Chapter 12, Module 7; Diarrhea Flashcards by W W

Abrupt onset 6-12 hr after exposure; nonbloody, watery diarrhea; lasts <1 wk; nausea/ vomiting, fever, abdominal pain, tenesmus

Viral gastroenteritis (e.g., Norwalk or rotavirus viral agents)

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In children can see severe dehydration; hyperactive bowel sounds, diffuse pain on abdominal palpation

Viral gastroenteritis (e.g., Norwalk or rotavirus viral agents)

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DIAGNOSTIC STUDIES FOR Viral gastroenteritis (e.g., Norwalk or rotavirus viral agents)?

PCR testing

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Acute onset 12-24 hr after exposure; lasts 3-7 days; large amounts of bloody diarrhea with abdominal cramping and vomiting

Shigella (gram-negative rod; fecal-oral transmission; common in day care setting)

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Lower abdominal tenderness, hyperactive bowel sounds, no peritoneal irritation

Shigella (gram-negative rod; fecal-oral transmission; common in day care setting)

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DIAGNOSTIC STUDIES FOR Shigella (gram-negative rod; fecal-oral transmission; common in day care setting)?

Fecal leukocytes, positive stool culture; PCR testing

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Acute onset 2-6 hr after ingestion; lasts 18-24 hr; large amounts of watery, nonbloody diarrhea; cramping and vomiting

Staphylococcus aureus food poisoning (gram¬ positive cocci; from improperly stored meats or custard-filled pies)

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Hyperactive bowel sounds

Staphylococcus aureus food poisoning (gram¬ positive cocci; from improperly stored meats or custard-filled pies)

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DIAGNOSTIC STUDIES FOR Staphylococcus aureus food poisoning (gram¬ positive cocci; from improperly stored meats or custard-filled pies)?

Fecal leukocytes, negative stool culture; PCR testing

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Acute onset 8-20 hr after ingestion; lasts 12-24 hr; large amounts of watery, nonbloody diarrhea; abdominal pain and cramping

Clostridium perfringens food poisoning (gram-positive rod; from contaminated food)

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Hyperactive bowel sounds, diffuse pain on abdominal palpation

Clostridium perfringens food poisoning (gram-positive rod; from contaminated food)

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DIAGNOSTIC STUDIES FOR Clostridium perfringens food poisoning (gram-positive rod; from contaminated food)?

Fecal leukocytes, negative anaerobic culture of stool; PCR testing

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Acute onset 3-5 days after exposure; lasts 3-7 days; moderate amounts of bloody diarrhea

Salmonella food poisoning (gram-negative bacilli; ingestion of contaminated food, poultry, eggs)

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Fever, lower quadrant abdominal pain

Salmonella food poisoning (gram-negative bacilli; ingestion of contaminated food, poultry, eggs)

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DIAGNOSTIC STUDIES FOR Salmonella food poisoning (gram-negative bacilli; ingestion of contaminated food, poultry, eggs)?

Fecal leukocytes, positive stool culture; PCR testing

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Acute onset 8-24 hr after ingestion of contaminated food; lasts 3-5 days; large amounts of nonbloody, watery, painless diarrhea; can be mild or fulminate

Vibrio choterae (gram¬ negative rod; fecal-oral transmission; ingestion of contaminated water, seafood, or food)

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Cyanotic,scaphoid abdomen, poorskin turgor, thready peripheral pulses,voice faint

Vibrio choterae (gram¬ negative rod; fecal-oral transmission; ingestion of contaminated water, seafood, or food)

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DIAGNOSTIC STUDIES FOR Vibrio choterae (gram¬ negative rod; fecal-oral transmission; ingestion of contaminated water, seafood, or food)?

Fecal leukocytes, negative stool culture; PCR testing

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Acute onset 8-18 hr after ingestion of contaminated food/water; lasts 24-48 hr; moderate amounts of nonbloody diarrhea; pain, cramping, abdominal pain; adults in United States generally do not develop illness from enterotoxic E. coli

Enterotoxic Escherichia coli (gram-negative rod; fecal-oral transmission; ingestion of contaminated water or food)

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No fever; dehydration is major complication

Enterotoxic Escherichia coli (gram-negative rod; fecal-oral transmission; ingestion of contaminated water or food)

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DIAGNOSTIC STUDIES FOR Enterotoxic Escherichia coli (gram-negative rod; fecal-oral transmission; ingestion of contaminated water or food)?

Fecal leukocytes, negative anaerobic culture of stool; PCR testing

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Acute onset 12-24 hr after ingestion of contaminated food or water; large amounts of bloody diarrhea; abdominal cramping and vomiting

Entamoeba histolytica parasite (cysts in food and water, from feces)

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Right lower quadrant abdominal pain; in small number of cases hepatic abscess forms

Entamoeba histolytica parasite (cysts in food and water, from feces)

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DIAGNOSTIC STUDIES FOR Entamoeba histolytica parasite (cysts in food and water, from feces)?

IHA: antibodies to E. histolytica; positive titer is >1:128; PCR testing

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Mild, watery diarrhea; crampy abdominal pain

Antibiotic-induced diarrhea (begins after taking antibiotics)

Diffuse abdominal pain on palpation, fever absent

Antibiotic-induced diarrhea (begins after taking antibiotics)

DIAGNOSTIC STUDIES FOR Antibiotic-induced diarrhea (begins after taking antibiotics)?

Usually not needed

Induced by antibiotics, most commonly ampicillin, clindamycin, or cephalosporins; symptoms range from transient mild diarrhea to active colitis with bloody diarrhea, abdominal pain, fever

Pseudomembranous colitis (antibiotic-induced Clostridium difficile)

Lower quadrant tenderness, fever

Pseudomembranous colitis (antibiotic-induced Clostridium difficile)

DIAGNOSTIC STUDIES FOR Pseudomembranous colitis (antibiotic-induced Clostridium difficile)?

CBC: leukocytes; sigmoidoscopy/ colonoscopy; C. difficile toxin assay or stool culture; C. difficile toxin; PCR testing

Children age <4 yr with history of gastroenteritis; history of bloody diarrhea, fever, and irritability

Hemolytic uremic syndrome (HUS) (primary cause of HUS in United States is E. coli 0157:H7)

Fever, irritability; can have oliguria or anuria

Hemolytic uremic syndrome (HUS) (primary cause of HUS in United States is E. coli 0157:H7)

DIAGNOSTIC STUDIES FOR Hemolytic uremic syndrome (HUS) (primary cause of HUS in United States is E. coli 0157:H7)?

CBC, platelet count, renal function tests, peripheral blood smear; negative stool culture; PCR testing

Premature or low-birth-weight infant who presents with feeding intolerance

Necrotizing enterocolitis

Vomiting, abdominal distention, lethargy, loose stools with blood and mucous

Necrotizing enterocolitis

DIAGNOSTIC STUDIES FOR Necrotizing enterocolitis?

Refer

Gl bleeding 2-3 days postnatal; history of lack of vitamin K injection; history of mother on anticonvulsants prenatally

Hemorrhagic disease of the newborn

Bruising, ecchymoses, mild to moderate bleeding

Hemorrhagic disease of the newborn

DIAGNOSTIC STUDIES FOR Hemorrhagic disease of the newborn?

Laboratory studies typically show mark¬ edly elevated PT and PTT with depressed levels of vitamin K-dependent factors

Intermittent diarrhea alternating with constipation; mucus with stool; seldom occurs at night or awakens patient; commonly present in morning; can have rectal urgency; episodes usually triggered by stress or ingestion of food; affects women three times as often as men

Irritable bowel syndrome (IBS)

Tender colon on palpation; can have abdominal distention; no weight loss; afebrile

Irritable bowel syndrome (IBS)

DIAGNOSTIC STUDIES FOR Irritable bowel syndrome (IBS)?

Diagnosis of exclusion; sigmoidoscopy, proctoscopy

History of severe diarrhea with gross blood in stools, no growth retardation; few reports of pain; age of onset second and third decades with small peak during adolescence; positive family history

Ulcerative colitis (distal colon is most severely affected and rectum is involved)

Overt rectal bleeding; initially no fever, weight loss, or pain on palpation of abdomen; moderate colitis: weight loss, fever, abdominal tenderness

Ulcerative colitis (distal colon is most severely affected and rectum is involved)

DIAGNOSTIC STUDIES FOR Ulcerative colitis (distal colon is most severely affected and rectum is involved)?

CBC shows leukocytosis or anemia, ESR elevated; stool cultures to rule out other causes of diarrhea; colonoscopy

History of chronic bloody diarrhea with abdominal cramping, tenderness, and rectal bleeding; in children a history of growth retardation, weight loss, moderate diarrhea, abdominal pain, and anorexia

Crohn disease (associated with uveitis, erythema nodosum)

Weight loss; rare gross rectal bleeding; fistulas common

Crohn disease (associated with uveitis, erythema nodosum)

DIAGNOSTIC STUDIES FOR Crohn disease (associated with uveitis, erythema nodosum)?

