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Clin Med 2 > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

Most cases of infectious diarrhea are

A

viral

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2
Q

Most cases of viral diarrhea are

A

norovirus

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3
Q

Most cases of severe diarrhea are

A

bacterial

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4
Q

Most cases of bacterial diarrhea are

A

campylobacter

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5
Q

Def of diarrhea

A

200g/day of loose water stool; 3x in 24hrs

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6
Q

Patho diarrhea

A

impaired water absorption or increased water secretion by the bowel

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7
Q

dysentery

A

infection of the intestinem resulting in severe diarrhea with blood or mucus

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8
Q

Acute v. Persistent v. Chronic

A

Acute- 14days or less
Persistent- more than 14 days and less than 30 days
Chronic- more than 30 days

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9
Q

Fxn small bowel

A
  • fluid and enzyme secreting organ

- absorbs nutrients

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10
Q

Fxn large bowel

A

absorb fluid and salt and excrete potassium

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11
Q

Viral causes of diarrhea

A

norovirus
rotavirus
adenovirus
astrovirus

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12
Q

Bacterial Causes of diarrhea

A 
salmonella
campylobacter
shigella
enterotoxigenic
E. coli
C. diff
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13
Q

Protozoan causes of diarrhea

A

cryptosporidium
giardia
cyclospora
Entamoeba

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14
Q

Clinical small bowel diarrhea

A 
watery
large volume
abdominal cramping
bloating
gas
weight loss
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15
Q

Clinical large bowel diarrhea

A 
frequent, regular
small volume
painful bowel movement
fever
blood or mucoid
inflammatory and RBC seen on microscopy
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16
Q

Diarrhea of large bowel due to

A 
salmonella
shigella
campylobacter
CMV
adenovirus
C. diff
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17
Q

Diarrhea of small bowel due to

A 
salmonella
e.coli
clostridium
s. aureus
rotavirus
norovirus
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18
Q

Petting zoo bacteria

A

salmonella

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19
Q

Daycare bacteria

A

shigella
cryptosporidium
giardia

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20
Q

Recent ABX use bacteria

A

C. diff

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21
Q

When to do stool culture

A
  • more than 6 unformed stools in 24hrs
  • severe abdominal pain
  • hospitalization
  • inflammatory diarrhea (bloody diarrhea, tempt over 101)
  • high risk
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22
Q

High risk features that need stool culture

A 
over 70
comorbidities
CV disease
DM
immunocompromised
IBD
Pregnancy
Sx more than 1 week
Public health concern
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23
Q

What is fecal lactoferrin

A
  • detect inflammation in the intestines
  • detect bacterial infections that cause inflammatory diarrhea
  • sensitive and specific
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24
Q

Manage diarrhea

A

fluid replacement
nutrition replacement- sugar, salt, water
ABX- fluoroquinolones
Antimotility agents- loperamide, pepto-bismol
Probiotics

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25
Q

Clinical norovirus

A
  • very contagious
  • acute N/V
  • watery diarrhea with abdominal cramps
  • sx begin in 12-48hrs
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26
Q

Transmission of norovirus

A
  • close personal contact with infected person
  • fecal-oral route with contaminated food
  • touching contaminated surfaces
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27
Q

When do norovirus sx end

A

24-72hrs

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28
Q

MC complication of norovirus

A

dehydration

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29
Q

Most common nosocomial infections

A

C. diff

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30
Q

Clinical C. diff

A
  • patient on ABX therapy and sx develop or 5-10days later

- watery diarrhea more than 3 movements in 24hrs

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31
Q

ABX most implicated with C.diff

A

Fluoroquinolones
Cephalosporins
Penicillins

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32
Q

Risk for C.diff

A

ABX use
recent hospitalization
advanced age

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33
Q

Patho C.diff

A
  • common in intestine

- grows out of control–> release toxins that damage lining of intestines

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34
Q

Tx c.diff

A

stop ABX
clean surfaces with soap and water
Vanco or Metronidazole

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35
Q

Where is camphylobacter located?

A

intestinal tracts of animals, mc in poultry

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36
Q

Incubation period of camphylobacter

A

3 days

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37
Q

Clinical camphylobacter

A 
abrupt onset of abdominal pain
bloody/mucoid diarrhea
fever
chills
aches
mimics appendicitis
38
Q

Tx camphylobacter

A

healthy ptn: IVF, antiemetic

Severe dz or immunocompromised: Levo, Cipro or azithromycin

39
Q

Salmonella associated with ingestion of

A

poultry, milk products and eggs

40
Q

When does salmonella occur

A

8-72hrs after ingestion of contaminated food/water

41
Q

Clinical salmonella

A 
N/V
vomiting
pea soup diarrhea with a little blood
abdominal cramping
fever
42
Q

When does salmonella sx resolve?

