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Clin Med III > diarrhea > Flashcards

diarrhea Flashcards

1
Q

most common viral cause of diarrhea

A
  • norovirus

- rotavirus in kis

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2
Q

most common cause of bacterial diarrhea

A
  • campylobacter

- usually severe diarrhea is bacteria

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3
Q

most common cause of diarrhea in general

A
  • viruses

- most are self limited

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4
Q

definition of diarrhea

A
  • passage of watery stools 3+ times in 24 hours

- due to either impaired water absorption or increased water secretion

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5
Q

acute diarrhea

A
  • < 14 days

- likely infectious

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6
Q

subacute/ persistent diarrhea

A
  • 14-30 days

- inflammatory or infectious

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7
Q

chronic diarrhea

A
  • 30+ days

- either osmotic, secretory, or inflammatory

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8
Q

cause of diarrhea d/t exposure to animals

A
  • salmonella
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9
Q

cause of diarrhea in daycares

A
  • shigella
  • cyrptosporidium
  • giardia
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10
Q

cause of diarrhea d/t fecally contaminated food or water

A
  • enterotoxigenic e coli
  • enteric viruses
  • v parahemolyticus
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11
Q

cause of diarrhea d/t unpasteurized milk

A
  • campylobacter

- salmonella

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12
Q

diarrhea of small bowel

A
  • watery, large volumes
  • abd cramping
  • bloating and gas
  • weight loss with persistent diarrhea
  • rarely occurs with fever, occult blood, or inflammatory cells in stool
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13
Q

diarrhea of large bowel

A
  • frequent, regular, smaller volume
  • painful BM
  • blood or mucoid stools
  • fever
  • inflammatory and RBC on microscopy
  • suggests invasive bacteria, enteric virus, cytotoxic bacteria (c diff)
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14
Q

enterotoxic diarrhea

A
  • create a toxin that floats in gut
  • causes large amounts of watery diarrhea
  • NO fever, elevated WBC, feval leukocytes
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15
Q

entertoxic bugs

A
  • c diff
  • e coli
  • staph aureus
  • cholera
  • giardia
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16
Q

invasive diarrhea

A
  • breaks through blood/gut barrier

- causes fevers, leukocytosis, fecal leukocytes

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17
Q

common causes of vomiting

A
  • s aureus
  • b cereus
  • norwalk like virus
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18
Q

common causes of watery diarrhea

A
  • c perfringens
  • enterotoxigenic e coli
  • enteric viruses
  • c parvum
  • c cayentanesis
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19
Q

common causes of inflammatory diarrhea

A
  • campylobacter
  • non-typhoidal salmonella
  • shigella toxin producing e coli
  • shigella spp
  • v parahemolyticus
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20
Q

when would you get stool cultures for diarrhea

A
  • severe illness with signs of hypovolemia
  • si/sx concerning for inflammatory diarrhea
  • high risk host
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21
Q

what can be dx on stool culture

A
  • campylobacter
  • salmonella
  • shigella
  • c diff toxin would be ordered seperately
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22
Q

what can be dx on O&P studies

A
  • giardia
  • strongylodies
  • enteroadherent bacteria
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23
Q

what would you look for in stoo to dx inflammatory diarrhea

A
  • fecal leukocytes

- fecal lactoferrin- more sens than leukocytes used by GI

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24
Q

why do most deaths from diarrhea occur?

A
  • dehydration
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25
Q

fluid management for diarrhea

A
  • oral rehydration preferred over IVF unless severe disease
  • use solutions that have salt and sugar to create osmotic pull
  • if need IVF can use NS or lactated ringers
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26
Q

homemade osmotic solution for diarrhea rehydration

A
  • 1/2 tsp salt
  • 1/2 tsp baking soda
  • 4 tbsp sugar
  • 1 liter water
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27
Q

diet for diarrhea

A
  • BRAT diet
  • small frequent feedings
  • consume fruit drinks, tea, flat carbonated drinks
  • avoid dairy- transiently lactase deficient
  • avoid caffeine- stimulant
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28
Q

medications to treat diarrhea

A
  • loperomide- caution with invasive bacteria
  • lomotil
  • bile acid sequestrants- persistent diarrhea despite antidiarrheal use
  • anxiolytics and antiemetics may decrease perception
  • pectin and zinc may lessen duration
  • probiotics
29
Q

norovirus

A
  • sx within 12-48 hours
  • acute onset n/v, watery diarrhea, abd cramping
  • sx last 24-72 hours
  • dehydration most common complication
30
Q

how is norovirus transmitted

A
  • close personal contact with infected person
  • fecal- oral route
  • touching contaminated surfaces
31
Q

c diff

A
  • A and B toxin release -> severe watery diarrhea, pseudomembranous colitis, toxic megacolon
  • sx may dev while on abx or 5-10 days after
32
Q

common causes of c diff

A
  • quinolones
  • clindamycin
  • cephalosporins
  • penicillin
33
Q

who should you suspect c diff in?

