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GI 1 > clinmed - c. diff colitis and ischemic bowel dz > Flashcards

clinmed - c. diff colitis and ischemic bowel dz Flashcards

1
Q

What is the first thing to assess when an older pt suddenly develops new onset diarrhea?

A
  • dehydration
  • know the clinical signs of fluid loss
  • don’t kill their kidneys
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2
Q

c. diff bacteria

A
  • spore forming, gram+ anaerobic bacillus

- normal part of flora in 5-15% of people

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3
Q

prevalence and issues with c. diff

A
  • use of broad spectrum abx has increased its prevalence
  • strains becoming more virulent
  • strains becoming more resistant to fluoroquinolones
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4
Q

pathogenesis process of c. diff

A
  • abx given
  • normal bacterial reduced
  • c. diff uninhibited by the normal bacterial that normally suppress it
  • additional access to conolic nutrients
  • c. diff proliferates
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5
Q

what determines if c. diff develops into disease or not?

A
  • if the bacteria lacks the gene for toxin production, no dz develops
  • if ti produces toxins A and B, it may cause colitis
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6
Q

damage caused by c. diff

A
  • damages colonocytes

- leads to inflammation and in some cases pseudomembranous colitis

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7
Q

complications of infection w/ c. diff

A
  • pseudomembranous colitis
  • toxic megacolon
  • perforation of the colon
  • sepsis
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8
Q

Who is at risk for c. diff?

A
  • abx exposure (esp broad spectrum)
  • PPI use
  • GI surg
  • long stay inpatient
  • co-morbidities
  • immunocompromised
  • advanced age
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9
Q
  • 80% of c. diff infections are related to healthcare

- what is this called?

A

iatrogenic cause

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10
Q

clinical presentation of c. diff

A
  • watery diarrhea w/ characteristic foul odor
  • fever
  • appetite loss (weight loss)
  • nausea
  • abdominal pain
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11
Q

Can a pt be colonized w/ c. diff, even the toxin producing kind, and NOT show signs of infection/sickness?

A

YES

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12
Q

lab results in c. diff

A
  • high WBC on CBC
  • low albumin on BMP
  • check the stool
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13
Q

What stool test do you order when you suspect c. diff?

A
  • c. diff toxin by PCR (genetic test NOT culture)
  • highly sensitive and specific for the TOXIN producing bacteria
  • rapid turn around (next day)
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14
Q

Why is a stool culture not usually used in diagnosing c. diff?

A
  • it’s sensitive however will get false positives

- labor intensive and results take 48-96 hrs

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15
Q

When is the antigen test for c. diff useful?

A
  • in two step testing processes (inpatients and nursing homes)
  • very rapid (<1) but nonspecific
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16
Q

What testing should NOT be used for c. diff?

A

toxin testing by enzyme immunoassay

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17
Q

tx of c. diff

A
  • dc the broad spectrium abx
  • IV fluids if needed
  • Metronidazole 500 mg TID or 10 days
  • isolation precautions
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18
Q

What abx should be used if the pt has recurrent c. diff or has already been treated w/ metronidazole?

A

vancomycin 125 mg QID for 10 days

19
Q

Tx for severe c. diff case/hospitalized pt

A
  • oral vanc
  • IV metronidazole
  • vanc enemas
20
Q

what is the bacteriotherapy tx option for RECURRENT infections w/ c. diff?

A
  • fecal transplant
  • performed by colonoscopy
  • cure rates in the >80% range
21
Q

tips in preventing c. diff infections

A
  • appropriate use of abx
  • proper isolation/contact precautions for those infected
  • cleaning and disinfection of equipment and environment
  • alert staff quickly
  • pt. and family education (hand sanitizers DONT kill spores)
22
Q

pseudomembranous colitis

A
  • SEVERE form of c. diff colitis

- very sick and hospitalized pts have high rate of mortalitiy

23
Q

In a pt w/ pseudomembranous colitis, what is the next step in testing?

A

-CT to look for toxic megacolon

24
Q

What pseudomembranous colitis patients do you consider surgery in?

A
  • shock (altered mental status, organ dysfunction, lactic acidosis)
  • peritonitis
  • significant leukocytosis
  • failure to improve on medical therapy for 5 days
25
Q

ischemic colitis

A
  • MC form of intestinal ischemia
  • “heart attack of the gut”
  • can be d/t a decrease in colonic perfusion OR atherosclerosis
26
Q

where does ischemic colitis often occur?

A
  • splenic flexure (#1)
  • descending colon
  • rectosigmoid colon
  • (watershed areas)
27
Q

precipitating causes of ischemic colitis

A
  • often NOT identifiable

- possibly hypotension, sepsis, MI, heart failure, surgery

28
Q

clinical presentation of ischemic colitis

A
  • older pt w/:
  • diarrhea** MC
  • hematochezia common
  • abd pain (usually mild)
  • abd tenderness
  • not severely ill appearing
  • not typically life threatening
29
Q

what is the preferred test for diagnosing ischemic colitis?

A

-colonoscopy WITHOUT bowel prep

30
Q

although plain radiographs aren’t usually helpful in diagnosing ischemic colitis, what would be the sign on one?

A

thumbprinting

31
Q

other imagingin ischemic colitis

A
  • US w/ doppler shows flow changes

- CT can appear normal

32
Q

Tx of ischemic colitis

A
  • IV fluids
  • NPO, bowel rest
  • abx
  • GI consult for colonoscopy
  • surgical consult
  • surgical resection if severe
33
Q

What is the clinical presentation of acute mesenteric ischemia?

A
  • very sick
  • acte and SEVERE abd pain
  • n/v
  • +/- diarrhea and hematochezia
  • ***pain WAY out of proportion to PE
  • usually > 60 yo
34
Q

cause of acute mesenteric ischemia

A

blockage of artery that feeds bowel

35
Q

what could you possibly see in the past medical hx of a pt w/ acute mesenteric ischemia

A
  • a. fib
  • thrombosis
  • prior emboli
  • risk of clot
  • hx of atherosclerosis
36
Q

Diagnosis of acute mesenteric ischemia

A
  • needs to be made quick! - mortality is 70-90% if diagnosis is delayed
  • contrast CT is best for initial eval
  • CTA is most sensitive
37
Q

classic radiological finding in acute mesenteric ischemia

A

thumb printing

38
Q

tx of acute mesenteric ischemia

A
  • surgical consult stat
  • medical emergency
  • revascularize if possible, if not resect bowel
39
Q

Chronic mesenteric ischemia

A
  • narrowing of blood vessels that supply the intestines

- caused by atherosclerosis

40
Q

chronic mesenteric ischemia is most commonly found in what population?

A
  • W>M

- >60 yo

41
Q

risk factors for chronic mesenteric ischemia

A
  • smoking
  • DM
  • HTN
  • dyslipidemia
42
Q

sx of chronic mesenteric ischemia

A
  • abdominal pain after meals –> anorexia/change in eating habits
  • weight loss
  • n/v
  • constipation or diarrhea
43
Q

diagnostic testing for chronic mesenteric ischemia

A
  • CTA scan*
  • CT, Xray and others to r/o other conditions like obstruction
  • ateriogram, doppler US, MRA
44
Q

tx of chronic mesenteric ischemia

A
  • anticoagulant meds
  • angioplasty and stenting
  • surgery if that fails: endarterectomy, bypass vessel or remove/repair aneurysm

GI 1 (16 decks)

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