Diarrhea (Small Group Session 17)

Question 1

Describe a general approach to acute diarrhea and the three broad categories of acute diarrhea.

Answer 1

Question 2

Compare and contrast the characteristics of small bowel vs. large bowel diarrhea in regards to the following:

• Volume
• Frequency
• Blood
• Pain-Location
• Rectal Symptoms
• Steatorrhea
• Weight Loss
• Effect of Fasting
• Nutritional Deficiency

Answer 2

Question 3

Small bowel or large bowel organism?

Gram positive or negative?

Clostridium perfringens

Answer 3

Clostridium perfringens

• Small bowel organism
• Gram positive

Question 4

Small bowel or large bowel organism?

Gram positive or negative?

Shigella

Answer 4

Shigella

• Large bowel organism
• Gram negative

Question 5

Small bowel or large bowel organism?

Gram positive or negative?

Escherichia coli 0157

Answer 5

Escherichia coli 0157

• Large bowel organism
• Gram negative

Question 6

Small bowel or large bowel organism?

Gram negative or gram positive?

Escherichia Coli (Toxigenic)

Answer 6

E. Coli (toxigenic)

• Small bowel organism
• Gram negative

Question 7

Small bowel or large bowel organism?

Gram negative or gram positive?

Yersinia

Answer 7

Yersinia

• Small bowel organism
• Gram negative

Question 8

Small bowel or large bowel organism?

Gram negative or gram positive?

Vibrio cholera

Answer 8

Vibrio cholera

• Small bowel organism
• Gram negative

Question 9

Small bowel or large bowel organism?

Gram negative or gram positive?

Campylobacter

Answer 9

Campylobacter

• Large bowel organism
• Gram negative

Question 10

Small bowel or large bowel organism?

Gram negative or gram positive?

Clostridium difficile

Answer 10

Clostridium difficile

• Large bowel organism (colon, but watery diarrhea 95% of the time)
• Gram positive

Question 11

Small bowel or large bowel organism?

Gram negative or gram positive?

Salmonella

Answer 11

Salmonella

• Found both in the small and large bowel
• Gram negative

Question 12

What is the mode of transmission?

Campylobacter

Answer 12

Campylobacter is transmitted via uncooked poultry, raw milk, and cheese.

Question 13

What is the mode of transmission?

Clostridium difficile

Answer 13

Clostridium difficile is transmitted as a result of disruption in the normal intestinal flora, post hospital stay, post antibiotic use.

Question 14

What is the mode of transmission?

Enterotoxigenic Escherichia coli (ETEC)

Answer 14

ETEC is transmitted via salad, cheese, meat and water. Pts who have travelled to undeveloped countries are at risk for ETEC. Travel risk: Mexico

Question 15

What is the mode of transmission?

Yersinia

Answer 15

Yersinia is food/water borne.

Question 16

What is the mode of transmission?

Salmonella Nontyphi

Answer 16

Salmonella nontyphi is transmited via undercooked poultry and eggs.

Question 17

What is the mode of transmission?

Enteroinvasive Escherichia coli (EIEC)

Enterohemorragic Escherichia coli (EHEC)

Answer 17

EIEC and EHEC are transmitted via underooked meat.

EHEC = undercooked beef (H for Hamburger)

EIEC = poultry

Question 18

Which of the following bacterial infections are treated?

Campylobacter

Clostridium difficile

ETEC

Yersinia

Salmonella Nontyphi

Shigella

EIEC

EHEC

Answer 18

Treatment is given for the following:

Clostridium difficile

Yersinia

Shigella

Question 19

What is the treatment for C. difficile?

Answer 19

C. difficile treatment:

• Metronidazole
• Oral rehydration therapy
• Vancomycin
• Fecal transplant

Question 20

What is the MOA of Metronidazole? What bacterial coverage does it provide?

Answer 20

Metronidazole

• Nitroimidazole class
• MOA: disrupts DNA & NA synthesis
  
  • Production of free radicals
• Coverage:
  
  • Potent against anaerobes
  • Active against C. diff
  • Activity against intestinal protozoa including Entamoeba, Giardia