Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Infectious Disease 2 > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

Definition of diarrhea

A
  • stool volume >200 g/d
  • loose to watery
  • abnormally frequent diarrhea (hard to measure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types of diarrhea to r/o

A
  • IBS: sensation of incomplete evacuation
  • Fecal incontinence
  • Overflow diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Daily fluids

A
  • 2 L ingested
  • 7 L digestive secretions
  • 8 L absorbed in small intestine
  • 500 mL absorbed in colon (can do slightly more if needed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Osmotic gap in stool

A
  • if there is a gap, indicates presence of abnormal solute in stool
  • Osmotic diarrhea has gap >100 (lots of solute)
  • Secretory diarrhea has gap <50: no abnormal solute in stool
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Types of diarrhea

A
  • Inflammatory or non-inflammatory

Non-inflammatory

  • Secretory
  • persistent

Inflammatory

  • dt invasion
  • hemorrhagic dt cytotoxin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Clinical features of osmotic diarrhea

A
  • > 100 osmotic gap: lots of solute
  • contains water and mal absorbed solutes (lactose, fat, etc.)
  • resolves with fasting or cessation of offending agent
  • Ex. lactose intolerance, miralax, etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clinical features of secretory diarrhea

A
  • <100 osmotic gap (no abnl solutes)
  • lots of water, lots of electrolytes
  • large volume of watery stool
  • ex. cholera
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Red flags for infectious diarrhea

A
  • high fever (>39C/102.2F)
  • systemic illness
  • Hematochezia
  • > 2 weeks
  • volume depletion
  • weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What percent of acute diarrhea is infectious?

A

90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Three important topics to cover during history

A
  1. Is IV fluid replacement needed: volume depletion, vitals
  2. Is it osmotic or secretory
  3. Is it inflammatory or non-inflammatory: is there hematochezia (inflammatory)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the best way to determine if viral, bacterial, parasite?

A

good history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Complications of infectious diarrhea

A
  • dehydration, hypovolemia
  • electrolyte loss (Na, K, Mg, Cl)
    Hypokalemia: dysrrhythmias
    Hypomg: tetany, tremor
    Metabolic acidosis: bicarb loss
  • vascular collapse: severe diarrhea, extremes of age
  • Acute tubular necrosis: renal failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Infectious Diarrhea

- worldwide epidemiology

A
  • leading cause of childhood mortality
  • 5 million deaths a year
  • 2,195 deaths a day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Infectious Diarrhea

- US epidemiology

A
  • 99 million acute cases a year
  • 5,000 deaths annually dt food borne illness
  • 95% of diarrhea deaths are people >65 yo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Infectious Diarrhea

- US risk factors

A
  • Immunocompromised
  • Institutionalized: SNF, prison
  • Social/occupational: day care
  • Travel: underdeveloped tropical regions (40%)
  • Food/Diet: raw meat, raw egg, shellfish, unpasteurized milk, buffets, picnic, poor food hygiene
  • *poop sprouts and poop spinach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the pathway for infectious diarrhea?

A

fecal to oral, always. And yes that is disgusting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Risk factors of fecal-oral transmission (6)

A
  • improper disposal of feces, poor sanitation
  • drinking contaminated water
  • poor hand hygiene (esp. food handlers)
  • improper food hygiene
  • inadequate food refrigeration
  • food exposure to flies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Three common viral pathogens

A
    • Virus MC cause in US
  • rotavirus
  • norovirus
  • adenovirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

7 common bacterial pathogens

A
  • E. coli
  • Salmonella
  • Shigella
  • Vibrio cholera
  • Yersinia
  • Campylobacter
  • C. difficile
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

3 common parasitic pathogens

A
  • giardia
  • cryptosporidium
  • entamoeba hystolytica
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Two main ways pathogens cause diarrhea

A
  • inflammation

- active secretion (creates osmotic difference)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Inflammatory diarrhea

