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GI/GU II Exam 1 > DSA 3. Acute Infectious Diarrhea > Flashcards

DSA 3. Acute Infectious Diarrhea Flashcards

1
Q

In the US, what are 5 high risk groups for diarrhea

A

travelers

immunodef ppl

daycare workers/kids & families: shigella, giardia, cryptosporidium, rotavirus

institutionalized pt: nursing home assisted living, hospitals

consumers of certain foods

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2
Q

What is important Hx/RF to consider if pt presents with diarrhea

A
  • recent ABx
  • ill contacts
  • travel
  • drinking unclean h2o
  • daycare/nursing home
  • animal exposure
  • Immunocompromised
  • unpasteurized dairy
  • raw/undercooked meat, fish, or shellfish
  • pregnancy (listeriosis)
  • swim/drink untreated h2o (lakes/rivers)
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3
Q

What is one of the most imp PE findings in a pt presenting w/ diarrhea

A

signs of dehydration - bc can cause death

  • mild: thirsty, dry mouth, decreased sweat or urine output, slight wt loss
  • moderate: orthostatic fall in BP, skin tenting, sunken eyes (infants = sunken fontanelle
  • severe: lethargy, obtundation, feeble pulse, hypotension, shock
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4
Q

besides dehydration, what are other PE findings for diarrhea

A

vitals - fever, hypotension, increase HR

Abd exam: tenderness, peritoneal signs, bowel sounds (increase- diarrhea; decrease - ileus/toxic megacolon)

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5
Q

describe acute infectious diarrhea

A

fecal-oral transmission

mild & self-limited - dont need further workup

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6
Q

what indications of further work up in pt presenting w/ diarrhea

A
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7
Q

What labs should be included in the work-up for diarrhea

A

1. Blood​: CBC, electrolytes, BUN, Cr, Blood culture

2. Stool

  • Fecal leukocytes: (infxn or inflam)
  • Fecal calprotectin: (IBD)
  • Fecal lactoferrin (= enzymes found in leukocytes; inflam like IBD
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8
Q

when ordering a stool culture, which bactera are included & which ones arent

A

included = salmonell, shigella, e. coli, campylobacter (some places) => take 24-48 hrs

not included:

  • enterohemorrhagic & other e. coli (ask for shigella-like detection for O157:H7 EHEC)
  • vibrio spp
  • yersinia
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9
Q

besides blood/stool labs/culture, what are other tests you can use to evaulate the cause of diarrhea?

what are they used for?

A

Stool immunoassay: C.Diff bacterial PCR/toxin

Ova/parasites: if Hx relevant - obtain 3 samples sequentially

Stool Protozal Ag- giardia, cryptosporidium, E. histolytica

Stool Viral Ag: rotovirus, norovirus

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10
Q

If stool studies dont show anything, what can you use to further investigate the cause

A

endoscopy

lower: flexible sigmoidoscopry w/ Bx
upper: EGD w/ duodenal aspirates & Bx

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11
Q

What radiology tests can be used to access diarrhea complaints

A

plain x-ray - detect free intraperitoneal air (ileus or toxic megacolon)

abd CT (usually w/ PO/IV contrast) - more sensitive for air - nonspecific identification of colitis

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12
Q

when do you suspect food poisoning

A

multiple illnesses after shared meal

summer time - food was in temp ideal for microorganism prolif

local health dept isolate organism of contaminated food

routine test not completed

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13
Q

What are common food poisoning pathogens?

what foods are they associated w/?

