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Clin med GI > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

What time frame is considered acute diarrhea

A

14 days

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2
Q

What time frame is considered chronic diarrhea

A

4+ weeks

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3
Q

What is severe acute diarrhea

A

4+ stools/day with systemic symptoms

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4
Q

What is the second leading cause of death in children <5

A

acute diarrhea because of dehydration

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5
Q

What are some high risk groups for acute diarrhea

A

travelers
immunodeficient
daycares
Extremes of age (<5, >65)

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6
Q

Characteristics of non-inflammatory diarrhea

A

watery, non bloody
GI symptoms only
larger volumes
no fecal leukocytes
small intestine

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7
Q

What are characteristics of inflammatory diarrhea

A

bloody diarrhea
systemic symptoms + tenesmus
small volume
fecal leukocytes
large intestine

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8
Q

what are reasons for non-infectious diarrhea

A

malabsorption
celiac, crohns, UC
medications
bile acids
mesenteric ischemia

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9
Q

What are the indications for workup of acute diarrhea

A

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

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10
Q

Which patients should you order ova/parasite testing in a stool sample

A

diarrhea in people who have traveled, have symptoms >1 week, or drank untreated water

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11
Q

If testing for parasites with acute diarrhea, which infections are we looking for

A

giardia
crytosporidium
E. Hystolytica

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12
Q

If diarrhea persists after treatment, how do you work a patient up

A

flexible sigmoidoscopy +/- colonoscopy with a bx

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13
Q

When are anti-diarrheals contraindicated

A

bloody diarrhea
fever
systemic symptoms
persistent diarrhea

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14
Q

What are the preferred empiric abx treatment for diarrhea

A

fluoroquinolone (Cipro or levo)
1-3 day course

*travelers diarrhea: ryfamixin or azithromycin

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15
Q

What are complications of acute diarrhea

A

reactive arthritis
hemolytic uremic syndrome
post infectious IBS
precursor to crohns or celiac

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16
Q

What are the primary causes of viral infectious diarrhea

A

primarily norovirus / rotavirus

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17
Q

What is the leading cause of food borne illness

A

norovirus

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18
Q

What is the typically duration of norovirus

A

hours to 3 days

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19
Q

What is the m/c cause of severe gastroenteritis in infants and kids

A

rotavirus
*vaccine now present

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20
Q

When is rotavirus more common

A

in winter

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21
Q

Who generally gets Shigella

A

young children at daycare/preschool

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22
Q

What is the presentation of shigella

A

small, frequent, bloody stools

*infects the colon so severe diarrhea is less likely

*+fecal leukocytes

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23
Q

What may shigella lead to

A

hemolytic uremic syndrome (Dysenteriae)
*shiga toxin

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24
Q

How do you treat shigella

A

fluoroquinalones
*azithromycin if younger than 18

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25
Q

What is the #1 cause of food borne illness in the US

A

Salmonella

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26
Q

Where does salmonella come from

A

eggs
milk
other dairy products

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27
Q

Where is the GI tract typically effect

A

small intestine
*LOVES Peyers patches

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28
Q

What are the symptoms associated with salmonella

A

N/V, fever that turns into abd. cramps and diarrhea

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29
Q

How do you treat salmonella

A

fluoroquinalones 3-7 days

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30
Q

What is the most common source for campylobacter

A

contaminated poultry

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31
Q

What are the symptoms of campylobacter

A

abrupt onset of abdominal pain and diarrhea

*often have a relapse of symptoms within a few days of apparent resolution

32
Q

What are the characteristic organisms for campylobacter

A

rapidly-motile spiral shaped organisms

33
Q

How do you treat campylobacter

A

3-5 days of azithromycin

34
Q

What is C. Jejuni associated with

A

Gullian- Barre

35
Q

What is seen with vibrio (cholera)