- pathophys overview: list the two mechanisms

A
  1. Direct invasion

2. Cytotoxin release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Inflammatory diarrhea

  • pathophys of direct invasion
  • common pathogens
A
  • invade gut lining, destroy macrophages as they try to engulf the pathogen
  • Salmonella typhi, Yersinia, Campylobacter, Norovirus, Rotavirus, Entamoeba histolytica
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Inflammatory diarrhea

  • pathophys cytotoxin release
  • common pathogens
A
  • directly cause cell death
  • C. diff
  • Shiga toxin producing orgs: shigella, STEC E. coli (STEC = shiga toxin producing e. coli)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is special about Shigella’s MOA

A

invasive AND produces cytotoxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Two main ways pathogens cause active secretion

A
  1. Enterotoxin production

2. Preformed toxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Secretory Diarrhea

  • Enterotoxin production: pathophys
  • example of pathogen
A
  • cause cells to secrete chloride into the lumen
  • Na and water follow
  • ex cholera
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Secretory Diarrhea

  • preformed toxins: pathophys
  • example of 2 pathogens
A
  • neurotoxins cause the secretin of water and electrolytes

- C. pefringes and staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Three types of toxins that make pathogens pathogenic

A
  1. Enterotoxins
  2. Cytotoxins
  3. Neurotoxins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Enterotoxins

  • how produced
  • effect
  • example
A
  • produced by pathogen inside the body
  • Act direction on mucosa to alter secretory mechanisms
  • Increase Cl secretion and inhibit Na resorption
    ex. cholera
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Cytotoxins

  • production
  • effect
  • examples
A
  • Produced by bacteria in body
  • destroy mucosal sells (direct destruction)
  • cause inflammation and dysentery
  • ex. shigella, STEC, c. diff
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Neurotoxins

  • production
  • effect
A
  • preformed toxins
  • produced outside the body
  • act directly on nervous system to alter secretion of electrolytes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Preformed toxins

  • vomiting
  • pain
  • fever
  • diarrhea
  • ex
A
  • common
  • 1-2+
  • rare
  • 3-4+ watery
  • staph, B. cereus, C. perfrigens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Enterotoxin

  • vomiting
  • pain
  • fever
  • diarrhea
  • ex
A
  • common
  • ?
  • rare
  • 3-4+ watery
  • vibrio cholerae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

C. diff cytotoxin

  • vomiting
  • pain
  • fever
  • diarrhea
  • ex
A
  • rare
  • 3-4+
  • rare
  • 2-3+ watery
  • C. diff
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Shiga-toxins

  • vomiting
  • pain
  • fever
  • diarrhea
  • ex
A
  • rare
  • 3-4+
  • common
  • 1-2+ bloody
  • Shigella, E. coli (STEC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Direct invasion: bacteria

  • vomiting
  • pain
  • fever
  • diarrhea
  • ex
A
  • rare
  • 2-4+
  • common
  • 1-4+ can be bloody
  • salmonella, Campylobacter, yersinia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Direct invasion: virus

  • vomiting
  • pain
  • fever
  • diarrhea
  • ex
A
  • maybe
  • 2-3+
  • common
  • 1-3+ watery
  • norovirus, rotavirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Types of non-inflammatory diarrhea

A
    • pathogen attaches superficially, produces enterotoxin
  • Gastroenteritis:
  • Viral: norovirus, rotavirus, adenovirus
  • Bacterial: Staph. aureus (MC), clostridium perfringens, Bacillus cereus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Gastroenteritis

  • overview
  • sx
A
  • affects stomach and small bowel
  • Caused by virus or preformed bacterial toxins
  • Nausea and vomitting
  • abd pain common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How to differentiate viral vs. bacterial gastroenteritis

A
  • Bacterial: <10 hr incubation, no fever, 24 hour duration

- Viral: >14 hr incubation, mild fever, 72 hour duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Viral gastroenteritis

  • overview
  • 3 main types
A
  • “stomach flu”
  • Think daycare, school, cruise ship, sports teams
  • Norovirus (60-80%), all year, all ages
  • Rotavirus: <2 YO
  • Adenovirus: assoc. URI sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Norovirus

