
Small volume bloody diarrhea, abdominal cramps, fever for 3-4 days
Complicated with reactive arthritis and HUS and conjunctivitis, urethritis
Shigella
Gram negative rod shaped bacilli Bloody diarrhea Eggs/ poultry Reptile exposure Increased risk in IC pt
Salmonella tphimurium
Self limiting
Antibiotics not indicated
Complications - reactive arthritis, endocarditis, septic arthritis and osteomyelitis
Gram negative rod
International travel
Sustained febrile illness 103-104, weakness, headache, anorexia, RLQ pain, rash of flat rose-colored spots
Salmonella typhi
Dx: samples of blood or stool tested
Tx: fluoroquinolones, ceftriaxone, azithromycin
Gram negative curved/ spiral shaped rod Watery —> bloody diarrhea Fever, crampy abdominal pain Ingestion of raw/undercooked meat/poultry Drinking contaminated water Corkscrew motion
Campylobacter jejunum Thx - supportive, no antibiotics Late onset complications - reactive arthritis and GBS Culture on campy blood agar Oxidase +
Gram negative bacillia, curved/ comma shaped with flagellum
Produces toxin that leads to profuse watery diarrhea with vomiting and dehydration
12-48 h incubation
Associated with eating raw oysters
Vibrio cholera Dehydration —> hypotension —> renal failure —> death Dx: stool microscopy /gram stain stool Tx: rehydration/electrolyte replacement Prevent with sanitation/vaccine
Gram negative bacilli Seafood associated diarrhea Watery —> bloody Cytotoxic, + fecal leukocytes Shellfish, oysters, shrimp, mollusks, crustaceans
Vibrio parahemolyticus
Gram negative bacillus
Coastal salt water
Eating raw oysters - vomiting, diarrhea, abdominal pain in 16h
Open wound in water - BULLOUS SKIN LESIONS LIFETHREATENING IN IC AND CIRRHOTIC PT
Vibrio vulnificuas
Gram negative No spores Rod shaped Facultative anaerobic Motile BRACKISH WATER Eating fish/shellfish NECROTIZING FASCIITIS Watery or bloody stools
Aeromonas hydrophila
N/V Watery diarrhea Bloating Abdominal cramps Fatigue/malaise Loss of appetite Low grade fever Self limiting Increased risk with H2/PPI blockers Associated with travel
Travelers diarrhea
Affects small intestine Contaminated water MOST COMMON PATHOGEN FOR TRAVELERS DIARRHEA Enterotoxin production N/V occasional fever
ETEC Lasts 3-6 days Dx clinically Antibiotics ay reduce infection by 1-2 days Bismuth may help
Watery—> bloody diarrhea —> ischemic colitis Most common cause of acute hemorrhagic colitis Abdominal tenderness NO FEVER PERIPHERAL LEUCKOCYTES + CBC FECAL LEUKCOTYES OR LACTOFERRIN + Shag like toxin Undercooked hamburger
0157:H7 EHEC aka STEC shiga-toxin-producing E. Coli
Complications —-> HUS more often than with shigella 5-10 days into course, if a child was treated with antibiotics
Tx: supportive, rehydration, avoid anti-motility agents
Other E. Coli strains
1 - persistent diarrhea in children
2 - infantile watery or bloody diarrhea
3 - fever, abdominal pain, watery—> bloody diarrhea with leukocytes
1 - persistent diarrhea in children ENTEROAGGREGATIVE E COLI
2- infantile watery or bloody diarrhea - ENTEROPATHOGENIC E. COLI
3- fever, abd pain, watery—> bloody ENTEROINVASIVE E. COLI
Gram negative coccobacilli Higher risk in iron-overload syndromes, cirrhosis, hemochromatosis, aplastic anemia, thalassemia BLOODY DIARRHEA FEVER, CRARMPS, N/V MIMICS APPENDICITIS AND CROHNS
Yersinia enterocolitica 10-20 days CLINICALLY INDISTINGUISHABLE FROM SALMONELLA OR SHIGELLA Dx: stool/blood cultures Complications: rash, reactive arthritis Tx: supportive care
Gram positive rod Associated with pregnant women, young or old pt, IC, hemochromatosis Fever, non-bloody diarrhea, HA, N/V Can grow in the cold Contaminated deli meat or soft cheeses
Listeria monocytogenes
2-3 days
Confirm Dx by blood culture or CSF
Complications: meningoencephalitis and listeria placentitis
Tx: ampicillin and trimethoprim/suflamethoxazole
