diarrhea/hernias

Question 1

high osmotic gap

Answer 1

over 100

osmotic diarrhea

Question 2

low osmotic gap

Answer 2

under 50

secretory diarrhea

Question 3

.what is an indirect hernia

Answer 3

most common

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

lateral to the epigastric artery

Question 4

.what is a direct inguinal hernia

Answer 4

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

Question 5

.what is a femoral inguinal hernia

gender

etiology

Answer 5

least common. passes through the femoral ring

more common in women

due to increased intra-abdominal pressure, weaked pelvic floor

Question 6

.umbilical hernia

when does it occur

tx

Answer 6

congenital and appears at birth

usually resolve by 2 y.o, some require surgery

Question 7

.what is a ventral hernia

Answer 7

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

Question 8

.incisional hernias

Answer 8

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

Question 9

.diaphramatic or hiatal hernia

involves what

sx

tx

Answer 9

involves protrusion of stomach through diaphram via the esophageal hiatus

GERD sx

surgery for serious cases

Question 10

.hesselbach triangle

Answer 10

inguinal ligament

the inferior epigastric artery

rectus abdominis

Question 11

organisms in viral non-inflammatory diarrhea

Answer 11

norwalk, rotavirus

Question 12

organisms in protozoal non-inflammatory diarrhea

Answer 12

giardia, cryptosporidium

Question 13

.sx in non invasive diarrhea

Answer 13

watery, high volume, non bloody

N/V suggest small bowel

Question 14

.sx in inflammatory diarrhea

Answer 14

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

Question 15

organisms in viral inflammatory diarrhea

Answer 15

CMV

Question 16

.Enteric fever (typhoid)

Answer 16

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

Question 17

antibx for diarrhea

Answer 17

cipro BID x 7d

Question 18

what is secretory diarrhea and what can it indicate

Answer 18

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

Question 19

what is inflammatory diarrhea

Answer 19

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

Question 20

3 common causes of pediatric diarrhea

Answer 20

rotavirus

norwalk

enterovirus

Question 21

acute vs chronic duration diarrhea

Answer 21

acute is < 2 weeks; usually infectious

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

Question 22

.salmonella

shigella

typhoid

e coli

campylobacter

yersinia enterocolitica

Answer 22

bloody diarrhea

Question 23

.vibrio cholera

vibrio parahaemolyticus and vulnificus

rotavirus

norovirus

e coli (enterotoxigenic)

bacillus cereus

staph aureus

c diff

Answer 23

watery diarrhea

Question 24

.c diff diarrhea can cause what

tx

Answer 24

vancomycin, fidaxomicin all first line agents

flagyl alternative

Question 25

N/V with diarrhea of these 4 organisms

Answer 25

rapid with st aureus norovirus, rotavirus cryptosporidium

Question 26

norovirus and rotavirus source onset fever duration therapy/tx

Answer 26

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

Question 27

clostridium perfrigens (TOXIN) source onset fever duration therapy/tx

Answer 27

source: food BEFORE cooking onset: 8-14 hours fever: rare duration: 24 hours therapy/tx: supportive

Question 28

St. aureus (TOXIN) ## Footnote source onset fever duration therapy/tx

Answer 28

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

Question 29

vibrio/cholera source onset fever duration therapy/tx

Answer 29

source: water onset: 2-3 days fever: rare duration: days therapy/tx: hydrate

Question 30

E coli (ENTEROTOXIC) source onset fever duration therapy/tx

Answer 30

source: Food onset: 5-15 days fever: low duration: 1-5 days therapy/tx: hydrate, bismuth, loperamide

Question 31

giardia lamblia source onset fever duration therapy/tx

Answer 31

source: Water, P-P onset: 5-25 days fever: no duration: until treated therapy/tx: flagyl 250mg BID x 10 days

Question 32

cryptospordium(may be HIV) ## Footnote source onset fever duration therapy/tx

Answer 32

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

Question 33

cyclospora ## Footnote source onset fever duration therapy/tx

Answer 33

source: imported uncooked food onset: 7 days fever: low duration: weeks therapy/tx: bactrim BID x 7 days

Question 34

salmonella (INVASIVE) ## Footnote source onset fever duration therapy/tx

Answer 34

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

Question 35

ENTEROHEMORRHAGIC E COLI/INVASIVE ## Footnote source onset fever duration therapy/tx

Answer 35

source: undercooked ground beef onset: 12-60 hours fever: yes duration: 5-10 days therapy/tx: supportive unless severe

Question 36

ENTEROHEMORRHAGIC E COLI/INVASIVE in kids/elderly sx risk for what rule out what avoid what tx

Answer 36

severe abdominal pain risk for HUS rule out GI bleeding and colitis avoid antibiotic and anti-diarrheal medications

Question 37

shigella (INVASIVE) \*\* what to know source onset fever duration therapy/tx

Answer 37

extremely contagious, can cause febrile seizures source: fecal-oral onset: 1-6 days fever: yes duration: 1-7 days therapy/tx: supportive, bactrim

Question 38

campylobacter (INVASIVE) affects what age group source onset fever duration therapy/tx

Answer 38

young kids and adults source: undercooked poultry onset: 2-5 days fever: yes duration: 2-5 days therapy/tx: supportive, FQ, or azithromycin

Question 39

profuse diarrhea

Answer 39

vibrio/cholera

Question 40

purulent diarrhea 4 invasive ones

Answer 40

salmonella enterohemorrhagic e coli shigella campylobacter

Question 41

loperamide tx

Answer 41

for enterotoxic e coli

Question 42

bactrim tx 2

Answer 42

cyclospora shigella

Question 43

flagyl tx FQ or azithromycin tx

Answer 43

giardia lamblia campylobacter

Question 44

septicemia with this

Answer 44

salmonella

Question 45

food before cooking food after cooking imported uncooked food poultry undercooked ground beef undercooked poultry

Answer 45

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

Question 46

fecal oral transmission

Answer 46

shigella

Question 47

HUS risk

Answer 47

enterohemorrhagic e coli

Question 48

.obturator hernia

Answer 48

rare, through pelvic floor in which contents protrude through obturator foramen most common in women with significant wt loss

Question 49

.most common hernia in both sexes

Answer 49

indirect

Question 50

.hernia often congenital due to a persistant patent process vaginalis

Answer 50

indirect

Question 51

.hernia may develop scrotal swelling

Answer 51

indirect

Question 52

.hernia medial to inferior epigastric artery

Answer 52

direct