Chapter 12, Module 7; Diarrhea Flashcards
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)
In children can see severe dehydration; hyperactive bowel sounds, diffuse pain on abdominal palpation
Viral gastroenteritis (e.g., Norwalk or rotavirus viral agents)
DIAGNOSTIC STUDIES FOR Viral gastroenteritis (e.g., Norwalk or rotavirus viral agents)?
PCR testing
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)
Lower abdominal tenderness, hyperactive bowel sounds, no peritoneal irritation
Shigella (gram-negative rod; fecal-oral transmission; common in day care setting)
DIAGNOSTIC STUDIES FOR Shigella (gram-negative rod; fecal-oral transmission; common in day care setting)?
Fecal leukocytes, positive stool culture; PCR testing
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)
Hyperactive bowel sounds
Staphylococcus aureus food poisoning (gram¬ positive cocci; from improperly stored meats or custard-filled pies)
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
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)
Hyperactive bowel sounds, diffuse pain on abdominal palpation
Clostridium perfringens food poisoning (gram-positive rod; from contaminated food)
DIAGNOSTIC STUDIES FOR Clostridium perfringens food poisoning (gram-positive rod; from contaminated food)?
Fecal leukocytes, negative anaerobic culture of stool; PCR testing
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)
Fever, lower quadrant abdominal pain
Salmonella food poisoning (gram-negative bacilli; ingestion of contaminated food, poultry, eggs)
DIAGNOSTIC STUDIES FOR Salmonella food poisoning (gram-negative bacilli; ingestion of contaminated food, poultry, eggs)?
Fecal leukocytes, positive stool culture; PCR testing
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)
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)
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
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)
No fever; dehydration is major complication
Enterotoxic Escherichia coli (gram-negative rod; fecal-oral transmission; ingestion of contaminated water or food)
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
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)
Right lower quadrant abdominal pain; in small number of cases hepatic abscess forms
Entamoeba histolytica parasite (cysts in food and water, from feces)
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
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
Hemolyticuremic 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 associatedwith HIVinfection
HIV enteropathy (direct infectionofmucosaand neuronal cells in Glsystem)
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