A

(picnic, banquet, restaurant)

chicken: salmonella, campylobacter, shigella

undercooked hamburger: EHEC (O157:H7)

fried rice: bacillus cereus

potato salad, mayo or cream pastries: staph aureus

eggs: salmonella

uncooked foods, lunch meat, soft cheese: listeria

seafood (esp raw): virbrio spp**, salmonella, acute hep A, norovirus, campylobacter

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14
Q

What causes watery diarrhea

A
  1. staph aureus
  2. bacillus cereus
  3. clostridium perfingens
  4. vibrio cholerae (rice water)
  5. aeromonas hydrophila (rice water, w/ bloody mucoid stool)
  6. ETEC
  7. C. diff
  8. rotovirus
  9. adenovirus
  10. norovirus
  11. giardia lamblia
  12. cryptosporidium parvum (LARGE Vol: 20 L/day)
  13. cyclospora cayetanensis
  14. cystoisospora belli
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15
Q

which pathogens begin w/ watery diarrhea and transition to bloody diarrhea

A

shigella

salmonella typhimurium

C. jejuni

vibrio parahemolyticus

EHEC

EIEC

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16
Q

Staph Aureus:

Microbio:

Sxs:

Tx:

RF:

A

Microbio: gram (+) cocci (grape clusters; preformed endotoxins

Sxs: N/V, watery diarrhea, rapid onset (w/i 6 hrs)

Tx: rapid resolution (24-48 hrs)

RF: ham, poultry, dairy, eegs, cream pastries, potato salad, mayo

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17
Q

Bacillus Cereus

Microbio:

Sxs:

Tx:

RF:

A

Microbio: gram (+) rod; preformed enterotoxins

Sxs: rapid onset (w/i 6 hrs); main = vomiting; watery diarrhea

Tx: rapid resolution (w/i 24-48 hrs)

RF: Fried rice;

occasionally =meats, veggies, dried beans, cereals

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18
Q

Clostridium perfingens

Microbio:

Sxs:

Tx:

RF:

A

Microbio: gram (+) (heat resistant) spore-forming rod; preformed enterotoxins

Sxs: watery diarrhea; crampy abd pain (no fever/vomit)

rapid onset (w/i 8-16 hrs)

Tx: rapid resolution (w/i 24-48 hrs)

RF: beef, ham, poultry, legumes, gravy
(heat resistant spores inadequately cooked)

need to ingest large quantity of organisms

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19
Q

Shigella (several types)

Microbio:

Sxs:

Tx:

RF:

A

Microbio: gram (-) rods (enterobacteriaceae fam); No flagella (no H antigens)–> non-motile

Toxin mediated (enterotoxin shiga toxin)

Sxs:: Only 100 organisms needed to be infected

Bloody diarrhea: (watery diarrhea –> intense colitis w/ fever and freq small-vol stools w/ blood and pus); abd cramps, fever (3-4 days)

Tx: bismuth, ampicillin, fluoroquinolone, or trimethoprim/sulfamethoxazole

RF: potato or egg salad, lettuce, raw veggies

Person-person under poor sanitary conditions (fecal-oral)

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20
Q

How do you Dx Shigella?

what are some complications?

A

Dx: fecal leukocytes (+); stool culture (difficult to differentiate from IBD), lactose (-)

Complications: after infxn - reactive arthritis & HUS

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21
Q

Salmonella typhimurium

Microbio:

Sxs:

Tx:

RF:

A

Microbio: gram (-), non-lactose fermenting, motile, rod

  • Orgnaism penetrate SI mucus layer & traverse the intestnal epithelium thu M cells overlying peyer’s patches
  • MC in US = non-typhoidal –> gasteroenteritis

Sxs: watery –> bloody diarrhea; fever, abd cramp, N/V

Tx: self-limited (5-10 days); ABx NOT indicated (non-typhoid)- give for disseminated dx, immunocompromised, infants

RF:

  • contaminated food (at least 100,000 needed) eggs, poultry, milk/dairy, beed, shellfish
  • animal exposure: reptile (turtle), ducks, birds
  • immunocompromised pt: HIV, leukemia, sickle cell pt, osteomyelitis
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22
Q

How do you Dx salmonella typhimurium

what are complications

A

Dx: stool culture; fecal leukocytes (+)