Colonoscopy with biopsies

Bloating, flatus, diarrhea exacerbated by ingestion of certain disaccharides (e.g., lactose, milk, milk products); can follow viral gastroenteritis

Carbohydrate malabsorption

Diffuse abdominal pain

Carbohydrate malabsorption

DIAGNOSTIC STUDIES FOR Carbohydrate malabsorption?

Trial elimination of offending foods

Greasy, fatty, malodorous stools; associated with deficiencies of vitamins K, A, and D; cystic fibrosis

Fat malabsorption

Rectal prolapse, poor weight gain, abdominal distention

Fat malabsorption

DIAGNOSTIC STUDIES FOR Fat malabsorption?

72-hr fecal fat, sweat test

Three or four stools/day; some contain mucus; rare past age 4-5 yr

Toddler's diarrhea

Physical examination and growth normal

Toddler's diarrhea

DIAGNOSTIC STUDIES FOR Toddler's diarrhea?

Clinical diagnosis

Increased stool frequency, looseness, paleness, and bulkiness of stool within 3-5 mo of dietary onset; children are lethargic, irritable, and anorectic; peak frequency 9-18 mo

Celiac sprue/protein hypersensitivity (reaction to protein in wheat, rye, barley, and oats)

Failure to thrive, abdominal distention, irritability, muscle wasting

Celiac sprue/protein hypersensitivity (reaction to protein in wheat, rye, barley, and oats)

DIAGNOSTIC STUDIES FOR Celiac sprue/protein hypersensitivity (reaction to protein in wheat, rye, barley, and oats)?

IgA anti tTG antibodies Clinical findings, improvement on gluten- free diet, CBC, anemia, folate deficiency, radiography, biopsy

Watery, foul diarrhea; common in day care, among travelers

Giardia species parasite (primary cause of chronic diarrhea in children)

Low-grade fever, weight loss; chronic form: fatigue, growth retardation, steatorrhea

Giardia species parasite (primary cause of chronic diarrhea in children)

DIAGNOSTIC STUDIES FOR Giardia species parasite (primary cause of chronic diarrhea in children)?

Giardia antigen test; PCR testing

Recurrent episodes; variable amounts watery, nonbloody diarrhea; amounts can be massive

Cryptosporidium species/ Isospora belli protozoan parasites (fecal-oral transmission; ingestion of contaminated water or direct oral-anal contact)

Weight loss, severe right upper quadrant abdominal pain with biliary tract involvement

Cryptosporidium species/ Isospora belli protozoan parasites (fecal-oral transmission; ingestion of contaminated water or direct oral-anal contact)

DIAGNOSTIC STUDIES FOR Cryptosporidium species/ Isospora belli protozoan parasites (fecal-oral trans¬ mission; ingestion of contaminated water or direct oral-anal contact)?

Stool for O&P Antigen Test; PCR testing

Following Gl surgery, diarrhea occurs after meals because of increased transit of food through colon

Postgastrectomy dumping syndrome

Diaphoresis and tachycardia

Postgastrectomy dumping syndrome

DIAGNOSTIC STUDIES FOR Postgastrectomy dumping syndrome?

Upper Gl series

Nocturnal diarrhea, postprandial vomit¬ ing, fatty stools from malabsorption

Diabetic enteropathy

Findings associated with diabetes

Diabetic enteropathy

DIAGNOSTIC STUDIES FOR Diabetic enteropathy?

Diagnosis of exclusion in diabetic people

Insidious onset, recurrent large amounts of nonbloody diarrhea, mild to moderate nausea/vomiting

HIV enteropathy (direct infection of mucosa and neuronal cells in Gl system)

Findings associated with HIV infection

HIV enteropathy (direct infection of mucosa and neuronal cells in Gl system)

DIAGNOSTIC STUDIES FOR HIV enteropathy (direct infection of mucosa and neuronal cells in Gl system)?

Testing for HIV

Mild to moderately severe nonwatery, nonbloody diarrhea

Medication-induced diarrhea

No specific findings related to diarrhea

Medication-induced diarrhea

DIAGNOSTIC STUDIES FOR Medication-induced diarrhea?

Usually none needed