  • overview
  • sx
  • timing
  • transmission
A
  • MC cause GE
  • winter
  • very contagious
  • can survive for a long time on surfaces!!
  • Self limiting
  • n/v/d, crampy pain, low grade fever, +/- HA
  • lasts 1-4 days
  • transmission: fecal-oral via fomites, food, water (possible person to person or airborne droplets)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Bacterial GE

  • cause of sx
  • sx
A
  • “food poisoning”
  • cause: preformed toxins (neuro toxins act on CNS)
  • rapid onset, short duration
  • vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Bacterial GE

- three orgs

A
  1. S. aureus: MC
  2. Clostridium perfringens: meat, gravy, buffet
  3. Bacillus cereus: “fried rice syndrome” from re-heating fried rice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Bacterial GE caused by S. aureus

A
  • Very common
  • milk, meat, custard
  • preformed neurotoxin > CNS > vomiting
  • onset 2-8 hrs
  • lasts 3-6 hrs
  • 24 hour “stomach bug”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Secretory Diarrhea

- overview

A
  • non-inflammatory
  • voluminous emts watery diarrhea
  • NO blood
  • NO high fever (usu)
  • active electrolyte secretion, no excess solute: low osmotic gap
  • diarrhea despite fasting
  • dehydration is worry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Secretory diarrhea

- examples

A
  • Travelers diarrhea

- Vibrio cholerae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Traveler’s Diarrhea

- 3 MC orgs

A
    • usually e. coli of some type
  • Enterotoxigenic E. coli
  • Enteroaggregative E. coli
  • Campylobacter jejuni
50
Q

Traveler’s Diarrhea

  • sx
  • pathogenesis
  • transmission
A

aka Montezuma’s revenge

  • self limited, watery diarrhea, starts ~3 days after exposure, lasts 3-4 days
  • causes secretion of Cl
  • contaminated food/water in underdeveloped countries in tropical climates
51
Q

Travelers Diarrhea

- tx

A
  • oral fluids and electrolytes
  • pepto-bismol: sx control (black stool)
  • Imodium: sx control
  • Abx unnecessary!!!
52
Q

Travelers Diarrhea

- prevention

A
  • wash hands
  • bottled water
  • be a boring eater :)
  • ice/raw foods
53
Q

Vibrio Cholerae

- overview

A
  • rare in US, common in world
  • rapid spread, outbreaks
  • HIGHLY contagious
  • contaminated food or water*
  • poor sanitation
  • rainy season
  • 10% develop severe dz
  • death dt hypovolemic shock
54
Q

Vibrio Cholerae

- pathophys

A
  • Secretogogue: directly activates adenylate cyclase which opens Cl channels and causes massive secretion of Cl ion into gut lumen
  • Also increase cAMP in cells which stimulates water and Na secretion
55
Q

Vibrio Cholerae

- trasmission

A

contaminated water MC

56
Q

Vibrio Cholerae

- sx

A
  • *Secretory diarrhea
  • large volume, watery (up to 1 L / hour)
  • “rice water stool”
  • vomiting common
  • reduced urine
  • rapid dehydration
  • muscle cramps
  • thirst
  • fever rare
57
Q

Vibrio Cholerae

- Tx

A
  • Oral rehydration #1
  • Glucose containing solutions (ORS) given orally is best option
  • Forces sodium-glucose cotransporter in small intestine to transport glucose and sodium into enterocytes, Cl and water follow
  • IV fluids if severe: Ringers lactate
  • Abx if hospitalized
  • Zinc has been shown to shorten illness in children
58
Q

Vibrio Cholerae

- vaccine

A
  • 10 days prior to travel
  • 18-64 yo
  • 1 dose
  • Vaxchora or PaxVax
  • Risk of getting dz is higher if visit friends/relatives
59
Q

Inflammatory Diarrhea

  • aka
  • basic pathophys
  • basic sx
A
  • dysentery, infectious colitis
  • invades colon wall
  • bloody diarrhea, fever >101F, abd pain
60
Q

Inflammatory Diarrhea

- pathogens

A

Many, she said to focus on:

