Diarrhea Acute Flashcards
duration
Etiology
Noninfect causes
less than 2 wks
usually infectous
drugs/GI dz/systemic states
Infections are typically
presentation
transmission
viral- norovirus/rota/adeno
self limited diarrhea/ab cramping
foodborne
Bacterial transmission
coastal areas w ingested shellfish bacteria
Campylobacter
Salmonella
Shigella
E coli (enterotoxigenic)
Yersinia
Sources
foodborne
Vibrio parahemolytica
poultry, unpast mild
poultry, eggs, dairy, pets
poultry, mayo salads, fecal oral
uncooked meat
pork
travelers diarrhea
Vibrio cholera geo
transmission
E coli
Africa, SE/E Asia, americas
contam water/food
common us parasites
Crypto trans
Unusual
Giardia trasmission
crypto, giardia
contam food/water or person to person
Chlorine does not kill crypto
contam water/kids @ daycare
Entamoeba histolytica geo
CM
complication
resource poor
asx
ameba ascend portal vein system, leading to liver abscess
Nematode infections
hookworms cm
Trichuris trichuria geo
unlikely for diarrhea
epigastric pain, nausea, d
tropical countries
Organism, presentation, transmission, dx
Enterobius (pinworm)
Trichuris (whipworm)
Necator americanus/Ancyclostoma (hookworm)
Ascaris lumbricoides (roundworm)
Strongyloides (threadworm)
Perianal pruritis, vulvovaginits- ingest eggs, PtP- perianal eggs
loose stool, mucus/blood- ingest eggs/soil-eggs in stool
Pruritic rash, ab pain, Fe def anemia- skin penetration (Asia/Africa/SA/SEUS)- eggs in stool/eosinopilia
Cough/SOB/IO- ingest eggs from food/water (same areas)-same
Duodenitis/Cough/SOB/hemoptysis- skin penetration and soil (SE Asia/US)- larva in stool/eos
Typical parasite diarrhea mechanism
Viral orgs result in
Rotavirus
Vibria cholera
eventually leads to
secretory etiology
direct damage to intes epithelium, leading to mucosal loss of fluid
enterotoxin (NSP4)- inc IC Ca, efflux Cl into lumen
secretory diarrhea- binds GP, activates AC, cAMP- CFTR chloride channel
efflux of Cl/water/Na/K/bicarb
ETEC
shigella
same as cholera
multiple enterotoxins- secretory diarrhea
Lost microvilli/diminished BB enzymes problem
Noravirus
Rotavirus
difference
inc carbs/proteins in gut- osmotic diarrhea (inc lumen)
blunts MV, malabsorbs fat/carbs
destroys villous epithelial cells/ blunts intestinal villi- decreased SA
N- self limited
R- much longer
Inflammation releases
results in
Shigella process
EHEC and Shigella shiga toxin
once systemic
cytokines- stimulate sec/motility
fat malabsroption/lost BA
invades mucosal cells, induce inflamm rxn- shallow ulcers form
bind epi surface proteins/endocytosis and stop protein synthesis (cell death)
targets endo cells, vasc damage and prothrombotic (Hemo/uremic)
AB associated diarrhea
inc carb solutes in intestinal lumen
deconjugated bile salts
erythromycin
clavulanate
if dec flora sign, can lead to
dec colonic flora, problems w carb/BA metabolism
osmotic diarrhea
secretory
binds motilin receptors, inc gastric emptying
intestinal motility
c diff
Osmotic diarrhea
Secretory diarrhea
Maldigestion
Altered motility diarrhea
Non antibiotic diarrhea mchs
nonabsorb carbs (PEG, sorb, man, lactulose, Mg)
activate AC, cAMP, inhibit Na/K atpase
lipase inhibitors
inc motility shortens transit
Watery diarrhea due to
MC
Bacteria include
Noravirus month/place
cm
most likely to cause
resolves in
usually infection
viruses
Camp, c diff, ETEC, salm, shigella, V parah, Yersinia
cold/cruise ships
NV/diarrhea/cramp
vomiting
48-72 hrs
Rotavirus is more
children
prolonged
worse course
Small volume stools w blood/mcus suggests
bloody diarrhea suggest
potential cause in IC patient
EHEC course
hemolytic/uremia
triad
colitis w severe pain/tenesmus
bacteria- EHEC, shigella, camp, Salm, Yers
CMV
3-4 days after ingestion- bloody diarrhea No FEVER
big concern, kids esp
AKI, micro hemolytic anemia, thrombo 5-10 days later
Salmonella transmission
CM
Sigella trsn
food/reptiles
watery diarrhea/bloody/high fever
food- same presentation, NV, freq stools, fluid loss is LARGE
Camylobacter trsn
adults
presntation
PE
late complication
contam food- same presn
pan/fever less common, mimics appendicitis
iliocecal area inflamed/enlarged LAD
RLG pain, RT
Guillan Barre- ab to epitopes cross react w GM1 ganglioside in PN myelin
Yersinia trsn
CM
also mimics
food products
fever, bloody/mucus d/ v
appendicitis
Need for further eval w sx such as
Workup
High F, severe diarrhe/fluid loss
Bloody stools, IC, +7 days
Fecal lactoferrin (+ suggests inflam)
Bacterial stool culture/PCR
C diff toxin/PCR
Ova/parasite test w travel
Mx of watery diarrhea
if severe dehydration/cant tolerate oral
Children w persisten vomiting/diarrhea to reduce need for rehydraion/hosp
supportive-oral balanced salts to replace lost water/Na/K/bicarb
IV
odansetron
Adults w watery diarrhea
avoid if
other agents to use
antimotilty to stop secretion (if healthy/no RF)
severe inf, C diff
loperamide/bismuth
Watery diarrhea and AB
exception
Bloody diarrhea- avoid
AB may ____ in E coli and shigella
Only use AB to treat
no effect
ETEC- use cipro
C diff
AB
inc expression/release of toxin
Camp, salmon, yersinia, shigella (no toxin)
