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Clin Med III Exam I > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

What is diarrhea a reflection of?

A

impaired water absorption or increase water secretion by the bowel

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2
Q

What are the two types of diarrhea

A

enterotoxic and invasive

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3
Q

When is diarrhea considered acute? What is most likely the cause?

A

14 days or less, likely infections

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4
Q

When is diarrhea considered persistent/subacute? What is most likely the cause?

A

more than 14 days but less than 30 days, most likely to be inflammatory or infections

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5
Q

When is diarrhea considered chronic? What are the three types?

A

longer than 30 days

osmotic, secretory and inflammatory vs non inflammatory

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6
Q

What is the most common type of diarrhea

A

infectious

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7
Q

What are the three causes of acute infectious diarrhea? examples of each

A

viruses- norovirus, rotavirus, adenovirus, astrovirus

bacteria- salmonella, campylobacter, shigella, E coli, C diff

protozoa- cryptosporidium, giardia

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8
Q

Out of the three causes of acute infectious diarrhea which is most common?

A

viral

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9
Q

When should a patient with diarrhea get a full work up or evaluation

A
  • persistent fever
  • bloody diarrhea
  • severe abdominal pain
  • sx of volume depletion
  • hx of IBD
  • poss of a widespread food borne outbreak
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10
Q

What symptoms are associated with diarrhea from the small bowel

A
  • large volumes of watery diarrhea
  • abdominal cramping
  • bloating
  • gas
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11
Q

What symptoms are associated with diarrhea from the large bowel

A
  • frequent, regular
  • small volumes
  • painful BM
  • fever
  • bloody or mucoid stool
  • inflammatory and RBCs
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12
Q

How does enterotoxic infection cause diarrhea

A

infectious agent created a toxin that floats around in the gut

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13
Q

How does invasive infection cause diarrhea

A

the infectious agents breaks through the blood/gut barrier

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14
Q

What are the signs of enterotoxic infectious diarrhea

A

large amounts of watery diarrhea

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15
Q

What are the signs of invasive infections diarrhea

A

fever, leukocytosis, fecal leukocytes

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16
Q

Bacteria that infects the small bowel

A
  • salmonella
  • E coli
  • C perfringes
  • S aureus
  • vibrio cholerae
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17
Q

Bacteria that infects the colon

A
  • campylobacter
  • shigella
  • C diff
  • yersinia
  • enteroinvasive e coli
  • klebsiella
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18
Q

Viruses that infect the small bowel

A

rotavirus, norovirus, astrovirus

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19
Q

Viruses that infect the colon

A

cytomegalovirus, adenovirus, HSV

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20
Q

Protozoa that infects the small bowl

A
  • cryptosporidium
  • microsporidium
  • giardia
  • cytoisospros
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21
Q

If diarrhea starts withing 6 hours of food ingestion what are the suspected pathogens

A

staph aureus or bacillus cereus

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22
Q

If diarrhea starts within 8-16 hours of food ingestion what is the suspected pathogen

A

clostridium perfringens

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23
Q

If the diarrhea starts more than 16 hours after food ingestion what are the suspected pathogens

A

other bacterial or viral infection

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24
Q

IF the major presenting sx is vomiting what are the most common pathogens

A
  • s aureus
  • b cereus
  • norwalk like virus
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25
Q

If the major presenting sx is watery diarrhea what are the most common pathogens

A
  • C perfringens
  • enterotoxigenic e coli
  • enteric viruses
  • C parvum
  • C cayentanensis
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26
Q

If the major presentation is inflammatory diarrhea what are the most common pathogens

A
  • campylobacter
  • non typhoidal salmonella
  • shigella
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27
Q

When should stool cultures be done

A
  • profuse watery diarrhea with signs of hypovolemia
  • concern for inflammatory diarrhea
  • high risk host
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28
Q

What are some high risk host features

A
  • older than 70
  • DM
  • CV disease
  • IBD
  • pregnant
  • immunocompromised
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29
Q

What is the pharmacologic management of diarrhea

A
  • anti motility drugs
  • anxiolytics and antiemetics
  • zinc supplementation
  • probiotics
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30
Q

When do sx begin to develop w/ norovirus

A

12-48 hours after exposure

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31
Q

Presentation of norovirus

A

acute onset N/V, watery diarrhea with abdominal cramps

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32
Q

How is norovirus transmitted

A
  • close personal contact with infected people
  • fecal oral with contaminated food
  • touching contaminated surfaces
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33
Q

What is the most common complication of norovirus

A

dehydration

34
Q

What do the toxins produced by C diff cause

A

severe watery diarrhea, pseudomembraneous colitis, toxic megacolon

35
Q

What is a common cause of C diff

A

abx treatment

36
Q

What are the most common abx that cause C diff

A
  • fluoroquinolones
  • cephalosporins
  • penicillin
37
Q

When should C diff infection be suspected

A

in a patient with diarrhea or ileus in the setting of relevant risk factors (age, recent hospitilization, abx)

