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GI 2 Final > Acute Diarrhea > Flashcards

Acute Diarrhea Flashcards

1
Q

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 ____

A

Bicarbonate and potassium

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2
Q

Frequent passage of small volumes of stool associated with rectal urgency and tenesmus
Accompanies IBS or proctitis

A

Pseudo-diarrhea

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3
Q

5 risk groups of diarrhea in the us

A 
Travelers 
Immunocompromised 
Daycare workers/attendees and family
Institutionalized persons 
Consumers of certain foods
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4
Q

Non infectious causes of diarrhea often manifest as LONGER THAN 14 DAYS include what kind of medications/food sweeteners

A

Antibiotics, cardiac anti-dysrhythmics, NSAIDS

Sorbitol

Chronic illness
Ischemic colitis

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5
Q

Indications to work up acute diarrhea include

A 
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
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6
Q

Labs to order when working up acute diarrhea

A 
CBC, ELECTROLYTES, BUN, CREATININE, BLOOD CULTURE
STOOL CULTURES 
OVA AND PARASITES 
Micro analysis of stool 
Immune assays for toxins, Ag
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7
Q 
Undercooked hamburger == \_\_\_\_\_\_\_\_\_
Fried rice == \_\_\_\_\_\_\_\_\_
Potato salad == \_\_\_\_\_\_\_\_\_\_
Eggs == \_\_\_\_\_\_\_\_
Lunch meats == \_\_\_\_\_\_\_\_\_\_
Seafood == \_\_\_\_\_\_\_\_\_
A 
Hamburger - E. coli 
Fried rice = b. Cereus 
Potato salad = s. Aureus 
Eggs = salmonella 
Lunch meat = listeria 
Seafood = vibrio
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8
Q

Gram positive cocci
Preformed enterotoxins —> rapid onset
N/v, watery diarrhea
Eggs, potato salad, mayonnaise

A

Staph aureus

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9
Q

Gram positive rod
Preformed enterotoxin - 6h onset
Vomiting, watery diarrhea
Fried rice.

A

B cereus

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10
Q 
Gram positive, spore forming (heat resistant), preformed enterotoxin 
Watery diarrhea, no fever or vomiting 
Crampy abdominal pain 
8-16h onset 
Beef, ham, poultry
A

C perrfringens

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11
Q

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

A

Shigella

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12
Q 
Gram negative rod shaped bacilli
Bloody diarrhea 
Eggs/ poultry
Reptile exposure
Increased risk in IC pt
A

Salmonella tphimurium
Self limiting
Antibiotics not indicated
Complications - reactive arthritis, endocarditis, septic arthritis and osteomyelitis

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13
Q

Gram negative rod
International travel
Sustained febrile illness 103-104, weakness, headache, anorexia, RLQ pain, rash of flat rose-colored spots

A

Salmonella typhi
Dx: samples of blood or stool tested
Tx: fluoroquinolones, ceftriaxone, azithromycin

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14
Q 
Gram negative curved/ spiral shaped rod 
Watery —> bloody diarrhea 
Fever, crampy abdominal pain
Ingestion of raw/undercooked meat/poultry 
Drinking contaminated water 
Corkscrew motion
A 
Campylobacter jejunum 
Thx - supportive, no antibiotics 
Late onset complications - reactive arthritis and GBS 
Culture on campy blood agar 
Oxidase +
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15
Q

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

A 
Vibrio cholera 
Dehydration —> hypotension —> renal failure —> death 
Dx: stool microscopy /gram stain stool 
Tx: rehydration/electrolyte replacement 
Prevent with sanitation/vaccine
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16
Q 
Gram negative bacilli 
Seafood associated diarrhea 
Watery —> bloody 
Cytotoxic, + fecal leukocytes 
Shellfish, oysters, shrimp, mollusks, crustaceans
A

Vibrio parahemolyticus

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17
Q

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

A

Vibrio vulnificuas

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18
Q 
Gram negative
No spores
Rod shaped
 Facultative anaerobic 
Motile 
BRACKISH WATER 
Eating fish/shellfish 
NECROTIZING FASCIITIS 
Watery or bloody stools
A

Aeromonas hydrophila

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19
Q 
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
A

Travelers diarrhea

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20
Q 
Affects small intestine 
Contaminated water 
MOST COMMON PATHOGEN FOR TRAVELERS DIARRHEA 
Enterotoxin production 
N/V occasional fever
A 
ETEC 
Lasts 3-6 days 
Dx clinically 
Antibiotics ay reduce infection by 1-2 days 
Bismuth may help
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21
Q 
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
A

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

22
Q

Other E. Coli strains
1 - persistent diarrhea in children
2 - infantile watery or bloody diarrhea
3 - fever, abdominal pain, watery—> bloody diarrhea with leukocytes

A

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

23
Q 
Gram negative coccobacilli 
Higher risk in iron-overload syndromes, cirrhosis, hemochromatosis, aplastic anemia, thalassemia 
BLOODY DIARRHEA
FEVER, CRARMPS, N/V 
MIMICS APPENDICITIS AND CROHNS
A 
Yersinia enterocolitica 
10-20 days 
CLINICALLY INDISTINGUISHABLE FROM SALMONELLA OR SHIGELLA 
Dx: stool/blood cultures 
Complications: rash, reactive arthritis 
Tx: supportive care
24
Q 
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
A

Listeria monocytogenes
2-3 days
Confirm Dx by blood culture or CSF
Complications: meningoencephalitis and listeria placentitis
Tx: ampicillin and trimethoprim/suflamethoxazole

25
Q 
Anaerobic, gram positive, spore forming bacillus 
Cytotoxic production
Watery diarrhea 
Pseudomembranes on colonic mucosa 
Recent hospitalization or antibiotic use
A 
C. difficile 
Dx: stool- PCR for toxin A and B 
Tx: with PO/IV metronidazole, PO vancomycin 
Complications —> toxic megacolon 
Colectomy
26
Q

Double stranded RNA virus
Most common cause of acute diarrhea in infants <2, especially during the winter
Vomiting and watery diarrhea —> sever dehydration
Fecal oral, 72h

A 
Rotavirus 
Lasts 2-3 days
- fecal leukocytes 
Detected by viral culture or PCR
WAGON WHEEL APPEARANCE ON ELECTRON MICROSCOPY 
Tx: supportive care
27
Q

Double stranded DNA virus
Children, 2nd most common cause of gastroenteritis in children
Watery diarrhea, high fever, chills myalgia, sore throat
CONJUNCTIVITIS
PHARYNGITIS

A

Adenovirus
Prolonged course
Dx: viral culture
Tx: supportive care

28
Q

Small non-enveloped RNA virus
Older children and adults
Vomiting, watery diarrhea 4-8 stools/day
Outbreaks associated with contaminated food/water/person-person
CRUISE SHISP, nursing homes, child care centers

A 
Norovirus 
24-48h symptoms 
Lasts 3 days 
- fecal leuckocytosis 
Routine viral cultures are unrevealing
Spontaneous resolution 
No workup necessary
Supportive care
29
Q

Herpes virus family: dsDNA linear
Rare case - PRIMARILY IN IMMUNOCOMPROMISED
CD4<200
Fever, abdominal pain, bloody diarrhea lasting several weeks

A

Cytomegalovirus

Dx: endoscopy with biopsy of ulcerated lesions using CMV specific stains

30
Q

Most common cause of dysentery in the world
Fever, tenesus, bloody diarrhea and pain
FLASK SHAPED ULCER
CAN PENETRATE BOWEL INTO PORTAL CIRUCLAITON TO FORM LIVER ABCESSES
TOXIC MEGACOLON OR PNEUMATOSIS COLI

A 
Entamoeba histolytica 
A parasite 
Persists for days-weeks
Stool O&amp;P
Stool Ag 
\+ fecal leukocytes 
Associated with crowded living condition 
Endemic to Asia, Africa, central and South America
Tx: metronidazole
31
Q

Pear-shaped, 4 flagella, 2 nuclei protozoan
Watery diarrhea
Steatorrhea, flatulence, abdominal pain, belching, weight loss, nausea, malaise, cramps, anorexia, bloating
14-28 days

A 
Giardia lamblia 
Check stool O AND P 
STOOL AG TEST 
Associated wth lakes/streams, hiking/camping
Beaver, dogs, rodents, big horn sheep 
Tx: metronidazole
32
Q

Self limited diarrhea in immunocompetent patients 7-14 days
Life-threatening, intractable in IC patients —> BILIARY DZ, ACALCULOUS CHOLECYSTITIS OR ASCENDING CHOLANGITIS
Watery diarrhea - large volume 20L/DAY
Associated with swimming pools

A 
Cryptosporidium. 
Stool Ag detected on direct microscopy 
MODIFIED ACID FAST STAINING, DIRECT FLUORESCENT ANTIBODIES 
Resistant to chlorine 
Tx: supportive care
33
Q

Nematode: roundworm that enters the body through exposed skin

A

Strongylodies stercoralis
Risk factors: rural, poor, immunocompromised
Dx: RHABDITIFORM LARVAE IN STOOL, EOSINOPHILS IN STOOL
Tx: ANTI-HLMINTIC

34
Q

Produce from imported endemic areas
Travel to areas
Malaise, anorexia, nausea, watery diarrhea

A 
Cyclosporine cayetanesis 
21 days in immunocompetent 
Indefinite in IC 
Treatment with chlorine/iodine DOES NOT kill cyclosporine oocyte 
Dx: oocyte in stool sample 
Tx: TMP/SMX
35
Q

Common in tropical areas
Acute watery diarrhea with crampy abdominal pain
Treatable and preventable
Lasts for weeks and ay result in malabsorption and weight loss

A

Cystoisospoa belli
Repeated stool examinations and concentration precedures are recommended
If stool exam is negative EXAMINE DUODENAL SPECIMENS BY BIOPSY
MODIFIED ACID FAST STAIN
Tx: Bactria DS

36
Q

Hook worm, can cause a bowel obstruction

A

Ascaris lumbricoides

37
Q

Fish tapeworm, can cause b12 deficiency -> pernicious anemia

A

Diphyllobothrium latum

38
Q

2nd most common cause of esophageal varices. Behind alcohol in infection
Bloody stools, bladder cancer, liver cysts

A

Schistosomiasis Mansoni

39
Q

Pork tape worm

Mostly asymptomatic, rare serious case of seizures and muscle or eye dz

A

Tania sodium

40
Q

Tapeworm
Sheep, dogs
Form cysts in liver or lungs
Looks like Hypatia sand on CT

A

Echinococcus granulosus

41
Q 
Noninflammatory
Proximal small bowel
Watery diarrhea 
No fecal leukocytes or increase in fecal lactoferrin
Consider:
A

Bacteria: vibrio cholera, ETEC, enteroaggregative E. coli, c. Perfringens, b cereus, s aureus, aeromonas hydrophila

Virus: rotavirus, norovirus, enteric adenovirus

Parasites: giardia lamblia, cryptosporidium

42
Q 
Inflammatory 
Colon or distal small bowel
Dysentery 
\+ fecal leukcotyes 
Substantial increase in fecal lactoferrin
CONSIDER
A

Inflammatory/bloody stools : shigella, salmonella, campylobacter, EHEC, EIEC, yersinia, vibrio parahaemolyticus, a hydrophila, entamaeoba histolytica

Inflammmatory with fecal leaks and fecal lactoferrin but NOT TYPICALLY BLOODY STOOSL: listeria monocyttogenes, clostridium diifficile

43
Q

1 - 6 hour incubation, consider

A

S aureus

B cereus

44
Q

6-18 h, consider

A

C. Perfringens

B cereus

45
Q

> 16h incubation, consider

A

Cholera, ETEC, EHEC, salmonella, campylobacter, shigella, vibrio

46
Q

Antimotiility agents loperamide and bismuth may be used in patients with no

A

NO FEVERE AND NONBLOODDY STOOLS

DO NOT USE IN C DIFF OR EHEC

47
Q

Alcohol gels are ineffective against which two causes of diarrhea

A

NOROVIRUS AND CDIFF

48
Q

Common causes of diarrrhea with vaccines

A

ROTAVIRUS
S TYPHI
V CHOLERAE
HEP A

49
Q

Reactive arthritis accompanies

A

Salmonella, campylobacter, shigella, yersinia

50
Q

Yersiniosis may lead to

A

Autoimmune type thyroiditis, pericarditis, glomerulonephritis

51
Q

Small bowel pathogens present with

A 
Large volume
Watery stools
Abdominal cramps 
Weight loss 
Absent WBCs
DEHYDRATION/MALABOSPRITON
52
Q

Large bowel pathogens present with

A

Frequent, small volume stools
Fever, blood or WBCs in stool
Fecal leuckotyes comon
Tenesmus

GI 2 Final (1 decks)

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