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Ahmed GI Sadness 1 > Acute Infectious Diarrhea > Flashcards

Acute Infectious Diarrhea Flashcards

1
Q

What are the five high risk groups in the US for acute infectious diarrhea?

A
  1. Travelers
  2. Immunodeficient
  3. Daycare workers/attendees and their family
  4. Institutionalized persons (ex. nursing home)
  5. Consumers of certain foods
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2
Q

What is the pathogenesis of acute infectious diarrhea?

a. Bacterial toxins, enterotoxin producing bacteria
b. entero-adherent pathogens
c. cytotoxin producing and invasive microorganisms

A
  1. –> small bowel hypersecretion
    1. profuse, watery diarrhea
    2. marked vomiting
    3. minimal or no fever
    4. abruptly (within a few hours of ingestion)
  2. –> small bowel hypersecretion
    1. vomiting usually less
    2. abdominal cramping/bloating is greater
    3. fever is higher
  3. High fever, abdominal pain
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3
Q

What in the history would be a high risk factor for diarrhea?

A
  1. Recent antibiotics?
  2. Ill contacts?
  3. Travel?
  4. Risk factors like unclean drinking water?
  5. Daycare/Nursing home?
  6. Animal exposure?
  7. Immunosuppression/immunocompromised?
  8. Unpasteurized dairy?
  9. Consume raw/undercooked meat, fish, or shellfish?
  10. Pregnancy (listeriosis)?
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4
Q

Pt. presents with thirst, difficulty swallowing food due to a dry mouth, and has only urinated a few times in the past 24 hours. What is the classification of their diarrhea?

A

Mild

thirst, dry mouth, decreased, axillary sweat, decreased urine output, sligh weight loss

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5
Q

What signs would imply moderate dehydration? severe?

A

moderate - orthostatic fall in blood pressure, skin tenting, sunken eyes (infants = sunken fontanelle)

severe - lethargy, obtundation, feeble pulse, hypotension, frank shock

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6
Q

What do you typically hear on ausculation for diarrhea? ileus or toxic megacolon?

A

a. increased bowel sounds
b. decreased bowel sounds

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7
Q

What is the transmission of acute infectious diarrhea?

A

fecal-oral transmission

typically self-limited

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8
Q

Flow chart of acute diarrhea work up

A

38.5oC = 101.3oF

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9
Q

What is the standard workup for acute diarrhea?

A

nothing - typically it is self limited

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10
Q

What signs make you do a full evaluation of acute diarrhea?

A
  • profuse diarrhea (6 or more stools/day) with dehydration
  • hypotension and tachycardia
    • not responsive to initial volume repletion
    • Dysentery? (bloody diarrhea with leukocytes [mucoid])
  • fever ≥38.5°C
  • duration >48 h without improvement
  • recent antibiotic use (check for C. Diff)
  • new community outbreaks
  • associated severe abdominal pain
    • in patients >50 years
    • peritoneal signs
  • elderly (≥70 years)
  • immunocompromised patients
  • creatinine level greater than 1.5 times the baseline value
  • peripheral leukocytes ≥ 15,000 cell/uL
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11
Q

What tests might be included in the work up of acute diarrhea?

A

CBC

electrolytes

BUN

Cr

Blood culture

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12
Q

What is the key to diagnosis of acute diarrhea?

A

microbiologic analysis of the stool

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13
Q

What organisms are included in a routine stool culture?

A
  • Salmonella
  • Shigella (Shiga toxin)
  • E. Coli
  • Most detect campylobacter (although may need to be requested)

*Takes 24-48 hours for results

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14
Q

If you want to check for enterohemorrhagic or othertypes of E. coli, vibrio species, or yersinia, you have to do what?

A

ask the lab (not included on standard culture)

same goes for:

  1. stool immunoassay for C. diff
  2. Ova and parasites (need 3 samples)
  3. Stool protozoal antigen (giardia, cryptosporidium, E. histolytica)
  4. Stool viral PCR/antigen (rotovirus, norovirus)
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15
Q

If your stool studies are unrevealing, what’s the next step?

A

endoscopy:

flexible sigmoidoscopy with biopsies

upper endoscopy with duodenal aspirates and biosopies

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16
Q

What do you see here?

A

ileus or toxic megacolon

radiology can also detect free intraperitoneal air

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17
Q

What is a benefit of abdominal CT?

A

more sensitive for free air

identify colitis

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18
Q

If pt reports food poisoning from bad chicken, you might suspect:

A

salmonella, campylobacter, shigella

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19
Q

If pt reports food poisoning from undercooked hamburger, you might suspect:

A

enterohemorrhagic E. coli (O157:H7)

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20
Q

If pt reports food poisoning from fried rice, you might suspect:

A

bacillus cereus

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21
Q

If pt reports food poisoning from eggs, you might suspect:

A

salmonella

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22
Q

If pt reports food poisoning after eating a turkey sandwich with american cheese, you might suspect:

A

listeria

due to uncooked foods like lunch meat or soft cheeses

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23
Q

If pt reports food poisoning from seafood, you might suspect:

A

vibrio species, salmonella, acute hepatitis A, norwalk, campylobacter

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24
Q
  • Staphylococcus Aureus*
    a. microbiology
    b. sx
    c. tx
    d. risk factors
A
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25
Q
  • Bacillus cereus*
    a. microbiology
    b. sx
    c. tx
    d. risk factors
A
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26
Q
  • Clostridum perfringens*
    a. microbiology
    b. sx
    c. tx
    d. risk factors
A
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27
Q

Shigella

a. microbiology
b. sx
c. dx/duration
d. tx
e. risk factors/complications

A
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28
Q

What are the four types of Shigella?