A
  • diarrhea and ileus
  • abx use or chemo within last 90 days
  • recent hospitalization
  • advanced age
34
Q

treatment for c dif

A
  • flagyl

- PO vanco

35
Q

campylobacter

A
  • incubation pd usually 3 days
  • abrupt onset abd pain and diarrhea- blood or mucoid
  • prodrome of f/c and aches in 30%
  • may mimic appendicitis
  • invasive bacteria
36
Q

treatment for campylobacter

A
  • supportive

- abx in immunocomp or severe disease: cipro, levo, or azithromycin

37
Q

what is the leading cause of food borne illness

A
  • salmonella
  • assoc with poultry, milk, eggs
  • often found in contaminated food or water
38
Q

salmonella

A
  • invasive bactera
  • n/v/d (pea soup)
  • not grossly bloody but may have “specs” of blood
  • abd cramping, f/c
  • higher bacteria burden= worse sx
  • fever resolves in 48-72 hours
  • self limited 4-10 days
39
Q

treatment for salmonella

A
  • supportive

- abx in immunocomp or severe disease: cipro or levo

40
Q

how long do you shed salmonella for

A
  • for up to a year after infection
41
Q

enterhemorrhagic e coli

A
  • abd pain and bloody diarrhea
  • no fever
  • abx not recommended- risk of hemolytic uremic syndrome (HUS)***
42
Q

sx of HUS

A
  • acute renal failure
  • hemolytic anemia
  • thrombocytopenia
43
Q

where does shigella multiply?

A
  • small bowel

- less susceptible to stomach acid

44
Q

how is shigella transmitted

A
  • person to person
  • contaminated water and food
  • fecal orally
  • day cares
  • MSM
  • humans are the only natural reservoir
45
Q

shigella sx

A
  • invasive bacteria
  • high fever
  • abd cramping, tenesmus
  • small volume diarrhea, bloody and mucoid
  • diarrhea initially may be watery
46
Q

treatment for shigella

A
  • supportive
  • risk of HUS**
  • self limited 7 days
  • abx only for severe disease or immunocomp:
  • quinolones, azithrymycin, bactrim
47
Q

botulism

A
  • neuroparalytic syndrome
  • potentially life threatening
  • uncommon infection
  • d/t clostridium botulinum
48
Q

how is botulism spread/ where is it found

A
  • lives in soil and untreated water
  • heat resistant- risk with canning food
  • spreads widely via vascular sys regardles sof entry
49
Q

botulism sx

A
  • sx onset 12-36 hours after exposure
  • n/v/d, abdominal pain, cramping
  • dry mouth and sore throat
  • bilat CN palsies
50
Q

treatment and dx for botulism

A
  • dx by serum toxin
  • 2 antitoxins available
  • abx usually only used in wound botulism- pen g and flagyl
51
Q

cholera sx

A
  • secretory diarrhea d/t toxin
  • massive volumes
  • rice water stools
  • no odor
  • profound fluid and electrolyte loss- rapidly progress to hypovolemia and shock within 24 hours
52
Q

treatment for cholera

A
  • hydration and abx

- tetracycline, ampicillin, azithromycin, bactrim, quinolones

53
Q

where is cholera common

A
  • 3rd world countries

- esp high when inadequate clean water access

54
Q

intestinal entomoeba transmission

A
  • parasite
  • d/t poor sanitation, contaminated food or water
  • cyst stage- infective stage
  • trophozoite- invasive form
  • cyst passes through stomach -> becomes trophozoite -> invades mucus barrier of colon -> bloody diarrhea
55
Q

intestinal entomoeba sx

A
  • usually asymptomatic
  • onset 1-3 weeks
  • sx range from mild to severe
  • complications: fulminant colitis with bowel necrosis, perforation, peritonitis
56
Q

treatment for intestinal entomoeba

A
  • metronidazole
  • tinidazole
  • ornidazole
57
Q

cryptosporidium

A
  • most commonn parasitic cause of acute foodborne diarrhea
  • transmitted person to animal, fecally contaminated food or water, person to person
  • treat with nitazoxanide
58
Q

causes of giardia

A
  • day care center
  • hx of camping, hiking etc.
  • ingetstion of fresh water
59
Q

giardia sx

A
  • watery, yellow, foul smelling diarrhea
  • alt soft and greasy stools
  • fatigue and abd bloating
  • weight loss up to 10% of BW
60
Q

treatment for giardia

A
  • metronidazole
  • tinidazole
  • nitazoxanide
  • even after tx sx may recur for up to 6 weeks
61
Q

what is the most common organism for travelers diarrhea

A
  • e coli

- in general due to variety of bacteria, viruses, and parasites

62
Q

prevention of travelers diarrhea

A
  • bottled water only
  • food that is thoroughly cooked
  • pasteurized dairy products
63
Q

treatment for travelers diarrhea

A
  • cipro or levo

- may consider imodium

64
Q

definition of IBS

A
  • recurrent abd pain or discomfort on average of 1 day/week in last 3 mo
  • 2 or more of the following:
  • improvement with defication
  • change in frequency of stool
  • change in form of stool
65
Q

dietary modifications for IBS

A
  • low gas prod foods- beans, onions, celery, bananas, apricots, bagels
  • avoid lactose and/or gluten
  • low FODMAP diet- fermentable foods like honey, corn syrup, apples, pears
66
Q

what is the hallmark of malabsorption

A
  • steatorrhea

- stool floats

67
Q

possible causes of malabsorption

A
  • celiac
  • bacterial overgrowth
  • lactase deficiency
68
Q

testing for malabsorption

A
  • quantitative stool fat test- gold std: ingest high fat diet X 2 days, stool tested X 3 days
  • qualitative sudan stain for fat
  • acid steatocrit

Clin Med III (26 decks)

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