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diarrhea/hernias Flashcards

1
Q

high osmotic gap

A

over 100

osmotic diarrhea

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2
Q

low osmotic gap

A

under 50

secretory diarrhea

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3
Q

.what is an indirect hernia

A

most common

passage of intestine through the internal inguinal ring down the the inguinal canal, may pass through scrotum

lateral to the epigastric artery

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4
Q

.what is a direct inguinal hernia

A

passage of intestine through external inguinal ring at the hesselbachs triangle, rarely enters the scrotum

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5
Q

.what is a femoral inguinal hernia

gender

etiology

A

least common. passes through the femoral ring

more common in women

due to increased intra-abdominal pressure, weaked pelvic floor

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6
Q

.umbilical hernia

when does it occur

tx

A

congenital and appears at birth

usually resolve by 2 y.o, some require surgery

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7
Q

.what is a ventral hernia

A

it occurs when there is a weakening in the anterior abdominal wall and may be incisional or umbilical

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8
Q

.incisional hernias

A

common in vertical incisions, especally pts with concurrent obesity and wound infection

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9
Q

.diaphramatic or hiatal hernia

involves what

sx

tx

A

involves protrusion of stomach through diaphram via the esophageal hiatus

GERD sx

surgery for serious cases

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10
Q

.hesselbach triangle

A

inguinal ligament

the inferior epigastric artery

rectus abdominis

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11
Q

organisms in viral non-inflammatory diarrhea

A

norwalk, rotavirus

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12
Q

organisms in protozoal non-inflammatory diarrhea

A

giardia, cryptosporidium

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13
Q

.sx in non invasive diarrhea

A

watery, high volume, non bloody

N/V suggest small bowel

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14
Q

.sx in inflammatory diarrhea

A

high fever, bloody,mucus, (not voluminous-large intestine)

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15
Q

organisms in viral inflammatory diarrhea

A

CMV

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16
Q

.Enteric fever (typhoid)

A

prolonged high fever, prostration, confusion, resp distress, diarrhea= think salmonella typhi or paratyphi

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17
Q

antibx for diarrhea

A

cipro BID x 7d

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18
Q

what is secretory diarrhea and what can it indicate

A

large volume with inflammation, indicates pancreatic insuffienciency, ingestion of performed bacterial toxins, or laxative use

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19
Q

what is inflammatory diarrhea

A

bloody diarrhea with fever, indicates invasive organism or inflammatory bowel disease

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20
Q

3 common causes of pediatric diarrhea

A

rotavirus

norwalk

enterovirus

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21
Q

acute vs chronic duration diarrhea

A

acute is < 2 weeks; usually infectious

chronic is > 4 weeks; usually secretory, malabsorption, maldigestive, osmotic

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22
Q

.salmonella

shigella

typhoid

e coli

campylobacter

yersinia enterocolitica

A

bloody diarrhea

23
Q

.vibrio cholera

vibrio parahaemolyticus and vulnificus

rotavirus

norovirus

e coli (enterotoxigenic)

bacillus cereus

staph aureus

c diff

A

watery diarrhea

24
Q

.c diff diarrhea can cause what

tx

A

vancomycin, fidaxomicin all first line agents

flagyl alternative

25
Q

N/V with diarrhea of these 4 organisms

A

rapid with st aureus

norovirus, rotavirus

cryptosporidium

26
Q

norovirus and rotavirus

source

onset

fever

duration

therapy/tx

A

source P-P both; food/water in norovirus

onset: 1-3 days
fever: low
duration: 1-2 days norovirus, 5-8 days rotavirus

therapy/tx: hydration and practice good hand washing

27
Q

clostridium perfrigens (TOXIN)

source

onset

fever

duration

therapy/tx

A

source: food BEFORE cooking
onset: 8-14 hours
fever: rare
duration: 24 hours

therapy/tx: supportive

28
Q

St. aureus (TOXIN)