Complication: septic arthritis, abscess, osteomyelitis, reactive arthritis, endocarditis

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23
Q

Salmonella typhi

Microbio:

Sxs:

A

Microbio: gram (-), rod, anaerobic

  • organism penetrate SI mucus layer & traverse the intestinal epithelium thru M cells overlying peyer patches
  • lives only in humans - healthy carrier (gallbladder colonization) - asymp carriers

Sxs:

  • typhoid fever, 7-14 days after ingestion,
  • 2 phases seperated by asymp phase
    • systemic sustained febrile illness
    • sometimes erythematous “salmon-colored” maculopapular rash of flat rose-colored spots & pea-soup green-yellow foul smelling diarrhea –> bloody diarrhea
  • encephalopathy, splenomegaly, conjunctivitis
  • relative bradycardia
  • intestinal perforation; hemorrhage –> death
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24
Q

Salmonella typhi

Dx

Tx

RF

A

Dx: stool culture; blood culture; fecal leukocytes

Tx: prevent - good food prep, hand wshing, vaccine; fluoroquinolone (becoming resistant), ceftriaxone & azithryomycin

RF: international tavel, poor sanitation

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25
Campylobacter jejuni Microbio: Sxs: Dx:
**Microbio:** _gram (-); motile w/ flagellum_; host = wild birds (include ducks) **Sxs:** watery --\> **bloody diarrhea**; fever, crampy abd pain, _erythema nodosum_ **Dx:** fecal leukocyte, stool culture: **have to order Campy Blood Agar**
26
Campylobacter jejuni Tx RF Complications
**Tx:** self limited (7 days); supportive **RF:** ingest raw/undercooked meat (**poultry**), dairy (raw milk); cross-contamination; contaminated water, _Traveler diarrhea_ **Complications:** reactive arthritis, **guillan-barre's syndrome**
27
Vibrio cholerae ## Footnote **Microbio:** **Sxs:** **Dx:**
**Microbio:** _gram (-) bacilli, anaerobric w/ flagellum_ (toxin production) **Sxs:** _watery diarrhea (rice water);_ **Profuse** (1 L/hr); **dehydration** (**electrolyte imbalance)** --\> hypotension --\> renal failure --\> death **Dx: Stool microscopy & gram stain**
28
Vibrio cholerae RF Tx/Prevention
**RF:** **waterborne illness (saltwater), raw oyster (sawfood);** _underdeveloped nation_ **Tx/Prevention: rehydration/electrolyte**, ABx may shorten duration; _vaccination_. sanitation
29
Vibrio Parahemolyticus Microbio Sxs Dx RF
**Microbio**: _gram (-) bacilli,_ cytotoxin production **Sxs**: watery --\> **bloody** diarrhea; N/V/abd cramps **Dx**: fecal leukocytes, stool culture **RF: seafod** (shellfish, oysters, shrimp)
30
Vibrio vulnificus Microbio Sxs RF
**Microbio:** _gram (-) bacillus_ **Sxs**: vomit, diarrhea, abd pain w/i 16 hrs; **bullous skin lesion** **RF: open would in water** (life threatening in immunocompromised - esp _cirrhosis_ & hemochromatosis)
31
Aeromonas Hydrophila Microbio Sxs Tx RF
**Microbio:** _gram (-), non-spore forming, rod-shaped, facultative anaerobic, motile w/ flagella_ **Sxs:** type 1: _cholera-like: water rice water diarrhea;_ type 2: **_bloody_** mucoid stool **Tx:** ampicillin **RF:** * **Fresh water** or brackish water * _eating fish or shellfish_ * MC: **foot & ankle** _wound_ in water ==\> rapidly become **necrotizing fascitis** * _Scuba divers_ - swallow small amount fresh water --\> _gastroenteritis_
32