  • Shigella
  • E. coli (STECs)
  • Salmonella (incld. tyhoid fever)
  • Campylobacter jejuni
  • C. diff
61
Q

Shigella

  • describe org
  • MC species
  • overview
A
  • gram neg bacillus
  • Four species cause diarrhea dz, Shigella sonnei is MC in US
  • not seasonal
  • VERY contagious, small infective dose
  • daycare breakouts
  • MC in children, families vulnerable
62
Q

Shigella

- Sx

A
  • 1-2 days after exposure
  • watery and/or bloody diarrhea
  • small volume of stool
  • tenesmus
  • abd pain
  • fever
  • 5-7 day course
63
Q

Shigella

- Dx

A

stool tests:

  • WBC +
  • guiac +
  • culture +
64
Q

Shigella

- Tx

A
  • severe dehydration rare, supportive care only
  • fluid replacement, rest, bland diet
  • pepto-bismol
  • Abx only in severe cases
65
Q

Escherichia coli

  • org description
  • org habitat
A
  • gram negative motile bacillus
  • some produce shiga toxins = inflammation
  • part of normal flora in people and animals, few strains are pathogenic
66
Q

E. coli

  • transmission
  • what do stool cultures detect?
A
  • contaminated food/water
  • person to person
  • contact with animals
  • cultures only detect pathogenic strains
67
Q

Two pathogenic strains of E. coli

A
  1. Enteroinvasic E. coli: invasive, causes dysentery similar to shigellosis
  2. Enterohemorrhagic E. coli: produces shiga toxin which causes colitis
68
Q

Enterohemorrhagic E. Coli

  • aka
  • sx
  • how common
  • reservoirs and vectors
A
  • E. coli 0157:H7
  • “hemorrhagic” bloody diarrhea
  • can cause hemolytic-uremic syndrome **
  • most common STEC in US
  • reservoirs: cattle, sheep, goats
  • vectors: birds, flies
69
Q

Enterohemorrhagic E. Coli

  • Transmission
  • outbreaks
A
  • contaminated food/water, contact with animals/feces/soil
  • food outbreaks: undercooked meat, vegetables irrigated with contaminated water (sprouts, spinach, lettuce)
  • can survive >9 mo in ground beef stored -20C
70
Q

Enterohemorrhagic E. Coli

- Sx

A
  • 3-4 days after exposure
  • starts watery, then bloody diarrhea
  • hemorrhagic colitis: severe abd pain, bloody stool, might present like UC
71
Q

Hemolytic-uremic syndrome

A
  • HUS
  • acute renal failure
  • hemolytic anemia
  • thrombocytopenia
  • 1 week after diarrhea stops, when pt is improving
  • 50% will require dialysis
72
Q

Enterohemorrhagic E. Coli

- lab testing

A
  • stool culture for STECs: detects shiga toxins or genes that encode them
  • report to state health dept
73
Q

Enterohemorrhagic E. Coli

- tx

A
  • supportive, fluid rehydration, bland diet
  • NO ABX (and stop them if they have been started): do not prevent complications/shedding DO increase risk of HUS and toxin release!
  • avoid anti-diarrheal like Lomotil
74
Q

Salmonella

  • org
  • epidemiology and risks
A
  • gram neg motile bacillus
  • 1.2M US annual cases
  • MC in summer
  • Children <5 highest risk
  • acid-lowering meds increase risk
  • handling of ducklings, reptiles, chicks, hedgehogs
75
Q

Salmonella

- sx

A
  • 12-72 hrs after exposure
  • diarrhea +/- blood, cramping, fever
  • children highest risk for dehydration
76
Q

Salmonella

- tx

A
  • supportive: rest, fluids and electrolytes
  • abx only if severe
  • bacteria shed in stool 4-5 weeks after illness!!
77
Q

Typhoid fever

- sx

A
  • severe illness caused by salmonella typhi

- sustained fever (103-104), chills, diarrhea (constipation too), cramping, HA, anorexia, cough, myalgia

