Diarrhea/Gastro

Question 1

List 4 classes of diarrhea and give an example of each

Answer 1

Osmotic: solutes draw fluid into intestine eg laxatives

secretory: water and electrolytes secreted into gut. persists despite fasting
eg cholera

Inflammatory
intestinal mucosa damaged causing secretion
eg IBD

altered motility
dx of exclusion

Question 2

List 10 infectious and 10 non-infectious causes of diarrhea:

Answer 2

Infectious

viral: norovirus, rotavirus, HIV, Hep A-E
bacterial: salmonella, yersinis, campylobacter, e.coli, cholera
parasitic: cryptosporidium, entamoeba histolitica, Giardia

Non-infectious
Drugs: ACE-I, ABx, BB, Dig
toxins: cholinergics
celiac dz
IBS
IBD
hyperthyroid

Question 3

What is an oral rehydration approach

Answer 3

60ml/kg over 4 hrs add 8ml/kg for each V/D

Question 4

List 10 notifiable Food-borne diseases and other related GI conditions (Box 94-1):

Answer 4

Botulism
Brucellosis
cholera
shiga toxin producing E. Coli
HUS
salmonellowis
shigellosis
typhoid fever
non cholera vibrio

Viral: Hepatitis A

Parasitic: cryptosporidiosis, cyclosporiasis, trichinosis

Question 5

If infected with salmonella, who should get therapy?

Answer 5

severe, not resolving after culture results, food handler, teacher or healthcare worker, LT 3mo, elderly, immunocompromised

Food handlers, healthcare workers cannot return to work until negative stool cultures

Question 6

List 4 Post infectious manifestations of Yersinia:

Answer 6

• Erythema nodosum (2-5% adults)
  
  • Polyarthritis (2-5% adults)
  • Sacroilitis
  • AS
  • Reiter’s syndrome
  • Exudative pharyngitis
  • Pneumonia, empyema, lung abscess
    Sepsis (in immunocompromise

Question 7

List clinical features of ciguatoxin poisoning.

Answer 7

GI Symptoms first 24hrs
- Nausea, Vomiting
- Profuse watery diarrhea
- Crampy abdominal pain
Diaphoresis

Neurologic symptoms (Can persist up to a year!)

• Dysestheisas and paresthesias around the perioral area
• “Burning Feet”
• “Loose painful teeth”
• Ataxia
• Weakness
• Vertigo
• Confusion, visual hallucinations
• Coma
• Distortion of temperature sensation