What is the epidemiology & RF for traveler's diarrhea (TD) how does it present
travel - asia, africa, south & central america, mexico (3 days-2 wks after travel) ingest contaminated food/water **RF**: travel to deveoping countries; H2 blocker or PPI (bc lower pH) sxs: N/V, _watery_ diarrhea, bloating, abd cramp, fatige, malaise, loss of appetite
33
what is the most common cause of travelers diarrhea
**enterotoxigenic E. coli (ETEC)** affect SI found in contaminate h2o, salads, meats, cheese _enterotoxin production_
34
what are causes of traveler's diarrhea
MC = ETEC (asia) camylobacter jejuni salmonella shigella aeromonas EAEC norovirus coronavirus
35
Giardia associated diarrhea may present in..
visitors to **russia** **campers** backpackers, swimmers
36
E. Coli (ETEC) Microbio Sxs Dx Tx RF
**Microbio:** _gram (-)_ \***single most imp agent for TD\*** **Sxs:** _watery diarrhea_, N/V, occasional fever, sudden onset (3-6 days long) **Dx:** fecal leukocyte **NEGATIVE,** *diagnose clinically* (cant differentiate btn ETEC and normal strains) **Tx:** ABx may reduce infxn by 1-2 days (bactrim, doxycycline, ciprofloxin); bismuth may help **RF:** kids, elderly, travelers - ingested contaminated food/water
37
E. Coli (EHEC - O157:H7) (aka shiga-toxin producing e. coli (STEC) Microbio Sxs Dx
**Microbio**: _gram (-), produces shiga-**like** toxin_ **Sxs:** * watery --\> **bloody diarrhea** (--\> ischemic colitis) * MCC = acute hemorrhagic colitis * abd tenderness, **NO FEVER** **Dx:** * **CBC- peripheral leukocytes (+) (increased WBC), anemia, thrombocytopenia** * **fecal leukocytes & _lactoferrin_** * stool culture: _shiga-like toxin_
38
E. Coli (EHEC - O157:H7) (aka shiga-toxin producing e. coli (STEC) Tx: RF: Complications:
**Tx:** **supportive**, **rehydration,** (_ABx ONLY in severe cases - BC it can INCREASE RISK OF HUS)_ **RF:** food (**under-cooked hamburger**), raw veggies, milk, unpasteurized apple cider, roast beef; animal contact **Complications: _HUS_**- occurs 5-10 days into course ( **\> chance in children &/or if EHEC treated w/ ABx**)
39
Besides ETEC and EHEC, what are the other strains of e. coli and how does it present
EAEC: persistent diarrha in kids, non-bloody, afebrile EPEC: infantile watery or bloody diarrhea EIEC: fever, abd pain, water --\> _bloody_ diarrhea w/ leukocytes
40
Yersinia enterocolitica Microbio Sxs Dx
**Microbio:** _gram (-) coccobacilli_, contaminated food/water OR DAIRY, contaminated domestic animal feces **Sxs:** _bloody diarrhea_, fever, N/V, abd cramps + _phayngitis_, **R-sided abd pain (mimic appendicitis or crohns** **Dx:** **stool/blood culture;** _clinically indistinguishable from salmonella or shigella;_ **fecal leukocytes**
41
Yersinia enterocolitica Tx RF complications
**Tx:** supportive **RF:** **derangement of Fe metabolism enhance virulence** _-Fe-overload syndrome, cirrhosis, hemochromatosis, aplastic anemia, thalssemia;_ diabetes, pre-existing GI disorder **complications:** _reactive arthritis,_ erythema nodosum, myocarditis, kidney dz
42
listeria monocytogenes Microbio Sxs Dx Complications
**Microbio:** _gram (+)_ **Sxs:** _non-bloody diarrhea_, fever, HA, N/V; pregnant pt - nonspecific (mild fever & malaise) **Dx: _blood culture_** or CSF **Complications:** meningoencephalitis & listeria placentitis
43
What are the RF for Listeria monocytogenes