source

onset

fever

duration

therapy/tx

A

source: food AFTER cooking
onset: 1-7 hours
fever: yes, rapid
duration: acute is 4-6 hr, total is 1-2 days

therapy/tx: supportive

29
Q

vibrio/cholera

source

onset

fever

duration

therapy/tx

A

source: water
onset: 2-3 days
fever: rare
duration: days

therapy/tx: hydrate

30
Q

E coli (ENTEROTOXIC)

source

onset

fever

duration

therapy/tx

A

source: Food
onset: 5-15 days
fever: low
duration: 1-5 days

therapy/tx: hydrate, bismuth, loperamide

31
Q

giardia lamblia

source

onset

fever

duration

therapy/tx

A

source: Water, P-P
onset: 5-25 days
fever: no
duration: until treated

therapy/tx: flagyl 250mg BID x 10 days

32
Q

cryptospordium(may be HIV)

source

onset

fever

duration

therapy/tx

A

source: water, outbreaks
onset: 2-10 days
fever: poss
duration: 30 days unless HIV

therapy/tx: supportive, HIV tx

33
Q

cyclospora

source

onset

fever

duration

therapy/tx

A

source: imported uncooked food
onset: 7 days
fever: low
duration: weeks

therapy/tx: bactrim BID x 7 days

34
Q

salmonella (INVASIVE)

source

onset

fever

duration

therapy/tx

A

source: poultry
onset: 6-72 hours
fever: yes, poss septicemia
duration: 4-7 days

therapy/tx: hydration

35
Q

ENTEROHEMORRHAGIC E COLI/INVASIVE

source

onset

fever

duration

therapy/tx

A

source: undercooked ground beef
onset: 12-60 hours
fever: yes
duration: 5-10 days

therapy/tx: supportive unless severe

36
Q

ENTEROHEMORRHAGIC E COLI/INVASIVE

in kids/elderly

sx

risk for what

rule out what

avoid what tx

A

severe abdominal pain

risk for HUS

rule out GI bleeding and colitis

avoid antibiotic and anti-diarrheal medications

37
Q

shigella (INVASIVE)

** what to know

source

onset

fever

duration

therapy/tx

A

extremely contagious, can cause febrile seizures

source: fecal-oral
onset: 1-6 days
fever: yes
duration: 1-7 days

therapy/tx: supportive, bactrim

38
Q

campylobacter (INVASIVE)

affects what age group

source

onset

fever

duration

therapy/tx

A

young kids and adults

source: undercooked poultry
onset: 2-5 days
fever: yes
duration: 2-5 days

therapy/tx: supportive, FQ, or azithromycin

39
Q

profuse diarrhea

A

vibrio/cholera

40
Q

purulent diarrhea

4 invasive ones

A

salmonella

enterohemorrhagic e coli

shigella

campylobacter

41
Q

loperamide tx

A

for enterotoxic e coli

42
Q

bactrim tx

2

A

cyclospora

shigella

43
Q

flagyl tx

FQ or azithromycin tx

A

giardia lamblia

campylobacter

44
Q

septicemia with this

A

salmonella

45
Q

food before cooking

food after cooking

imported uncooked food

poultry

undercooked ground beef

undercooked poultry

A

food before cooking: clostridium perfringens

food after cooking: st aureus

imported uncooked food: cyclospora

poultry: salmonella

undercooked ground beef: enterohemorrhagic e coli

undercooked poultry: campylobacter

46
Q

fecal oral transmission

A

shigella

47
Q

HUS risk

A

enterohemorrhagic e coli

48
Q

.obturator hernia

A

rare, through pelvic floor in which contents protrude through obturator foramen

most common in women with significant wt loss

49
Q

.most common hernia in both sexes

A

indirect

50
Q

.hernia often congenital due to a persistant patent process vaginalis

A

indirect

51
Q

.hernia may develop scrotal swelling

A

indirect

52
Q

.hernia medial to inferior epigastric artery

A

direct

53
Q
A

GI (14 decks)

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