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GI II Test 1 CLIN > 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
* Bacillus cereus* a. microbiology b. sx c. tx d. risk factors
26
* Clostridum perfringens* a. microbiology b. sx c. tx d. risk factors
27
Shigella a. microbiology b. sx c. dx/duration d. tx e. risk factors/complications
28
What are the four types of *Shigella*?
29
* Salmonella typhimurium* a. microbiology b. sx c. dx/tx d. risk factors e. complications
30
* Salmonella typhi* a. microbiology b. sx c. dx/tx d. risk factors
31
* Campylobacter jejuni* a. microbiology b. sx c. tx d. risk factors
32
* Vibrio cholerae* a. microbiology b. sx c. tx d. risk factors
33
* Vibrio parahemolyticus* a. microbiology b. sx c. tx d. risk factors
34
* Vibrio vulnificus* a. microbiology b. sx c. tx d. risk factors
35
* Aeromonas hydrophila* a. microbiology b. sx c. tx d. risk factors
36
How soon after a trip does traveler's diarrhea begin?
**3 days to 2 weeks** (most begin 3-5 days) self limited - most resolve between 1-5 days
37
What medications are risk factors for traveler's diarrhea?
H2 blockers, PPIs
38
What is the **most common** pathogen of traveler's diarrhea?
ETEC - **enterotoxigenic E. coli** affects small intestine
39
What organisms can cause TD?
Enterotoxigenic E. coli Campylobacter jejuni Salmonella Shigella Aeromonas EAEC Norovirus Coronavirus Giardia Norovirus
40
Escherichia coli - enterotoxigenic: ETEC) a. microbiology b. sx c. dx d. tx e. risk factors
41
Escherichia coli (enterohemorrhagic: EHEC) a. microbiology b. sx c. dx d. tx e. risk factors
42
i feel like just use sketchy
bc this dsa is too much and if i tried to make flashcards in detail there would be 100000000
43
What sx do we see in the following? a. Enteroaggregative E. coli b. Enteropathogenic E. coli c. Enteroinvasive E. coli
44
* Yersinia enterocolitica* a. microbiology b. sx c. dx d. tx e. risk factors
45
* Listeria monocytogenes* a. microbiology b. sx c. dx d. tx e. risk factors
46
What is the etiology of whipple disease?
*Tropheryma whipplei*
47
What do you see in hx/PE of someone with whipple disease?
**arthralgias** **weight loss** **malabsorption** **chronic diarrhea** HF hypotension
48
What diagnositc tests are used to dx whipple disease?
49
How do we treat whipple disease?
antiobiotics
50
If untreated, whipple disease is...
**fatal** goal of tx: prevent progression of neuro signs
51
* Clostridium difficile* a. microbiology b. sx c. dx d. tx e. risk factors
52
For nosocomial infections, stool cultures are...
not helpful - except with c. dificile
53
* Rotavirus* a. microbiology b. sx c. dx d. tx e. risk factors
54
* Adenovirus* a. microbiology b. sx c. dx d. tx e. risk factors
55
Norwalk virus (norovirus) a. microbiology b. sx c. dx d. tx e. risk factors
56
* Cytomegalovirus* (CMV) a. microbiology b. sx c. dx d. tx e. risk factors
57
* Entamoeba histolytica* a. microbiology b. sx c. dx d. tx e. risk factors
58
* Giardia lamblia* a. microbiology b. sx c. dx d. tx e. risk factors
59
* Cryptosporidium parvum* a. microbiology b. sx c. dx d. tx e. risk factors
60
* Strongyloides sterocoralis* a. microbiology b. sx c. dx d. tx e. risk factors
61
* Cyclospora cayetanensis* a. microbiology b. sx c. dx d. tx e. risk factors
62
* Cystoisospora belli* a. microbiology b. sx c. dx d. tx e. risk factors
63
What is a concer with *Ascaris lumbricoides*?
can get long --\> bowel obstruction
64
What parasite can get up to 30 feet long, cause B12 def, and comes from raw/undercooked fish?
65
*Schistosoma mansoni*
66
Taenia solium, Taenia saginata
67
*Echinococcus granulosus*
68
Enterobius vermicularis (pinworm)
69
In which patients can you use anti-motility agents?
those with no fever and non-bloody stools \*shouldn't be used in c. diff or EHEC
70
What products can worsen diarrhea?
lactose containing products
71
Alcohol gels are ineffective against?
norovirus and c. diff
72
What infections have a vaccine?
rotavirus s. typhi v. cholera hep a
73
What infections can cause reactive arthritis?
salmonella campylobacter shigella yersinia
74
Yersiniosis can lead to...
AI type throiditis pericarditis glomerulonephritis
75
What causes guillian-barre syndrome?
campylobacter jejuni
76
What can cause hemolytic uremic syndrome?
Enterohemorrhagic E. coli Shigella
77
Infections affecting ____ present with WBCs in the stool
large bowel \*can be blood too, fecal leukocytes are common

GI II Test 1 CLIN (9 decks)

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