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MCM Test 3 > B2.051 Big Case Diarrhea and Abdominal Pain > Flashcards

B2.051 Big Case Diarrhea and Abdominal Pain Flashcards

1
Q

classify diarrhea

A

3 or more loose/watery stools per day
change from normal bowel habits
usually >200 /day

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2
Q

dysentery

A

diarrhea with blood

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3
Q

gastroenteritis

A

infection of the GA tract by bacteria, viruses, parasites

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4
Q

what accounts for improvement in mortality from diarrhea

A

better sanitation and food safety
improved case management (rehydration)
rotavirus vaccine

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5
Q

what are some adverse outcomes of recurrent diarrhea?

A

malnutrition
micronutrient deficiencies
developmental delays

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6
Q

what is the distinction between chronic/acute diarrhea?

A

more or less than 2 weeks

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7
Q

what are the 4 mechanisms of diarrhea?

A

secretory
osmotic
malabsorptive
exudative/inflammatory

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8
Q

outline the mechanisms of absorption in the intestines

A

sodium coupled solute transporter takes things like glucose, galactose, AAs, etc. through the mucosa against concentration gradients while water moves into enterocytes along gradient
Na+/H+ exchangers allow for electrolyte absorption without other solutes
paracellular transport allows for passive solute transport across enterocyte membrane

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9
Q

outline the mechanisms for intestinal secretion

A

chloride channels in small bowels allow Na+ and water to follow Cl- into the lumen
Cl-/HCO3- and Na+/H+ exchangers in colon

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10
Q

what are the 4 characteristics of secretory diarrhea

A
  1. increased water secretion by activation of Cl- channels
  2. decreased Na+ and water absorption
  3. severe fluid and electrolyte losses
  4. isotonic, low stool osmotic gap, persists during fasting
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11
Q

what are the 3 characteristics of osmotic diarrhea

A
  1. increased osmotic pressure due to non-absorbed solutes
  2. water pulled into lumen
  3. high stool osmotic gap, abates during fasting
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12
Q

what are 2 characteristics of malabsorptive diarrhea

A
  1. failure of nutrient absorption

2. steatorrhea (fat in diarrhea)

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13
Q

what are 2 characteristics of inflammatory/exudative diarrhea

A
  1. multifactorial

2. fecal leukocytes, persists during fasting

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14
Q

what do you look for in a physical exam of a patient w diarrhea?

A 
degree of dehydration
growth chart
pallor, icterus, petechiae, rash
abdominal distention, tenderness
rectal exam
extraintestinal manifestations
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15
Q

characterize <5% dehydration state

A

well, alert
normal eyes
drinks normally
skin recoils

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16
Q

characterize 5-10% dehydration state

A

restless, irritable
sunken eyes
thirsty
skin recoils slowly

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17
Q

characterize >10% dehydration

A

lethargic, unconscious
sunken eyes
drinks poorly/unable to drink
skin recoils very slowly

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18
Q

what are the two major classes of acute diarrhea?

A 
infectious (viral, bacterial, parasitic)
non infectious (drugs, food allergies, extraintestinal infections, surgical conditions)
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19
Q

what is intussusception?

A

telescoping of the intestines caused by the inhibiting of periscopic movements by a tumor/neoplasia/etc
diminishes blood supply to part of the intestine resulting in necrosis/inflammation/diarrhea

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20
Q

what are some causes of chronic diarrhea?

A 
malabsorption
inflammation
congenital disorders
intestinal failure
infectious
drug induced
neurohormonal
fecal impaction 
IBS
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21
Q

what blood tests would you do in a case of acute diarrhea?

A

electrolytes
CBC with differential
peripheral smear

22
Q

what stool tests would you do in a case of acute diarrhea?

A

culture
ova and parasites
extend for immunocompromised patients

23
Q

what additional blood tests would you get for chronic diarrhea?

A

other organ function measures
TSH
celiac disease
vitamins

24
Q

what additional stool tests would you get for chronic diarrhea?

A

pH
electrolytes
osmotic gap
fecal leukocytes and fat

25
Q

what tests other than blood/stool would you look into for chronic diarrhea?