A
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29
Q
  • Salmonella typhimurium*
    a. microbiology
    b. sx
    c. dx/tx
    d. risk factors
    e. complications
A
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30
Q
  • Salmonella typhi*
    a. microbiology
    b. sx
    c. dx/tx
    d. risk factors
A
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31
Q
  • Campylobacter jejuni*
    a. microbiology
    b. sx
    c. tx
    d. risk factors
A
32
Q
  • Vibrio cholerae*
    a. microbiology
    b. sx
    c. tx
    d. risk factors
A
33
Q
  • Vibrio parahemolyticus*
    a. microbiology
    b. sx
    c. tx
    d. risk factors
A
34
Q
  • Vibrio vulnificus*
    a. microbiology
    b. sx
    c. tx
    d. risk factors
A
35
Q
  • Aeromonas hydrophila*
    a. microbiology
    b. sx
    c. tx
    d. risk factors
A
36
Q

How soon after a trip does traveler’s diarrhea begin?

A

3 days to 2 weeks (most begin 3-5 days)

self limited - most resolve between 1-5 days

37
Q

What medications are risk factors for traveler’s diarrhea?

A

H2 blockers, PPIs

38
Q

What is the most common pathogen of traveler’s diarrhea?

A

ETEC - enterotoxigenic E. coli

affects small intestine

39
Q

What organisms can cause TD?

A

Enterotoxigenic E. coli

Campylobacter jejuni

Salmonella

Shigella

Aeromonas

EAEC

Norovirus

Coronavirus

Giardia

Norovirus

40
Q

Escherichia coli - enterotoxigenic: ETEC)

a. microbiology
b. sx
c. dx
d. tx
e. risk factors

A
41
Q

Escherichia coli (enterohemorrhagic: EHEC)

a. microbiology
b. sx
c. dx
d. tx
e. risk factors

A
42
Q

i feel like just use sketchy

A

bc this dsa is too much and if i tried to make flashcards in detail there would be 100000000

43
Q

What sx do we see in the following?

a. Enteroaggregative E. coli
b. Enteropathogenic E. coli
c. Enteroinvasive E. coli

A
44
Q
  • Yersinia enterocolitica*
    a. microbiology
    b. sx
    c. dx
    d. tx
    e. risk factors
A
45
Q
  • Listeria monocytogenes*
    a. microbiology
    b. sx
    c. dx
    d. tx
    e. risk factors
A
46
Q

What is the etiology of whipple disease?

A

Tropheryma whipplei

47
Q

What do you see in hx/PE of someone with whipple disease?

A

arthralgias

weight loss

malabsorption

chronic diarrhea

HF

hypotension

48
Q

What diagnositc tests are used to dx whipple disease?

A
49
Q

How do we treat whipple disease?

A

antiobiotics

50
Q

If untreated, whipple disease is…

A

fatal

goal of tx: prevent progression of neuro signs

51
Q
  • Clostridium difficile*
    a. microbiology
    b. sx
    c. dx
    d. tx
    e. risk factors
A
52
Q

For nosocomial infections, stool cultures are…

A

not helpful - except with c. dificile

53
Q
  • Rotavirus*
    a. microbiology
    b. sx
    c. dx
    d. tx
    e. risk factors
A
54
Q
  • Adenovirus*
    a. microbiology
    b. sx
    c. dx
    d. tx
    e. risk factors
A
55
Q

Norwalk virus (norovirus)

a. microbiology
b. sx
c. dx
d. tx
e. risk factors

A
56
Q
  • Cytomegalovirus* (CMV)
    a. microbiology
    b. sx
    c. dx
    d. tx
    e. risk factors
A
57
Q
  • Entamoeba histolytica*
    a. microbiology
    b. sx
    c. dx
    d. tx
    e. risk factors
A
58
Q
  • Giardia lamblia*
    a. microbiology
    b. sx
    c. dx
    d. tx
    e. risk factors
A
59
Q
  • Cryptosporidium parvum*
    a. microbiology
    b. sx
    c. dx
    d. tx
    e. risk factors
A
60
Q
  • Strongyloides sterocoralis*
    a. microbiology
    b. sx
    c. dx
    d. tx
    e. risk factors
A
61
Q
  • Cyclospora cayetanensis*
    a. microbiology
    b. sx
    c. dx
    d. tx
    e. risk factors
A
62
Q
  • Cystoisospora belli*
    a. microbiology
    b. sx
    c. dx
    d. tx
    e. risk factors
A
63
Q

What is a concer with Ascaris lumbricoides?

A

can get long –> bowel obstruction

64
Q

What parasite can get up to 30 feet long, cause B12 def, and comes from raw/undercooked fish?

A
65
Q

Schistosoma mansoni

A
66
Q

Taenia solium, Taenia saginata

A
67
Q

Echinococcus granulosus

A
68
Q

Enterobius vermicularis (pinworm)

A
69
Q

In which patients can you use anti-motility agents?

A

those with no fever and non-bloody stools

*shouldn’t be used in c. diff or EHEC

70
Q

What products can worsen diarrhea?

A

lactose containing products

71
Q

Alcohol gels are ineffective against?

A

norovirus and c. diff

72
Q

What infections have a vaccine?

A

rotavirus

s. typhi
v. cholera

hep a

73
Q

What infections can cause reactive arthritis?

A

salmonella

campylobacter

shigella

yersinia

74
Q

Yersiniosis can lead to…

A

AI type throiditis

pericarditis

glomerulonephritis

75
Q

What causes guillian-barre syndrome?

A

campylobacter jejuni

76
Q

What can cause hemolytic uremic syndrome?

A

Enterohemorrhagic E. coli

Shigella

77
Q

Infections affecting ____ present with WBCs in the stool

A

large bowel

*can be blood too, fecal leukocytes are common

Ahmed GI Sadness 1 (25 decks)

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