A 
fever= 48-72hrs
gastroenteritis= 4-10days
43
Q

TX salmonella

A

IVF replacement
electrolyte replacement
Severe diz/immuno: Cipro or Levo

44
Q

Short term carriage

A

normal shedding of virus after infection; no sx but bacteria shedding

45
Q

Long term carriage

A

shedding of bacteria for more than 1 year after infection; no sx but bacteria shedding

46
Q

Special property of shigella

A

less susceptible to stomach acid and multiples in small bowel

47
Q

Transmission of shigella

A

direct person to person and contaminated food and water

fecal oral in developed countries

48
Q

Natural reservoir for shigella

A

human

49
Q

Where is shigella common

A

day care centers

50
Q

Clinical shigella

A

high fever
small volume diarrhea that is initially watery and then bloody and mucoid
abdominal cramping
tenesmus

51
Q

Tx shigella

A

IVF
Electrolyte depletion
Severe dz/immunocompromised: Fluoroquinolone (no Cipro), Azithromycin, Bactrim

52
Q

How long does shigella last

A

7 days

53
Q

Microbiology of botulism

A

gram + rod shaped anaerobe

54
Q

Special about botulism spores

A

heat resistant

55
Q

How does botulism spread

A

vascular system

56
Q

Botulism causes what type of syndrome

A

neuroparalytic

57
Q

What is the most potent bacterial toxin

A

botulism

58
Q

Botulism spread via

A

home canning of fruits, veggies, fish

59
Q

Clinical botulism

A 
sx begin 12-36hrs
N/V
Diarrhea
abdominal pain and cramping
dry mouth and sore throat
bilateral cranial nerve involvement/palsy
60
Q

Dx botulism

A

serum toxin

61
Q

TX botulism

A

antitoxins

abx possible- Pen G, Metronidazole

62
Q

What does cholera cause?

A

profound fluid and electrolyte loss in stool and rapid progression to hypovolemic shock

63
Q

Where does cholera affect?

A
  • resource limited areas with inadequate clean water access

- Africa, Asia, Caribbean (MC Haiti)

64
Q

Transmission of cholera

A

ingestion of contaminated food and water

65
Q

Clinical cholera

A
  • incubation 1-2days
  • abdominal pain
  • rice water stool, fishy smell
  • borborygmi
  • vomiting
66
Q

Dx cholera

A

stool culture and rapid dipstick

67
Q

Tx cholera

A

Aggressive volume depletion

ABX for moderate/severe depletion- macrolides, Fluoroquinolones, tetracyclines

68
Q

Prevention of cholera

A
  • clean water with sanitation

- oral cholera vaccines

69
Q

MC cause of intestinal entomoeba

A

E. histolytica

70
Q

Increased risk of intestinal entomoeba

A

institutional patients and MSM

71
Q

Infection of intestinal entomoeba due to

A

ingestion of amebic cysts via contaminated food and water

72
Q

Clinical intestinal entomoeba

A 
Onset 1-3days
Asymptomatic
Mild diarrhea to severe dysentery
Abdominal pain
Weight loss
Fever
73
Q

Complication of intestinal entomoeba

A

fulminant colitis with bowel necrosis leading to perforation and peritonitis

74
Q

Tx intestinal entomoeba

A

Metronidazole
Tinidazole
Ornidazole

75
Q

What is the most common parasitic cause of acute foodborne diarrhea in US

A

Cryptosporidium

76
Q

Transmission of Cryptosporidium

A

infected person or animal

fecally contaminated food/water

77
Q

Tx Cryptosporidium

A

Antiparasitic meds- Nitazoxanide

78
Q

What is a common cause of waterborne and foodborne diarrhea in daycare center outbreaks

A

Giardia

79
Q

Tx giardia

A

Metronidazole
Tinidazole
Nitazoxanide

80
Q

Def travelers diarrhea

A

diarrhea develops during or within 10 days of returning from travel

81
Q

MC organism in travelers diarrhea

A

E. coli

82
Q

MC organism in travelers diarrhea in SE Asia

A

Campylobacter

83
Q

MC organism in travelers diarrhea in Jamaica

A

Rotavirus

84
Q

Countries with highest risk of travelers diarrhea

A

India, Nepal, W./C. Africa

85
Q

Prevent travelers diarrhea

A

Bottle only water
Food thoroughly cooked
Pasteurized dairy products

86
Q

Tx travelers diarrhea

A

Cipro and Levo

87
Q

Clinical travelers diarrhea

A
  • patient comes back from trip 5 days ago
  • malaise
  • anorexia
  • abdominal cramps
  • watery diarrhea
88
Q

When to use oral or IV fluids

A

Oral is best for diarrhea
IVF in severe dehydration- normal saline or ringers lactate (best due to electrolytes) (200mL/kg body weight)
Want fluids with water, salt and sugar

89
Q

Who shouldn’t take antimotility meds

A

protozoan and parasitic patients

90
Q

How does loperamide work

A

slow down gut motility, decrease number of stool and diarrhea less watery

91
Q

When to use bile acid sequesters

A
  • patients with persistent diarrhea despite antidiarrheal use
  • cholestyramine, colestipole, colesevelum

Clin Med 2 (25 decks)

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