Acute Diarrhea DSA Powerpoint Flashcards
what does schistosoma mansoni cause
bloody stools
bladder cancer
liver cysts
most common cause of acute infectious diarrhea (2 bacteria)
salmonella
campylobacter
commoin in tropical and subtropical areas of the world
acute non bloody watery diarrhea
in immunosupp pts diarrhea can be severe
caused by coccidian parasite
malabsoprtion and weight loss bc can last 4 weeks
cystoisospora belli (formerly isospora belli)
shigella
children potato or egg salad, lettuce, raw veggies blood disarrhea fecal leukocytes positive lactrose negative reactive arthritis and HUS
mutation for FAP
APC or MUTYH
child diarrhea defined as
> 20/g/kg/day stool
cryptosporidium 2 main clinical symptoms
-type of diarrhea
outbreaks involving what
self limited diarrhea in immunocompetent pts
-no treatment
life threatetning intractable in immunosupp pts
-AIDS cd4 count below 200, antivirals to increase CD4 count
- watery diarrhea large volume (over 20L a day)
- outbreaks involving swimming pools
motile S shaped gram neg rod
campylobacter
HUS
shigella most common
EHEC next most common
happens in children more that are treated with antibiotics
yersiniosis may lead to
autoimmune type thyroiditis, pericarditis, GN
shigella treatment
bismuth, amp, fluoroquin, trimeth/sulfa
chronic diarrhea cuases
SSRI cholinesterase inhib NSAIDs PPI ACEI metformin allopurinol
what is recommended to person with IBS
low FODMAP diet
yersinia enterocolitica
- higher risk in
- type of diarrhea
- complications
- treatment
iron overload syndromes bloody and non bloody mimics appendicitis hemochromatosis supportive care
for celiac and pt with IgA defeiicency check what
anti-DGP
treatment of constipation/fecal impaction
diagnose too
diagnose with DRE
tx: enema, digital disruption
short bowel syndrome increased chance of
oxylate kidney stones
give clacium supplemntation
increawsed cholest gallstones
treatment for salmonella typhimurium
antiobiotics are usually not indicated
genetic defect Familial juvenile polyposis
18 and 10
MADH4 and BMPR1A
get from produce from endemic areas
- lettuce, fresh basil, imported raspberries
- travel to endemic area
- watery diarrhea
- indefinite in immunosupp and 21 days in immunocomp
cyclospora cayetanesiss
treatment for EHEC
supportive
antibiotics only in severe cases
traveler’s diarrhea risk factor
H2 blocker/PPI
secretory diarrhea
- sodium
- osmotic gap
high, normal
SBS: colon removed need at least ___ cm of prox jejunum for oral nutriotino
200 cm
2nd most common cause of gastroenteritis in children
watery diarrhea and vomiting
conjunctivitis
pharyngitis
adenovirus
etiology of bacterial overgrowth
PPI
gastric surgery of small bowel
SI motility disorder
gastrocolic or coloenteric fistula
which organisms do you use immunoassays for
c diff
rotavirus
giardia
e histolytica
painless rectal bleed
diverticulosis bleed
whipple disease finding
PAS (+) macrohages with gram + bacilli
screening for lynch
colonscopy every 1-2 yrs starting at 25 or 5 yrs younger than age of youngest affect family member at diagnosis
-pelvic exam, transvag US, endometrial samp for women at 30-35
upper endoscopy every 2-3 yrs at 30-35
prophylatic hysterectomy with oophorectomy age 40 or once done childbearing
salmonella typhimurium
gram negative, non lactose fermenting, motile, rod shaped blood diarrhea fecal leukocytes + eggs and poultry reptile exposure complications are septic arthitis, osteomyelitis increased risk sicle cell pts non typhoidal--> gastroenteritis
short bowel syndrome from what disease
crohns ,mesenteric infarction, radiation enertiis, volvuus, tumor resetion and trauma
diarrhea defined clinically
3 or more loose or watery stools/day
or
decreaes in consistency and increase in frequency of BM of individual
undercooked foods, lunch meat, soft cheeses
listeria
alcohol gels are ineffective aginast
norovirus and c dif
lynch syndrome inherit
auto dom
TD in nepal
cyclospora
gene mutaiton lynch
MLH1, MSH2
microscopic colitis presentation
idiotpathic or from meds women in 50s,60s chronic or intermittent watery diarrhea normal mucosa on endoscopy -histo: chronic inflammation, thickened band subep collagen
need to asks for specific labs for
c diff pcr/toxin
ova parasites
giardia and cryptosporidium stool antigen
fever, abdominal pain, bloody diarrhea in immunosuppresed pts under 200 CD4
CMV
seafood especially if raw
vibrio species mainly
watery diarrhea that occurs in immunocompromised host that can be found on a modified acid fast staining of the stool
cystoisorpora belli
MEN2A
PTH hyperplasia
Medullary throid carcinoma
pheochromocytoma
antimotility agents should not be used with
C diff or EHEC infection