38
Q

How do you diagnose C diff

A

stool culture

39
Q

Is C diff a normal bacteria in the intestine

A

YES, but when it grows out of control it releases the toxins that damage the lining of the intestine

40
Q

How do you treat C diff

A

metro or PO vanco

41
Q

What are the two campylobacter species that cause human infection

A

C jejuni and C coli

42
Q

What is the incubation period for campylobacter

43
Q

What is the presentation of campylobacter infection

A

abrupt onset of abdominal pain and bloody/mucoid diarrhea

associated w/ a prodrome of fever, chills and aches

44
Q

What does campylobacter often mimic

A

appendicitis

45
Q

How do you diagnose campylobacter infection

A

stool culture

46
Q

How do you treat campylobacter infection in a healthy patient? In immunocompromised?

A

Healthy- supportive (IVF,antiemetics)

Immunocompromised- abx (fluoroquinolones or azithro)

47
Q

What causes salmonella

A

ingestion of poultry, milk products or eggs

48
Q

What are the cardinal features of salmonella

A
  • N/V
  • diarrhea (pea soup, not grossly bloody)
  • abdominal cramping
  • fever with chills
49
Q

What is the relation between the bacteria burden and the severity of sx

A

the higher the burden the worse the sx

50
Q

How do you diagnose salmonella

A

stool culture

51
Q

Treatment of salmonella

A

supportive (IVF, electrolyte replacement

52
Q

What does long term carriage mean?

A

someone can still spread salmonella for more than 1 yeat after infection

53
Q

What are the symptoms of e coli

A

abdominal pain and bloody diarrhea

NO FEVER

54
Q

What is hemolytic-uremic syndrome

A

triad of acute renal failure, hemolytic anemia, thrombocytopenia

55
Q

Why should you not give patients abx if they have e coli

A

high risk of HUS

56
Q

Where does shigella multiple

A

in the small bowel

57
Q

How is shigella transmitted

A

direct person to person contact and by contaminated food and water

58
Q

How is shigella transmitted in developed countries

A

fecal oral

59
Q

How does shigella present

A

high fever, bloody diarrhea, abdominal pain, tenesmus

60
Q

How do you diagnose shigella

A

stool culture

61
Q

How do you treat shigella

A

IVF, electrolyte repletion

caution w/ abx, risk of HUS

62
Q

What populations are at high risk for intestinal entomoeba

A

institutional patients and males having sex with males

63
Q

What are the two phases that the intestinal entomoeba exists in

A
  • cyst stage (infective form)

- trophozoite (invasive disease)

64
Q

How is intestinal entomoeba transmitted

A

ingestion of amebic cysts via contaminated food or water–>cysts pass through the stomach and release trophozoites–>trophozoites invade and penetrate the mucous barrier of the colon

65
Q

What is the onset of intestinal entomoeba

66
Q

What is the presentation of intestinal entomoeba

A

range from mild diarrhea to evere dysentary, abd pain, weight loss, fever

67
Q

What are some complications of intestinal entomoeba

A

fulminant colitis with bowel necrosis—>perforation and peritonitis

68
Q

What is the treatment for intestinal entomoeba

A
  • flagyl
  • tinidazole
  • ornidazole
69
Q

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

A

crytosporidium

70
Q

How do you treat crytosporidium

A

nitazoxanide

71
Q

How is crytosporidium transmitted

A

spread from infected human or animal–> host ingests cyst–>gets absorbed in the body–>cyst excreted

72
Q

Presenting sx of giardia

A

watery, yellow, foul smelling diarrhea with alternating soft greasy stool

73
Q

Where are giardia outbreaks common

A
  • day care centers

- hx of camping

74
Q

How do you treat giardia

A
  • flagyl
  • tinidazole
  • nitazoxanide
75
Q

What is travelers diarrhea

A

diarrhea that develops withing 10 days of returning from travel

76
Q

What is the most common cause of travelers diarrhea

A

e coli (not hemorrhagic strain)

77
Q

What is the most common cause of travelers diarrhea in southeast asia

A

campylobacter

78
Q

What is the most common cause of travelers diarrhea in Jamacia and in kiddos

79
Q

What is the treatment for travelers diarrhea

A

flurorquinolones

80
Q

How does travelers diarrhea present

A

malaise, anorexia, abdominal cramps and watery diarrhea

81
Q

When should a foodborne illness be considered

A

when a patient presents with diarrhea and N/V

82
Q

What is irritable bowel syndrome

A

chronic abdominal pain and altered bowel habits in absence of any organic cause

Clin Med III Exam I (9 decks)

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