78
Q

Typhoid fever

  • transmission
  • incubation
A
  • US pts usually get during travel outside the country
  • chronic carrier state can occur
  • incubation: 6-30 days
79
Q

Typhoid fever

- tx

A
  • abx
  • no tx: 30% die
  • vaccination avail if plan to travel to SE Asia
80
Q

Campylobacter jejuni

A
  • gram neg motile rod
  • flagellated
  • illness similar to salmonellosis
  • Foodborne and travel
  • undercooked poultry, meats, dairy, water
  • causes dysentery, also mild travelers diarrhea
  • late complication: Guillain-Barre syndrome (rare)
81
Q

C. Diff
- org
-

A
  • gram positive bacillus
  • spore-forming
  • normal inhabitant of colon
  • Secretes enterotoxin (A) and cytotoxin (B)
  • Abx associated colitis
82
Q

C. diff

- sx

A
  • 5-10 days after abx
  • diarrhea +/- blood
  • cramping pain
  • pseudomembranous colitis
83
Q

C. diff

- lab test

A

stool assay for c. diff toxin

84
Q

C. diff

- tx

A
  • oral or enema vanc

- fecal transplant

85
Q

Listeria

  • organism
  • transmission
A
  • listeria moncytogenes
  • gram positive bacillus
  • food borne, can cause outbreaks
  • unpasteurized dairy products and lunch meat
86
Q

Listeria

- who is at high risk

A
  • immunocompromised

- pregnant women (13X risk)

87
Q

Listeria

- sx

A
  • fever and flu like sx
  • diarrhea less common
  • can cause sepsis
  • encephalitis/meningitis
88
Q

Listeria

  • Dx
  • Tx
A
  • blood culture

- abx

89
Q

Yersinia

  • org
  • transmission
A
  • Yersinia enterocolitica
  • gram neg bacillus
  • raw, undercooked, contaminated pork
  • Children>adults
  • MC in winter
90
Q

Yersinia

- sx

A
  • fever
  • diarrhea +/- blood
  • severe abd pain, common in RLQ
  • mimics appendicitis!
  • arthritis and erythema nodosum
91
Q

Yersinia

  • Dx
  • Tx
A
  • special culture to isolate (add request to lab order)

- Abx

92
Q

Invasive amebiasis

  • org
  • transmission
A
  • entamoeba histolytica
  • food or water, in US usually institutionalized, migrant laborers, Indian reservations
  • only 10-20% symptomatic
93
Q

Invasive amebiasis

- sx

A
  • Mild, intermittent diarrhea
  • urgency
  • +/- generalized pain/cramping
  • liver abscess (rare)
94
Q

Amebic dysentery

A
  • severe form of invasive amebiasis

- pain, bloody stool, fever

95
Q

Persistent Diarrhea

  • define
  • common causes
A
  • > 14 days
  • Protozoa: guardia, cryptosporidium
  • insidious onset, intermittent sx
  • non-invasive (no inflammation or cell death), attach superficially to lining
  • common signs: weight loss, malabsorption
96
Q

Persistent diarrhea

- w/u

A
  • full GI w/u

- test for IBD, celiac, IBS, etc

97
Q

Giardiasis

  • org
  • describe org
  • transmission
A
  • Giardia lamblia
  • lives in intestines, passes in feces
  • Cysts can survive for months in cold water
  • transmission: contaminated water (mountain stream, camping)
  • MC intestinal parasite in US
98
Q

Giardiasis

- Sx

A
  • diarrhea
  • gas/bloat
  • greasy, foul smelling stools
  • cramps
  • upset stomach
  • n/v
  • intermittent, can be chronic
  • weight loss, malabsorption, lactose intolerance, vitamin A, B12 can occur
99
Q

Giardiasis

- dx

A
  • Microscopic stool examination (stool for O and P)

- stool antigen test

100
Q

Giardiasis

- tx

A

Flagyl

101
Q

Cryptosporidium

  • pathogen
  • epidemiology
A
  • cryptosporidium parvum and C. hominis
  • protozoa
  • large waterborne outbreaks
  • contaminated water, resistant to chlorine
  • only small # oocysts needed for infection
102
Q