A

sweat chloride
radiology
endoscopy

26
Q

characterize norovirus

A

ssRNA virus of Caliciviridae family

most common cause of acute gastroenteritis in US

27
Q

transmission/incubation norovirus

A

contaminated food/water
person to person
short incubation

28
Q

symptoms norovirus

A

nausea, vomiting, watery diarrhea, abdominal pain
mild mucosal abnormalities
self limited in immunocompetent host

29
Q

characterize rotavirus

A

dsRNA virus, encapsulated
common cause of diarrheal mortality in children worldwide
protection by maternal antibodies in first 6 months
vaccine available

30
Q

transmission/incubation rotavirus

A

contaminated food/water
person to person
small infection inoculum
short incubation period

31
Q

symptoms rotavirus

A

nausea, vomiting, watery diarrhea, abdominal pain

destruction of mature enterocytes w loss of absorptive surface

32
Q

characterize salmonella

A

gram negative bacilli in Enterobacteriacea family
2 types: typhoid and non typhoid
non typhoid >1 mil in US per year

33
Q

transmission salmonellosis (non typhoid)

A

contaminated food, particularly poultry, eggs

very small inoculum

34
Q

mechanisms of salmonellosis

A

virulence genes and toxins
type 3 secretion system- endocytosis of bacteria in mucosal cells
flagellin activates TLR5 and causes inflamm
lipopolysaccharide actiates TLR4 and causes inflamm

35
Q

symptoms salmonellosis

A

watery diarrhea or dysentery, may have fever
usually self limited
antibiotic treatment not recommended
can be severe in immunocompromised patients

36
Q

transmission s.typhi

A

contaminated food/water
person to person
resistant to gastic acid

37
Q

mechanism of s.typhi

A

invade mucosal cells and disseminate via mononuclear cells throughout the body

38
Q

symptoms s.typhi

A

anorexia, nausea, vomiting, ab pain, dysentery followed by flu like phase with fever and bacteremia
positive blood cultures
extraintestinal manifestations
antibiotic treatment

39
Q

characterize campylobacter

A

common in adults/travelers
contaminated food/water
small inoculum

40
Q

mechanism of campylobacter

A

mucosal colonization and adherence
virulence toxins- cytotoxins, cholera-like enterotoxins
invasion uncommon

41
Q

symptoms campylobacter

A

watery diarrhea, dysentery (uncommon)
usually self limited
extraintestinal complications- arthritis and Guillain-Barre syndrome

42
Q

what are the 4 types of E.coli?

A 
enterotoxigenic (ETEC)
enteropathogenic (EPEC)
enterohemorrhagic (EHEC)
enteroinvasive (EIEC)
enteroaggregative (EAEC)
43
Q

what are 3 parasites that can cause diarrhea?

A

giardia
cryptosporidium- spreads in pools (resistant to chlorine)
entamoeba

44
Q

what are some life threatening conditions to look for in a patient with diarrhea/ ab pain?

A 
HUS
pseudomembranous colitis (C.diff)
appendicitis, intussusception, obstruction
toxic megacolon
poisoning
severe dehydration
45
Q

what is HUS?

A

hemolytic uremic syndrome

46
Q

what are 3 features of HUS?

A

microangiopathic hemolytic anemia
thrombocytopenia (decreased platelets)
renal injury

47
Q

what is HUS usually associated with?

A

prodromal diarrheal illness
gastroenteritis due to shiga toxin producing E.coli (EHEC) or other organism
-5-15% of cases develop HUS

48
Q

clinical features of HUS

A 
diarrhea
bloody stools
weakness, lethargy, oliguria/anuria (small or no pee)
pallor
petechial (pinpoint bleeds)
49
Q

lab findings of HUS

A

anemia with schistocytes
thrombocytopenia
increased LDH (cellular contents released in RBC breakdown)
decreased haptoglobin
increased indirect bilirubin (metabolized hemoglobin)
increased creatinine, hematuria,proteinuria
shiga toxin +

50
Q

how do you manage HUC?

A

renal support, hydration, RBC transfusions
AVOID platelet transfusion
AVOID antibiotics and anti-diarrheals

51
Q

histo finding of HUS

A

see sheared RBC’s
due to formation of platelet clots
RBCs collide with clots and break

MCM Test 3 (23 decks)

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