**pregnant women** (--\> listeria placentitis) extremes of ages, immunosupressed, pt w/ hemochromatosis contaminated food: raw milk, _unpasteurized dairy,_ **deli meats**
44
Tropheryma whipplei Etiology: Hx/PE Dx Tx/Prognosis
**Etiology:** **whipple dz, rare multi-system dz,** _gram (+) bacillus, not acid fast_ (white men 40-60s); _source unknown_ **Hx/PE:** fever, LAD, **arthralgia, _wt. loss,_ malabs, chronic diarrhea,** hypoalbuminemia & edema, HF, vascular regurg, CNS symps, late hypotension **Dx:** _Endoscopy w/ duodenal Bx - periodic acid Schiff (+) macrophages w/ characterisitc bacillus_; labs - evidence of malabs & steatorrhea **Tx/Prognosis:** _ABx - prolonged tx for at least 1 yr;_ drugs that cross BBB; goal- prevent progression _untreated =_ **fatal**
45
Clostridium difficile Microbio Sxs Dx Rf
**Microbio**: _anaerobic, gram (+), spore forming bacillus; cytotoxin production_ **Sxs:** _watery-_diarrhea, abd pain, fever **Dx:** **_stool assay - PCR for toxin (A & B)_**; peripheral leukocytes (+), fecal leukocytes (+/-), **pseudomembranes** on colonic mucosa (sigmoidoscopy) **RF:** w/i last 2 months = hospitalized/ill contact, ABx: **_clindamycin, cephalsporin, fluoroquinolones_**, PPI
46
What are Tx and complications for C. diff
**Wash hands w/ _soap & water_** po/iv metronidazole; po vancomycin Complications: **toxic megacolon** (50% mortality rate) - aggressive tx & SRG consult for colesctomy
47
What are nosocomial infxns
= hospital & long-term care facilities **infxous diarrhea** is one of most freq categories --\> _foul smelling & WBC \> 1,500_ **MC = C. diff** _Norovirus_
48
Rotovirus Virology Sxs Dx Tx/Prevention
**Virology**: _ds-RNA_, spread fecal-oral **Sxs:** * **MCC of acute diarrhea in infants (\<2);** esp _winter_ months * _watery_ diarrhea, vomiting * w/i 72 hrs; last 2-3 days * death - dehydration **Dx:** fecal leukocytes (-); **viral culture/PCR -"Wagon wheels"** **Tx/Prevention:** supportive care**/_vaccine_**
49
Adenovirus (serotypes 40 & 41) Virology Sxs/population Dx Tx
**Virology**: _ds-DNA_ **Sxs/population** * **children** * _watery_ diarrhea & vomiting * **fever**, chills, myalgias, sore throat * _MCC: viral_ _Conjucntivitis_ _in children_ * _Pharyngitis- exudate_ **Dx:** viral culture- can shed for months after resolution **Tx:** supportive care
50
Norkwalk virus (Norovirus) Virology Sxs/population Dx Tx
**Virology**: _small non-enveloped RNA_ **Sxs/population** * older children/adults ; **outbreak** via contaminate food, water, person-to-person (_nursing home, child care centers, **cruise ships**)_ * _watery_- diarrhea, vomit * w/i 24-48 hrs & lasts 3 days **Dx:** fecal leukocytes (-), _routine viral culture- UNREVEALING_ **Tx:** supportive care
51
CMV Population Virology Sxs Dx
**Population: immunosuppressed pt** (AIDS, organ transplant pts, _CD4 count \< 200)_ **Virology**_: herpes fam- ds-DNA linear_ **Sxs:** **_bloody_**-diarrhea, fever, abd, pain; lasts several weeks **Dx:** _Endoscopy w/ Bx of ulcerated lesions using CMV **specific** stains_
52
Entamoeba histolytica (=trophozoite) Sxs Dx
**Sxs:** * **MCC of _dysentery_ in the world** * most = asymp BUT need Tx if found * **bloody diarrhea** * fever, tenesmus, abd pain * **penetrate bowel & into portal circulation --\> _liver abscess_** **Dx:** * **_"flask-shaped ulcer" on histolgy_** * check stool for **ova & parasite** * **Stool Ag** * fecal leukocytes (+)
53
