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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
fluid management for diarrhea
- 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
26
homemade osmotic solution for diarrhea rehydration
- 1/2 tsp salt - 1/2 tsp baking soda - 4 tbsp sugar - 1 liter water
27
diet for diarrhea
- BRAT diet - small frequent feedings - consume fruit drinks, tea, flat carbonated drinks - avoid dairy- transiently lactase deficient - avoid caffeine- stimulant
28
medications to treat diarrhea
- 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
norovirus
- sx within 12-48 hours - acute onset n/v, watery diarrhea, abd cramping - sx last 24-72 hours - dehydration most common complication
30
how is norovirus transmitted
- close personal contact with infected person - fecal- oral route - touching contaminated surfaces
31
c diff
- A and B toxin release -> severe watery diarrhea, pseudomembranous colitis, toxic megacolon - sx may dev while on abx or 5-10 days after
32
common causes of c diff
- quinolones - clindamycin - cephalosporins - penicillin
33
who should you suspect c diff in?
- diarrhea and ileus - abx use or chemo within last 90 days - recent hospitalization - advanced age
34
treatment for c dif
- flagyl | - PO vanco
35
campylobacter
- 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
treatment for campylobacter
- supportive | - abx in immunocomp or severe disease: cipro, levo, or azithromycin
37
what is the leading cause of food borne illness
- salmonella - assoc with poultry, milk, eggs - often found in contaminated food or water
38
salmonella
- 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
treatment for salmonella
- supportive | - abx in immunocomp or severe disease: cipro or levo
40
how long do you shed salmonella for
- for up to a year after infection
41
enterhemorrhagic e coli
- abd pain and bloody diarrhea - no fever - abx not recommended- risk of hemolytic uremic syndrome (HUS)***
42
sx of HUS
- acute renal failure - hemolytic anemia - thrombocytopenia
43
where does shigella multiply?
- small bowel | - less susceptible to stomach acid
44
how is shigella transmitted
- person to person - contaminated water and food - fecal orally - day cares - MSM - humans are the only natural reservoir
45
shigella sx
- invasive bacteria - high fever - abd cramping, tenesmus - small volume diarrhea, bloody and mucoid - diarrhea initially may be watery
46
treatment for shigella
- supportive - risk of HUS** - self limited 7 days - abx only for severe disease or immunocomp: - quinolones, azithrymycin, bactrim
47
botulism
- neuroparalytic syndrome - potentially life threatening - uncommon infection - d/t clostridium botulinum
48
how is botulism spread/ where is it found
- lives in soil and untreated water - heat resistant- risk with canning food - spreads widely via vascular sys regardles sof entry
49
botulism sx
- sx onset 12-36 hours after exposure - n/v/d, abdominal pain, cramping - dry mouth and sore throat - bilat CN palsies
50
treatment and dx for botulism
- dx by serum toxin - 2 antitoxins available - abx usually only used in wound botulism- pen g and flagyl
51
cholera sx
- 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
treatment for cholera
- hydration and abx | - tetracycline, ampicillin, azithromycin, bactrim, quinolones
53
where is cholera common
- 3rd world countries | - esp high when inadequate clean water access
54
intestinal entomoeba transmission
- 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
intestinal entomoeba sx
- usually asymptomatic - onset 1-3 weeks - sx range from mild to severe - complications: fulminant colitis with bowel necrosis, perforation, peritonitis
56
treatment for intestinal entomoeba
- metronidazole - tinidazole - ornidazole
57
cryptosporidium
- most commonn parasitic cause of acute foodborne diarrhea - transmitted person to animal, fecally contaminated food or water, person to person - treat with nitazoxanide
58
causes of giardia
- day care center - hx of camping, hiking etc. - ingetstion of fresh water
59
giardia sx
- watery, yellow, foul smelling diarrhea - alt soft and greasy stools - fatigue and abd bloating - weight loss up to 10% of BW
60
treatment for giardia
- metronidazole - tinidazole - nitazoxanide - even after tx sx may recur for up to 6 weeks
61
what is the most common organism for travelers diarrhea
- e coli | - in general due to variety of bacteria, viruses, and parasites
62
prevention of travelers diarrhea
- bottled water only - food that is thoroughly cooked - pasteurized dairy products
63
treatment for travelers diarrhea
- cipro or levo | - may consider imodium
64
definition of IBS
- 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
dietary modifications for IBS
- 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
what is the hallmark of malabsorption
- steatorrhea | - stool floats
67
possible causes of malabsorption
- celiac - bacterial overgrowth - lactase deficiency
68
testing for malabsorption
- 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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