Diarrhea Flashcards
What time frame is considered acute diarrhea
14 days
What time frame is considered chronic diarrhea
4+ weeks
What is severe acute diarrhea
4+ stools/day with systemic symptoms
What is the second leading cause of death in children <5
acute diarrhea because of dehydration
What are some high risk groups for acute diarrhea
travelers
immunodeficient
daycares
Extremes of age (<5, >65)
Characteristics of non-inflammatory diarrhea
watery, non bloody
GI symptoms only
larger volumes
no fecal leukocytes
small intestine
What are characteristics of inflammatory diarrhea
bloody diarrhea
systemic symptoms + tenesmus
small volume
fecal leukocytes
large intestine
what are reasons for non-infectious diarrhea
malabsorption
celiac, crohns, UC
medications
bile acids
mesenteric ischemia
What are the indications for workup of acute diarrhea
signs of inflammation
profuse watery diarrhea
immunocompromised
>70y/o or SNF
recent abx use
systemic illness
>7-14 days of sx
no improvement over 48 hours
Which patients should you order ova/parasite testing in a stool sample
diarrhea in people who have traveled, have symptoms >1 week, or drank untreated water
If testing for parasites with acute diarrhea, which infections are we looking for
giardia
crytosporidium
E. Hystolytica
If diarrhea persists after treatment, how do you work a patient up
flexible sigmoidoscopy +/- colonoscopy with a bx
When are anti-diarrheals contraindicated
bloody diarrhea
fever
systemic symptoms
persistent diarrhea
What are the preferred empiric abx treatment for diarrhea
fluoroquinolone (Cipro or levo)
1-3 day course
*travelers diarrhea: ryfamixin or azithromycin
What are complications of acute diarrhea
reactive arthritis
hemolytic uremic syndrome
post infectious IBS
precursor to crohns or celiac
What are the primary causes of viral infectious diarrhea
primarily norovirus / rotavirus
What is the leading cause of food borne illness
norovirus
What is the typically duration of norovirus
hours to 3 days
What is the m/c cause of severe gastroenteritis in infants and kids
rotavirus
*vaccine now present
When is rotavirus more common
in winter
Who generally gets Shigella
young children at daycare/preschool
What is the presentation of shigella
small, frequent, bloody stools
*infects the colon so severe diarrhea is less likely
*+fecal leukocytes
What may shigella lead to
hemolytic uremic syndrome (Dysenteriae)
*shiga toxin
How do you treat shigella
fluoroquinalones
*azithromycin if younger than 18
What is the #1 cause of food borne illness in the US
Salmonella
Where does salmonella come from
eggs
milk
other dairy products
Where is the GI tract typically effect
small intestine
*LOVES Peyers patches
What are the symptoms associated with salmonella
N/V, fever that turns into abd. cramps and diarrhea
How do you treat salmonella
fluoroquinalones 3-7 days
What is the most common source for campylobacter
contaminated poultry
What are the symptoms of campylobacter
abrupt onset of abdominal pain and diarrhea
*often have a relapse of symptoms within a few days of apparent resolution
What are the characteristic organisms for campylobacter
rapidly-motile spiral shaped organisms
How do you treat campylobacter
3-5 days of azithromycin
What is C. Jejuni associated with
Gullian- Barre
What is seen with vibrio (cholera)
rapid volume loss and electrolyte abnormalities
What is vibrio parahaemolyticus typically found
salt water reservoirs, especially in summer and fall
*raw and undercooked seafood
Who do you treat with vibrio parahaemolyticus and what is used
severe illness / immunocompromised
doxy/fluoroquinalones
Where is cholera found
asia, africa, central/South America
*most US cases are from travelers
What are the symptoms for cholera
profuse watery diarrhea, usually abrupt onset from enterotoxin
*rice water stools
How do you treat cholera
tetracycline, doxy, azithro, cipro
*can use empirically for endemics
How do enterotoxigenic E. coli adhere to the GI tract
fimbriae
What are the symptoms of enterotoxigenic E. coli
loose stools or severe diarrhea up to 1 week
*m/c in resource limited area
How is enterotoxigenic E. coli clinically diagnosed
neg fecal leukocytes
neg routine stool culture
What is the mainstay tx of entertoxigenic E. coli
rehydration
How is enterohemorrhagic E. Coli
undercooked meat, especially ground beef
What type of toxin does enterohemorrhagic E. coli create
shiga toxin which leads to bloody diarrhea, TTP, HUS, and hemolytic anemia
*most often progress to bloody diarrhea
What can you NOT give those with enterohemorrhagic E. coli
antidiarrheals
antibiotics (increase risk for HUS
What is a common cause of food poisoning
Staph Aureus
Where is S. Aureus generally found in relation to food
high in sugar, those with cream, and all particularly at room temp
How long does food poisoning typically last
24 hours or less
What is clostridium perfringes
spore forming bacterium found in soil and animal intestinal flora
How id C. Perfringes transmitted
via improperly refrigerated cooked meats
What is the most common antibiotic associated diarrhea
antibiotic diarrhea
*not C. Diff
Which abx can lead to C. Diff
clindamycin
ampicillin
amoxicillin
cephalosporin
fluoroquinolone
What are the symptoms of pseudomembranous colitis
severe watery diarrhea, abdominal cramping, fever, leukocytosis
If someone with pseudomembranous colitis has watery diarrhea, what toxin do they have
toxin A
What toxin causes colon cellular destruction with pseudomembranous colitis
toxin B
What is occurring to the bowel underneath the pseudomembranes
mucosa will be necrotic
What can pseudomembranous colitis lead to
toxic megacolon
How is C.Diff transmitted
fecal-oral via spores
What symptoms will someone with C. Diff have
greenish, foul smelling, watery-diarrhea
*up to 5-15 BMs per day
What will be seen in labs with severe fulminant C. Diff
WBC >30k
Albumin <2.5
Elevated lactate
increase serum creatinine
What can fulminant C diff progress to
respiratory failure
metabolic acidosis
toxic megacolon
colon perf
death
How do you screen for C. Diff
glutamate dehydrogenase (C. diff antigen)
What is the hallmark for severe C. Diff
pseudomembranous colitis
How do you treat C. Diff
PO Vanco
Who is cryptosporidium typically seen in
generally immunocompromised (AIDS)
Where does cryptosporidium come from
contaminated food/water
*commonly recreational water
What are the symptoms for cryptosporidium
watery diarrhea
abdominal cramps
malaise
**In AIDS patients: frequent foul smelling stool, malabsorption, weightloss
How do you detect cryptosporidium
Acid fast stain
*must test min of 3 specimens to improve the yield
How do you treat cryptosporidium
supportive tx, anti-diarrheal- hydration
How can you prevent cryptosporidium
boil water x 1 min
water filtration
avoidance of high risk lakes/streams
Where is Giardia most commonly seen
with camping and contaminated water
What are the symptoms of Giardia
watery diarrhea
flatulence
abd. cramping
epigastric pain
nausea
How do you diagnose Giardia
+stool ova and parasites
*to increase yield of results, obtain samples at different times