What are RF, Tx & Complications for Entamoeba histolytica
**RF:** crowded living (fecal-oral) - mental health institutions, poor sanitation, ingested contaminated food/water _endemic areas_, africa, central/south america **Tx**: eliminate invading trophozoites; eradicate intestinal carriage or organism **Complications**: _toxic megacolon or **pneumatosis coli**_ (air in lining of colon)
54
Giardia lamblia Parasitology Sxs Dx
**Parasitology:** _pear shaped, 4 flagella, 2 nuclei protozoan (trophozoite)_; fecal-oral transmission; interfere w/ fat abs **Sxs:** could be asymp * _watery malodorous diarrhea;_ common cause for **persistent diarrhea** * steatorrhea, flatulence, abd pain, belching, wt loss, nausea, malaise, cramps, anorexia, bloating **Dx:** _fecal leukocytes (-);_ check stool for _ova parasites; **stool Ag detection**_
55
What are RF and Tx for Giardia lamblia
**RF**: * _water (lake/streams) - hiking/camping_ * zoonosis: beaver, cattle, dogs, rodents, big horn sheep * person-to-person (daycare) * contamincated water in Russia * _IgA def_ Tx: supportive, tinidazole/metronidazole
56
Cryptosporidium parvum Parasitology Sxs Dx
**Parasitology:** oocyte w/ 4 motile sporozoites; person-to-person **Sxs** * self limited diarrhea - immuno**competent** pts (7-14 days) * life-threatening intractable in immuno**_suppressed_** pt (can be indefinite) * _watery_ diarrhea -_large volumes! --\> can lead to dehydration_ **Dx:** * **stool Ag detection or direct microscopy** * **-modified acid-fast staining, direct fluorescent Ab** * fecal leukocytes (-)
57
What are RF and Tx for Cryptosporidium parvum
RF: water-borne - contaminated food/water outbreaks involve: **swimming pool**, daycare, unsanitary milk production, municipal water supply Tx: _resistant to chlorine tx_ immuno**competent-** supportive/hydrate immuno**_suppressed_**- antivirals to increase CD4 count & boost immune system
58
Strongyloides stercoralis Parasitology Sxs RF
**Parasitology:** **nematode-roundworm**; enter via exposed skin _(bare feet on contaminated soil)_ --\> Larvae travel & grow in lungs--\> cough--\> then swallowed --\> travel to SIs - all continents except for Antarctica: (MC tropical/subtropical) **Sxs:** often asymp Abd pain, vomiting, bloating, diarrhea, cough, SOB, Perianal urticaria, migratory rash **RF** * socioeconomic disadvantaged, institutionalized populations, and in _rural areas_ * associated w/ agricultural activities * _Risks for hyperinfection_: immuno**_compromised_** (Chemo/steroid use) --\> pt w/ **HTLV-1** are more susceptible (not tru for HIV/AIDS pts)
59
Strongyloides stercoralis Dx Tx
Dx: _rhabditiform larvae in stool; eosinophils in stool_ Tx: anti-helmintic
60
Cyclospora cayetanensis RF Sxs Dx Tx
**RF:** **Produce** from endemic areas- lettuce, fresh basil, and imported raspberries (**chlorine or iodine** is _CANT_ kill these) **Travel** - endemic areas (MC tropical/subtropical) **Sxs:** * Malaise, anorexia, nausea, low-grade fever * **Watery** diarrhea * last up to 21 days in immuno**competent** * Indefinitely in immuno**_suppressed_** **Dx**: fecal leukocytes (-); **oocysts** in stool **Tx**: Bactrim
61
Cystoisospora belli RF Sxs Dx Tx