Cryptosporidium

- sx

A
  • abrupt, profuse, watery diarrhea
  • abd cramp
  • +/- nausea and anorexia
  • persists 1-2 weeks, then abates
  • asx shedding of oocysts continues for weeks
103
Q

Cryptosporidium

- dx

A
  • stool antigen test

- microscopic examination of stool (stool for O&P)

104
Q

Cryptosporidium

- Tx

A
  • abx
  • usually self-limited in immunocompetent people
  • can be severe in AIDS
105
Q

Blastocystis hominis

- organism

A
  • unclear classification historically
  • genus: Stramenopiles (protists)
  • common, found throughout world
106
Q

Blastocystis hominis

  • transmission
  • sx
A
  • contaminated water
  • diarrhea
  • gas
  • abd cramps
  • anal itching **
  • weight loss
  • poss constipation
  • many people asx
107
Q

Blastocystis hominis

- tx

A

abx

108
Q

Clinical skills

A

see presentation for all the details

109
Q

Diarrhea

- how to differentiate small colon from large

A
  • Small: watery, high volume stool, signs of malabsorption, dehydration
  • Large: frequent, small volume stool, blood, urgency, tenesmus
110
Q

Signs infection due to S. aureus or B. cereus

A

“food poisoning”

  • vomiting
  • 6 hrs after food
  • no/low fever
111
Q

Signs infection viral

A
  • incubation >14 hours

- HA

112
Q

Signs invasive or toxin producing

A
  • severe abd pain
  • high fever
  • peritoneal signs
113
Q

Mild dehydration

  • alterness
  • vitals
  • s/sx
  • weight loss
A
  • normal
  • no change
  • thirst
  • <5%
114
Q

moderate dehydration

  • alterness
  • vitals
  • s/sx
  • weight loss
A
  • restless, irritable, weak
  • tachycardia, postural hypotension
  • thirsty, dry membranes, poor skin turgor, dark urine
  • 5-10%
115
Q

Severe dehydration

  • alterness
  • vitals
  • s/sx
  • weight loss
A
  • unconscious, lethargy, floppy, unable to drink
  • weak/absent pulse, low blood pressure
  • sunken eyes, depressed fontanels, wrinkled skin, minima/no urine
  • > 10%
116
Q

S/sx indicate need to start a w/u

A
  • high fever >101 or toxic appearing
  • severe sx, >6 diarrheas a day
  • severe dehydration
  • Evidence of colitis: bloody stool, severe abd pain
  • empiric tx failed
  • duration >2 weeks
117
Q

Lab w/u for diarrhea

A
  • fecal leukocytes: positive is inflammatory
  • Stool for ova and parasites: multiple samples best dt intermittent shedding
  • Stool culture: good for acute sx, helps narrow differential
  • CBC: anemia, leukocytosis, thrombocytopenia (HUS)
  • BMP: electrolytes, hyponatremia, metabolic acidosis (secretory diarrhea)
118
Q

What orgs are on stool culture

A
  • Salmonella
  • Shigella
  • Campylobacter
  • C. diff
  • E. coli (STEC)
  • +/- vibrio
  • +/- Yersinia
119
Q

Diarrhea supportive care

A
  • oral rehydration: pedialyte, sports drinks, make your own
  • IV fluids if can’t quit vomiting or VERY volume depleted
  • anti-diarrheal: imodium, pepto-bismol
  • anti-emetics
  • BRAT diet, avoid dairy
120
Q

When to use Abx

A

only when needed!!

  • severe
  • hospitalized
  • infants
  • elderly
121
Q

Late complications of diarrhea

A
  • Reiter’s syndrome: reactive arthritis, urethritis, conjunctivitis
  • HUS (shigella, EHEC)
  • Autoimmune type sequelae: pericarditis, thyroiditis, glomerulonephritis
  • Post-infectious IBS
122
Q

Exposure/condition vs. pathogen

A

great chart at end of lecture

Infectious Disease 2 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions