Diarrhea Flashcards
1
Q
Most cases of diarrhea, infectious or nah
A
Infectious
2
Q
Most cases of infectious diarrhea, viral or bacterial?
A
Viral
3
Q
Most common cause of infectious viral diarrhea
A
Norovirus
4
Q
Most cases of severe diarrhea etiology?
A
Bacterial.
5
Q
What bug causes most cases of bacteria?
A
Campylobacter
6
Q
Infectious diarrhea consists of three classes, what are they
A
Viral
Bacterial
Parasitic
7
Q
Two mechanisms of diarrhea from a water standpoint
A
IMpaired water absorption or increased water secretion
8
Q
Two types of diarrhea (pathologically)
A
Enterotoxic or invasive/inflammatory
9
Q
Acute diarrhea timeline and likely etiology
A
<14 days, likely infectious
10
Q
Persistent/subacute diarrhea timeline and etiology
A
14-30 days. Could be inflammatory (IBD) or infectious
11
Q
Chronic diarrhea timeline
A
> 30 days
12
Q
3 types of chronic diarrhea
A
Osmotic, secretory, and inflammatory vs non inflammatory
13
Q
Role of large bowel (bc you always forget this one)
A
Absorbs fluid and salt. Not really nutrients, except potassium!
14
Q
When to consider non infectious etiology for diarrhea
A
When the course becomes more persistent and chronic
15
Q
Most common causes of acute viral diarrhea
A
Norovirus, rotavirus, adenovirus, astrovirus
16
Q
Most common causes of acute bacterial diarrhea
A
Salmonella, campylobacter, shigella, e coli, C diff
17
Q
Most common cause of protozoa diarrhea
A
Cryptosporidium, giargia, cyclospora, entamoeba
18
Q
Diarrhea is pretty normal. But when do we get nervous and do an acute evaluation of someone w/ diarrhea?
A
Persistent fever Bloody diarrhea severe abd pain (Toxic MC) Hypovolemia sx Hx of IBD Possible outbreak
19
Q
Small bowel diarrhea typical sx
A
Watery Large volume Abd cramping Bloating gas Weight loss if persistent No fecal leukocytes, fever!!!
20
Q
Large bowel diarrhea sx
A
Frequent, regular Small volume Painful BM Fever Bloody/mucoid stools Inflammatory and RBC seen on microscopy
21
Q
Large bowel diarrhea is typically invasive or enterotoxic
A
Invasive bacteria (salmonella, shigella, campylobacter
22
Q
Enteric viruses that love to cause large bowel diarrhea
A
CMV or adenovirus
23
Q
What post abx organism loves to cause large bowel diarrhea
A
C diff!
24
Q
Difference between enterotoxic and invasive infectious diarrhea
A
Enterotoxic is when the bug creates a toxin. No fever, no WBC, no Fleuk
Invasive is when the bug bores into the gut barrier. FEVER, LEUKOCYTOSIS, + FECAL LEUK
25
No Fever, no wbc, no fecal leukocytes
Enterotoxic
26
Fever, leukocytosis, + fecal leukocytes
Invasive
27
Bugs typically associated with enterotoxic
C diff, e coli, staph aureus, cholera, giardia
28
You ate some weird food and within 6 hours you're puking up a storm. What two bugs is it probably? What if you're vomiting?
Preformed toxin via staph aureus or bacillus cereus.
Vomiting makes bacillus cereus look likely
29
You ate some weird food within 8-16 hours, what do you probably have?
Clostridium perfringens
30
>16 hours ago you ate some funky food?
Probably caused by something else. Norovirus. Usually norovirus
31
Which bug is associated with exposure to animals?
Salmonella
32
What bugs are associated with daycare centers?
Shigella, cryptosporidium and giardia. Oh and rotavirus
33
Travel indicates which kinds of diarrhea?
Bacterial or parasites. Think of e coli (travelers) or something funky and weird
34
Sx concerning for inflammatory diarrhea
Bloody diarrhea
Passage of many small volume stools containing blood or mucous
Temp >101.3
35
When to get a stool culture
1) Severe illness w/ sx of hypovolemia. Should be hospitalized
2) Concerned for Inflammatory diarrhea
3) High risk host features
36
High risk features (like the kind of patient that would make you want to get a stool cx)
```
>70yo
Comorbid CVD, DM
IC
IBD
Pregnant
Symptoms >1wk
Public health crisis
```
37
What kind of bacterias can stool cx diagnose
Campylobacter, shigella, salmonella
38
Wanna order a c diff toxin?
Gotta make that real clear, needs to be ordered seperately
39
Role of fecal leukocytes and fecal lactoferrin
Support the diagnosis of inflammatory diarrhea. Fecal lactoferrin is more sensitive for detecting inflammation in the intestines due to bacterial infections
40
Most common cause of death from diarhrea
Dehydration. Always assess and correct hydration status and electrolytes
41
Severe diarrhea likely needs IV ___ or ____
Potassium or sodium bicarb
42
Diarrhea and lactose intolerance
Diarrhea can be caused by transient lactase deficiency
43
Norovirus sx
Acute onset (12-48hr)
N/V
Watery, non bloody diarrhea
Abdominal cramps.
Classic small bowel diarrhea but with vomiting
44
How long does norovirus last
24-72 hours.
FECAL ORAL ROUTE
45
Most common cause of acute diarrhea
Norovirus
46
What causes c diff?
Antibiotic associated colitis. 20% chance after completing a broad spectrum abx
Signigicant cause of MM among older hospitalized patients
47
C diff is enterotoxic, what are two major complications that can occur?
Pseudomembranous colitis and toxic megacolon
48
Abx most freq implicated with C diff
FQ
Cephs
PCN
49
When would we see the dvlpment of C diff symptoms
either while on the abx or even 5-10 days after completion
50
Tx for C diff
500mg q8hr Flagyl or PO Vanco (EXPENSIVE)
51
Most common cause of acute bacterial diarrhea
Campylobacter
52
Sx of campylobacter
Abrupt onset abd pain and diarrhea (bloody or mucoid)
Can sometimes have a prodrome of fever, chills and aches
53
Campylobacter, invasive or enterogenic?
Invasive. Think about the bloody diarrhea
54
What can campylobacter mimic
Appendicitis
55
Tx for campylobacter is usually supportive, but who gets abx? What abx?
IC and severe disease.
FQ and Azithromycin
56
Leading cause of foodborne disease in the US.
| What food?
Salmonella. Associated with poultry, milk, eggs
57
Salmonella invasive or enterotoxic
Invasive!
58
Classic features of salmonella
N/V
PEA SOUP DIARRHEA- not grossly bloody despite invasive
Abd cramping
fever w/ chills
59
Salmonella and the effect of bacteria burden
Higher the bacteria burden, the worse the symptoms are
60
Salmonella is self limiting. How long does it take for the GI sx to go away?
4-10 days
61
Abx therapy indications for salmonella?
Not in healthy patients, they just get supportive.
FQ for severe dx, IC
62
Salmonella and viral shedding. Short term carriage vs long term
Short term: Normal shedding of virus post infection.
Long term: Shedding of virus for >1yr post infection. Remember typhoid mary? Salmonella susie
63
E coli sx
Abdominal pain and bloody diarrhea.
NO FEVER
64
Abx and E coli/Shigella?
NOT RECOMMENDED. These two bugs have a high risk of Hemolytic uremic syndrome.
65
Hemolytic uremic syndrome triad
Acute RF
Hemolytic anemia
Thrombocytopenia
66
Shigella gram? Invasive or enterotoxic?
Gram negative anaerobe. INVASIVE
67
What's our classic day care bug
Shigella. Fecal oral route
68
Shigella Sx
It's invasive, so classic invasive.
High fever
Diarrhea
Abd cramping
Tenesmus
69
The bacterias we can get stool cultures on are all
INVASIVE
| Shigella, campylobacter, salmonella
70
Shigella tx
Supportive, it's self limiting. Abx is not indicated dt high risk of HUS, but if someone is dying or IC give FC/azith/bactrim
71
How do we make the diagnosis of botulism
Serum toxin
72
Botulism sx
N/V/D
Abd pain/cramping
dry mouth/sore throat
Bilateral cranial nerve involvement/palsies
BOTULISM WILL GO FOR NERVES AND THROAT
73
Botulism therapy
Antitoxin.
Equine serum antitoxin for most people.
If <1yr we give Botulism immune globulin
74
Is cholera enterotoxic or invasive
Enterotoxic. Think about how watery that diarrhea is
75
Bacteria that causes cholera
Vibrio cholerae
76
Hallmark sign of cholera
Non bloody, liquid grey rice water diarrhea.
Profound fluid/e loss, can turn into hypovolemic shock in a day
77
Tx for cholera
Hydration and abx (Tetra, ampi, azith, bactrim , FQ)
78
Intestinal entomoeba's kinda cool. They exist in cyst form and trophozoite. Tell me about that
Cyst: Infective form. You consume the cysts (Fecal oral) and they make their way down to your stomach. The stomach acid causes them to open and release trophozoites. The trophozoites are the invasive part, and that's where we see symptoms.
79
Intestinal entomoeba sx
The trophozoites invade and penetrate the mucous barrier of the colon, which leads to bloody diarrhea.
This can be a range, from mild diarrhea to severe dysentery.
80
How long does intestinal entomoeba take to kick in?
1-3 weeks after ingestion
81
Complications of intestinal entomoeba
Fulminant colitis w/ bowel necrosis. This can lead to perforation and peritonitis
82
Tx for intestinal entomoeba
Flagyl, and then the "azole"
83
Most common cause of parasitic foodbourne diarrhea in the US
Cryptosporidium
84
Tx for cryptosporidium
Antiparasitic, nitazoxanide. Good for kids bc it's liquid
85
What does giardia look like on microscope?
Flagellated protozoan parasite
86
Sx of giardia
Watery, yellow, foul smelling diarrhea w/ soft greasy stools. Pretend it's like deer poop!
Can cause crazy weight loss
87
Causes of giardia
Daycare center, CAMPING HISTORY, drinking funny water.
88
Tx for giardia
Flagyl & antiparasites. Even after txing though you can have recurrent episodes for 6 weeks
89
When to suspect travelers diarrhea
Dvlps during or within 10 days of returning from travel.
90
Most common bug for traveler's diarrhea
E coli- NOT THE HORRIFYING BLOODY ONE
91
Most common travelers diarrhea cause for kids (or in jamaica!)
Rotavirus
92
Tx for travlers diarrhea
FQ
93
Tx for traveler's diarrhea
Self limited, consider loperamide.
94
When to consider diarrhea being foodbourne
N/V/D.
Things tend to like to go out the same mode they came in. Eating something toxic will make you vomit
95
Name some non infectious causes of diarrhea!
```
IBD
Irritable bowel syndrome
Partial SBO
Pelvic abscess in rectum
Fecal impaction
Ingestion of poorly absorbably sugars (lactulose & acute alcohol)
```
96
Irritable bowel syndrome definition
Recurrent abd pain or discomfort 1 day per week for >3 months. Must have 2 of following:
1) Improvement w/ defecation
2) Change in frequency of stool (C)
3) Change in form of stool (D
97
Four types of IBS
IBS w/ constipation
IBS w/ diarrhea
Mixed IBS
Unclassified- this seems flakey
98
When should IBS get an endoscopy?
```
Moderate rectal bleeding
Weight loss
Unexplained Fe anemia
Nocturnal sx
fhx of CRC/IBD
celiac
```
99
Mainstay of IBS tx
Dietary modification & inc physical activity.
| Low gas producing foods, no lactose, low fermentable foods, no gluten
100
Rx therapy for patients with IBS-C
Polyethylene glycol
Lubiprostone: (works on chloride & enhances intestinal fluid secretion) PRO-CHLORIDE
Linaclotide: Guan agonist, stimulates fluid secretion and transit
101
Hallmark for malabsorption
STEATORHHEA
>30g of fat per day
102
Conditions that may cause malabsorption
Celiac
Bacterial overgrowth
Lactase deficiency
103
Gold standard for diagnosing steatorrhea (malabsoorption)
QUANTITATIVE (HOW MUCH FAT) stool fat test. Stool is collected for 3 days. Patient eats a high fat diet for 2 days before and during the collection.
104
Other methods for diagnosing steatorrhea/malabsorption
QUALITATIVE (IS THERE FAT)
Sudan stain, determines the percentage of fat in the stool. (because sudan doensn't have a lot of fat)
Acid steatocrit- cheap and reliable. Not the best though
105
Sweat replacement drinks are not suitable replacements for ORS. It's an osmolarity thing. Too high. We want a lower osmolarity. Lower osmolarity ORS are associated with what good things?
Decreased stool output
Dec vomiting
Less need for IVF
106
Components or ORS
Sodium chloride
Sodium bicarb
Potassium chloride
Glucose
107
Glucose is the biggest ingredient in ORS, why is that?
In many S. bowel illnesses, glucose absorption is still active. So if glucose and salt are present, the colon can actually use that transporter to take in some water.
108
Go to IVF for severe dehydration
NS and LR
109
Rehydrating in severe dehydration
200ml/kg in 24 hours. Ex:
| 70kg person needs 14,000 mL. Or 14 bags
110
Loperamide is CI with what kind of bacteria
INVASIVE. Body is trying to flush out the bacteria with the diarrhea and you're just letting it build up
111
Loperamide MOA
Slows gut motility, decreasing the number of stools and the watery consistency of the diarrhea
112
When to consider using BAS for diarrhea
Persistent diarrhea despite antidiarrheal use. 50% of those IBS-D patients have bile acid malabsorption, and all that extra bile acid causes diarrhea by stimulating the colon.