pathogen typically affects large bowel presents with
frequent
small volume stools
pain in lower abd or rectum
adult diarrhea defined as
greater than 200g/day of stool weight
how do you detect norwalk
PCR
short bowel syndrome
removal of significant segment of SI
TI resection
bile salt and vit b12 malabsorption
B12 injectables, bile salt binding resins low fat diet, fat soluble vitamin replacement
autoimmune gastritis
desrution of fundic glands
achlorhydria
pronounced hypergastrinemia
hyperplasia gastric enterochromaffin like cells
development of small multicentric carcinoid tumors
cowden diseae
lipoma, harmartomas, and benign hair follicle tumors
hair follicle tumor on the skin and face
strongyloides stercoralis
how get, where, what type parasite, what pts more susceptible, how diagnose, treat
bare feet on contaminated soil roundworm rural areas HTLV-1 pts are more susceptible rhabditiform larvae in stool, eosinophils in stool
treat: ivermectin
EIEC
fever, abd pain, watery bloody diarrhea with leukocytes
dysnetery
diverticulitis tx
antibiotics and npo/clear liquid diet
protozoa that can penetrate bowel and into portal circulation and cause liver lung or brain abscess
e histolytica
osteoma of mandilble, skull, and long bones
-95% develop colorectal polyps (adenomatous)
supernumerary teeth
thydoid adrenal tumors
desmoid tumors
auto dom
gardner’s syndrome
fish tapeworm, can get long (30 ft), raw/undercooked fish
diphyllobothrium latum
vibrio cholera
get from what
treatment
waterborne illness
raw oysters
rehydration/electrooyte replacement
echinococcus granulosus
what is parasite
get from what
complications
image on CT
tapeworm
unsanitary livestock slaughter especially sheep
dogs main carrier
form cysts in liver or lungs
looks like free flowing hydatid sand on CT
what can develop in peutz heghers syndrome
GI malignancy or breast cancer
also gonadol or pancreati cancer
what kind of toxins does staph have and what type of diarrhea
preformed enterotoxins
watery diarrhea
rapid onset wtithin 6 hours
causes of osmotic diarrhea
mg antacids, sorbitol, lactose intolerance, laxatives
MEN1
pituitary adenoma
PTH hyperplasia
pancreatic tumors
95% of cases of colon adenocarcinoma believed to come from
higher risk
adenomas and serrated polyps
higher risk if over 1 cm or 1 cm
most common cause of chronic diarrhea
stool osmotic gap
meds
IBS
lactose intolerance
SOG = normal
special cultures for
EHEC
virbrio
yersinia
others
cyclospora cayetanensis
treament of water or food with chlorine or iodine is ____ to kill cyclospora oocysts
how detect cysts
treatment
unlikely
stool sample
trimethoprim/sulfamethoxazole
anaerobic toxin forming gram + bacillus
C diff
widal test positive with O and H antigens
salmonella typhi
multiple myeloma is associated with what
impaction and hypercalcemia
what does FIT detect
human globin
TD in asia
campylobacter jejuni
pathogen typically affects small bowel presents with
large volume watery stool abdominal cramps weight loss pain is mid abdomen or diffuse
whipple disesae present
fever, arthralgias, LAD
weight loss
malabsroption, chronic diarrhea
encephalitis
causes of constpiation diet thryoid drug supplement
inadequate fiber and fluid intake
hypothryroidism
CCB use
calcium supplementation
routine stool culture includes
salmonella
shigella
e coli (ask for shiga toxin)
most detect campylobacter
diagnosis lynch:
besthesda criteria
CRC under 50
CRC or lynch syndrome associated tumor at any age
CRC with with one or more 1st degree relations with CRC or lynch syndrome related cancer with one of the cancers before
CRC with two or more second degree relative with CRC or lynch syndrome related cancer at any age
tumors with infiltrating lymphocytes, mucious.signet ring diff or medullary growth pattern in pts younger than 60
C diff description
anaerobic, gram positive, spore forming bacillus
vibrio vulnificus
how you get it
associated with
life threat in
warm shallow coastal salt water raw shellfish (oysters) open wound in water bullous skin lesions life threatening in cirrhosis pts
other risk factors for C diff
chemo
PPI
IBD
enteral tube feeding
protozoa that can cause toxic megacolon or pneumatosis coli
how to diagnose this infection
and treatment
e histolytica
stool antigen to diagnose
metronidazole treatment
watery diarrhea
pear shaped 4 flagella 2 nuclei protozoan
giardia
treatment for salmonella typhi
fluorquin
ceftriaxone
azithromycin
profuse watery diarrhea that doesn’t improve with fasing, episodes of getting hot and her face turns red
what tumor and whats elevated
carcinoid tumor secreting serotonitn
5-HIAA
most common form of TD
ETEC
cytoisospora belli negative stool exam then what
-treatment
duodenal specimen by biopsy
also modified acid-fast stain
treat: trimeth/sulfameth
sign that goes with colon ancer which is lesions all over the skin
sign of lesar-trelat
clostridium perfringens
toxin
diarrhea
onset
cause
preformed enterotoxin
watery diarrhea
rapid onset 8-16 hrs
beef, ham, poultry, legumes, gravy
lynch syndrome associated with
HNPCC
associated with endometrial, bladder, ovarian, rneal, and SI cancer
MEN 2B
mucosal neuromas
marfanoid body habitus
medullary thryoid carcinoma
pheochromocytoma
hook worm, fecal oral transmission, can get long, can cause bowel obstruction
ascaris lumbricoides
cerebellar lesions
trichilemmomomas
hamartromatous polyps and lipomas
PTEN syndrome
cowden disease
suspect HNPCC in
personal early onset CRC
FH CRC, or assocaited cancers
osmotic diarrhea
- stool sodium
- osmotic gap
low, increased
worldwide problem (africa), 2nd most common cause of esophageal varices behind alcohol in africa get from contaminated freshwater snails
schistosoma mansoni
pt has rash on knees and elbows which is ___ associated with malabsorption disease which can lead to ___ so check with ___
dermatitis herpatitis with celiac
can lead to vitamin D deficiency
check with DEXA scan
aeromonas hydrophila description environment eating what other transmission 2 types treatment
gram negative, non spore forming rod, facultatively anaerobic bacteria, motile with flagellum
fish or shellfish
wounded in fresh water or open wounds, foot and ankle most common
necrotizing faciitis aka flesh eating bacteria
- choleral like
- bloody mucoid stools
- ampicillin
risk factor diverticular disease of colon
older
CT disease
c diff toxin type of diarrhea other risk factor treatment complication
toxin A and B (PCR to detect)
pseudomembranes
recent hospitalization, PPI use, antibiotic use
-clindamycin, cephalosporins, fluorquin risk factors
treatment: metronidazole or oral vancomycin
complication: toxic megaclon, need surgery
EAEC
persistent diarrhea in children
what do you get malabsoprtion of in whipples
ADEK
vibrio parahemolyticus
cytotoxin production bloody diarrhea from seafood consumption positive fecal leukocyte non-O1 and non O139 variants
organism that is assciated with sinus bradycardia, neutropenia, and enlarged spleen
-invades peyers patches
salmonella typhi
-carrier state in GB
lactose intolerance test
hydrogen breath
test for bacterial overgrowth
breath test: glucose, lactulose, or C-xylose
most common cause of dysentery in the world
e histolytica
what do you lose in diarrhea
bicarb
potassium
treatment for campylobacter
supportive bc self limited
ROME III criteria for IBS dx
ab discomfort or pain 3/days month for past 3 months with symptom onset over 6 months before diagnosis and at leas 2/3:
- relieved with defecation
- onset associated with change in frequency of stool
- onset associated with a change in form (appearance) of stool
blood in urine, haptoglobin decreased, hemolysing (elevated indirect bilirubin), schistocytes
HUS
confirmation of listeria
blood culture
treatment for microscopic colitis
stop offending meds, loperamide, budesonide, bile-salt binding agents or 5-ASA
treatment C diff
metronidazole
vancomycin
motile comma shaped gram negative bacillus
cholera
watery diarrhea in infants under 2
wagon wheel appearance on electron microscopy
rotavirus
B cererus toxin is ___
main symptom
onset
presenttation
preformed enterotoxin vomiting rapid within 6 hrs fried race consumption watery diarrhea
TD with Russia visit, especially st. petersburg
giardia
also campers
SBS: colon and 100 cm prox jejunum preserved
oral nutrition with low fat and high complex carb diet
reactive arthritis following infection by
salmonella
campylobacter
shigella
yersinia
adenomatous colon polpys
brain tumor
CRC 100% over 40
auto dom
turcot’s syndrome
taenia solium
pork tape worm
most asymptomatic
rare serious cases of seizures and muscle or eye disease
pernicious anemia from
increase risk of
autoimmune gastritis
increased risk of gastric adenocarcinoma
causes of secretory diarrhea
hormones (tumors)
laxative abuse
villous adenoma
bile salt malabsorption
no colon and less than 100-200 cm of prox jejunum
TPN
what does a medullary thyroid carcinoma secrete
calcitonin
toxic shock syndrome bateria most common and second most
staph aureus 1 strep pyogenes (group A) 2
pt had all small bowel resected except 50 cm of proximal jejunum what should be diet
TPN
low fat if still had colon and 100 cm of jejunum
EPEC
infantile watery or bloody diarrhea
familial juvenil polyposis
hamartomatous polyposis syndrome
auto dom
>10 juvenile hamartomous polyps mainly in colon
increased risk adenocarinoma
