diarrhea/hernias Flashcards
high osmotic gap
over 100
osmotic diarrhea
low osmotic gap
under 50
secretory diarrhea
.what is an indirect hernia
most common
passage of intestine through the internal inguinal ring down the the inguinal canal, may pass through scrotum
lateral to the epigastric artery
.what is a direct inguinal hernia
passage of intestine through external inguinal ring at the hesselbachs triangle, rarely enters the scrotum
.what is a femoral inguinal hernia
gender
etiology
least common. passes through the femoral ring
more common in women
due to increased intra-abdominal pressure, weaked pelvic floor
.umbilical hernia
when does it occur
tx
congenital and appears at birth
usually resolve by 2 y.o, some require surgery
.what is a ventral hernia
it occurs when there is a weakening in the anterior abdominal wall and may be incisional or umbilical
.incisional hernias
common in vertical incisions, especally pts with concurrent obesity and wound infection
.diaphramatic or hiatal hernia
involves what
sx
tx
involves protrusion of stomach through diaphram via the esophageal hiatus
GERD sx
surgery for serious cases
.hesselbach triangle
inguinal ligament
the inferior epigastric artery
rectus abdominis
organisms in viral non-inflammatory diarrhea
norwalk, rotavirus
organisms in protozoal non-inflammatory diarrhea
giardia, cryptosporidium
.sx in non invasive diarrhea
watery, high volume, non bloody
N/V suggest small bowel
.sx in inflammatory diarrhea
high fever, bloody,mucus, (not voluminous-large intestine)
organisms in viral inflammatory diarrhea
CMV
.Enteric fever (typhoid)
prolonged high fever, prostration, confusion, resp distress, diarrhea= think salmonella typhi or paratyphi
antibx for diarrhea
cipro BID x 7d
what is secretory diarrhea and what can it indicate
large volume with inflammation, indicates pancreatic insuffienciency, ingestion of performed bacterial toxins, or laxative use
what is inflammatory diarrhea
bloody diarrhea with fever, indicates invasive organism or inflammatory bowel disease
3 common causes of pediatric diarrhea
rotavirus
norwalk
enterovirus
acute vs chronic duration diarrhea
acute is < 2 weeks; usually infectious
chronic is > 4 weeks; usually secretory, malabsorption, maldigestive, osmotic
.salmonella
shigella
typhoid
e coli
campylobacter
yersinia enterocolitica
bloody diarrhea
.vibrio cholera
vibrio parahaemolyticus and vulnificus
rotavirus
norovirus
e coli (enterotoxigenic)
bacillus cereus
staph aureus
c diff
watery diarrhea
.c diff diarrhea can cause what
tx
vancomycin, fidaxomicin all first line agents
flagyl alternative
N/V with diarrhea of these 4 organisms
rapid with st aureus
norovirus, rotavirus
cryptosporidium
norovirus and rotavirus
source
onset
fever
duration
therapy/tx
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
clostridium perfrigens (TOXIN)
source
onset
fever
duration
therapy/tx
source: food BEFORE cooking
onset: 8-14 hours
fever: rare
duration: 24 hours
therapy/tx: supportive
St. aureus (TOXIN)
source
onset
fever
duration
therapy/tx
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
vibrio/cholera
source
onset
fever
duration
therapy/tx
source: water
onset: 2-3 days
fever: rare
duration: days
therapy/tx: hydrate
E coli (ENTEROTOXIC)
source
onset
fever
duration
therapy/tx
source: Food
onset: 5-15 days
fever: low
duration: 1-5 days
therapy/tx: hydrate, bismuth, loperamide
giardia lamblia
source
onset
fever
duration
therapy/tx
source: Water, P-P
onset: 5-25 days
fever: no
duration: until treated
therapy/tx: flagyl 250mg BID x 10 days
cryptospordium(may be HIV)
source
onset
fever
duration
therapy/tx
source: water, outbreaks
onset: 2-10 days
fever: poss
duration: 30 days unless HIV
therapy/tx: supportive, HIV tx
cyclospora
source
onset
fever
duration
therapy/tx
source: imported uncooked food
onset: 7 days
fever: low
duration: weeks
therapy/tx: bactrim BID x 7 days
salmonella (INVASIVE)
source
onset
fever
duration
therapy/tx
source: poultry
onset: 6-72 hours
fever: yes, poss septicemia
duration: 4-7 days
therapy/tx: hydration
ENTEROHEMORRHAGIC E COLI/INVASIVE
source
onset
fever
duration
therapy/tx
source: undercooked ground beef
onset: 12-60 hours
fever: yes
duration: 5-10 days
therapy/tx: supportive unless severe
ENTEROHEMORRHAGIC E COLI/INVASIVE
in kids/elderly
sx
risk for what
rule out what
avoid what tx
severe abdominal pain
risk for HUS
rule out GI bleeding and colitis
avoid antibiotic and anti-diarrheal medications
shigella (INVASIVE)
** what to know
source
onset
fever
duration
therapy/tx
extremely contagious, can cause febrile seizures
source: fecal-oral
onset: 1-6 days
fever: yes
duration: 1-7 days
therapy/tx: supportive, bactrim
campylobacter (INVASIVE)
affects what age group
source
onset
fever
duration
therapy/tx
young kids and adults
source: undercooked poultry
onset: 2-5 days
fever: yes
duration: 2-5 days
therapy/tx: supportive, FQ, or azithromycin
profuse diarrhea
vibrio/cholera
purulent diarrhea
4 invasive ones
salmonella
enterohemorrhagic e coli
shigella
campylobacter
loperamide tx
for enterotoxic e coli
bactrim tx
2
cyclospora
shigella
flagyl tx
FQ or azithromycin tx
giardia lamblia
campylobacter
septicemia with this
salmonella
food before cooking
food after cooking
imported uncooked food
poultry
undercooked ground beef
undercooked poultry
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
fecal oral transmission
shigella
HUS risk
enterohemorrhagic e coli
.obturator hernia
rare, through pelvic floor in which contents protrude through obturator foramen
most common in women with significant wt loss
.most common hernia in both sexes
indirect
.hernia often congenital due to a persistant patent process vaginalis
indirect
.hernia may develop scrotal swelling
indirect
.hernia medial to inferior epigastric artery
direct