A

rapid volume loss and electrolyte abnormalities

36
Q

What is vibrio parahaemolyticus typically found

A

salt water reservoirs, especially in summer and fall

*raw and undercooked seafood

37
Q

Who do you treat with vibrio parahaemolyticus and what is used

A

severe illness / immunocompromised

doxy/fluoroquinalones

38
Q

Where is cholera found

A

asia, africa, central/South America

*most US cases are from travelers

39
Q

What are the symptoms for cholera

A

profuse watery diarrhea, usually abrupt onset from enterotoxin

*rice water stools

40
Q

How do you treat cholera

A

tetracycline, doxy, azithro, cipro

*can use empirically for endemics

41
Q

How do enterotoxigenic E. coli adhere to the GI tract

A

fimbriae

42
Q

What are the symptoms of enterotoxigenic E. coli

A

loose stools or severe diarrhea up to 1 week
*m/c in resource limited area

43
Q

How is enterotoxigenic E. coli clinically diagnosed

A

neg fecal leukocytes
neg routine stool culture

44
Q

What is the mainstay tx of entertoxigenic E. coli

A

rehydration

45
Q

How is enterohemorrhagic E. Coli

A

undercooked meat, especially ground beef

46
Q

What type of toxin does enterohemorrhagic E. coli create

A

shiga toxin which leads to bloody diarrhea, TTP, HUS, and hemolytic anemia

*most often progress to bloody diarrhea

47
Q

What can you NOT give those with enterohemorrhagic E. coli

A

antidiarrheals
antibiotics (increase risk for HUS

48
Q

What is a common cause of food poisoning

A

Staph Aureus

49
Q

Where is S. Aureus generally found in relation to food

A

high in sugar, those with cream, and all particularly at room temp

50
Q

How long does food poisoning typically last

A

24 hours or less

51
Q

What is clostridium perfringes

A

spore forming bacterium found in soil and animal intestinal flora

52
Q

How id C. Perfringes transmitted

A

via improperly refrigerated cooked meats

53
Q

What is the most common antibiotic associated diarrhea

A

antibiotic diarrhea
*not C. Diff

54
Q

Which abx can lead to C. Diff

A

clindamycin
ampicillin
amoxicillin
cephalosporin
fluoroquinolone

55
Q

What are the symptoms of pseudomembranous colitis

A

severe watery diarrhea, abdominal cramping, fever, leukocytosis

56
Q

If someone with pseudomembranous colitis has watery diarrhea, what toxin do they have

A

toxin A

57
Q

What toxin causes colon cellular destruction with pseudomembranous colitis

A

toxin B

58
Q

What is occurring to the bowel underneath the pseudomembranes

A

mucosa will be necrotic

59
Q

What can pseudomembranous colitis lead to

A

toxic megacolon

60
Q

How is C.Diff transmitted

A

fecal-oral via spores

61
Q

What symptoms will someone with C. Diff have

A

greenish, foul smelling, watery-diarrhea
*up to 5-15 BMs per day

62
Q

What will be seen in labs with severe fulminant C. Diff

A

WBC >30k
Albumin <2.5
Elevated lactate
increase serum creatinine

63
Q

What can fulminant C diff progress to

A

respiratory failure
metabolic acidosis
toxic megacolon
colon perf
death

64
Q

How do you screen for C. Diff

A

glutamate dehydrogenase (C. diff antigen)

65
Q

What is the hallmark for severe C. Diff

A

pseudomembranous colitis

66
Q

How do you treat C. Diff

A

PO Vanco

67
Q

Who is cryptosporidium typically seen in

A

generally immunocompromised (AIDS)

68
Q

Where does cryptosporidium come from

A

contaminated food/water
*commonly recreational water

69
Q

What are the symptoms for cryptosporidium

A

watery diarrhea
abdominal cramps
malaise

**In AIDS patients: frequent foul smelling stool, malabsorption, weightloss

70
Q

How do you detect cryptosporidium

A

Acid fast stain
*must test min of 3 specimens to improve the yield

71
Q

How do you treat cryptosporidium

A

supportive tx, anti-diarrheal- hydration

72
Q

How can you prevent cryptosporidium

A

boil water x 1 min
water filtration
avoidance of high risk lakes/streams

73
Q

Where is Giardia most commonly seen

A

with camping and contaminated water

74
Q

What are the symptoms of Giardia

A

watery diarrhea
flatulence
abd. cramping
epigastric pain
nausea

75
Q

How do you diagnose Giardia

A

+stool ova and parasites
*to increase yield of results, obtain samples at different times

Clin med GI (9 decks)

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