**RF:** MC tropical/subtropical; ingest contaminated food/water **Sxs:** * acute, _non-bloody watery_ diarrhea * Crampy abd pain, * Can last for weeks --\> cause malabs & wt loss. * Immuno**suppressed** pts & infants/kids- diarrhea = severe * **Dx:** * _Eosinophilia_ possible * oocysts passed in small amounts intermittently --\> **repeated stool exam & concentration procedures** * if stool exam (-) --\> exam **duodenal specimens by Bx** * **oocysts** visualized on wet mounts by microscopy with bright-field; stained by **modified acid-fast stain** **Tx:** treatable/preventable; Bactrim Ds
62
What is Ascaris lumbricoides (aka Ascaris or ascariasis)
hookworm/whipworm (aka soil-transmitted helminths) fecal-oral ingest eggs from soil can grow long --\> _bowel obstruction_
63
Where can you find Diphyllobothrium latum what are sxs?
=fish tapeworm (raw/undercooked) can grow long (30 feet) abd symptoms abs vit B12 --\> **B12 def** --\> pernicious anemia and neurological symptoms
64
Where do you find Schistosoma mansoni (schistosomiasis; trematodes) what are sxs & Tx
Worldwide prob, uncommon USA; Africa -2nd MCC of _esophageal varices_ (1st = Alc) contaminated _freshwater snails_ --\> skin contact w/ contaminated water --\> _**bloody** stools, bladder CA, liver cysts_ MCC of small portal vein branch obstruction Tx: Praziquantel
65
Differentiate Taenia solium & Taenia saginata
**Taenia solium**- pork tape worm (hooks); undercooked pork; mostly asymp; rare serious cases= Cysticercosis (seizures) and muscle or eye disease **Taenia saginata-** beef tape worm (suckers); undercooked beef; mostly asymp
66
Where do you find Echinococcs granulosis how does it present
=tapeworm unsanitary livestock (sheep); dogs= main carriers--\> pet infected fecal-oral poor sanitation- ingest soil, water &/or veggies contaminated w/ infected dog feces Form _cysts in liver or lungs_ --\> _free-flowing: “hydatid sand” on CT_
67
What are sxs, dx and tx of Enterobius vermicularis (pinworm)
=fecal-oral Sxs: severe perianal itching Dx: "scotch" tape test Tx: medenazole
68
What is the general protocol for Tx of acute infxous diarrhea
**Hydration (po/iv)** **maintain electrolyte balance** Anti-motility agent if _no fever & NON-bloody stool;_ **not for C. diff or EHEC** Probiotic maybe helpful ABx- usually not required
69
What are dietary recommendations for acute infxous diarrhea
BRAT diet- banana, rice, applesauce, toast easily digestable - boiled potatoes, crackers, yogurt, soup rice water avoid lactose, high fiber foods, fats, caffeine, alc
70
What are prophylaxis/prevention methods of acute infxous diarrhea
**wash hands w/ soap & water** (sanitizer _ineffective against_ norovirus & C. diff) **travelers:** eat hot foods, _bismuth - darken tongue/stool_; ABx prophylaxis in certain pts (**not usually recommended**)
71
What acute infxous agents have a vaccine
rotavirus s. typhi v. cholera hep A
72
what infxous agents may lead to reactive arthritis
salmonella campylobacter shigella yersinia (=conjunctivits, urethritis, arthritis; cant see, cant pee, cant climb a tree)
73
What can Yersiniosis lead to
reactive arthritis autoimmune-type thyroidistis pericarditis glomerulonephritis
74
Pathogens that affect _small bowel_, will present with which symptoms
large vol, _watery_ stools, abd cramp, _wt. loss_, **dehydration/malabs** =Salmonella, V. cholerae, ETEC, EPEC, Yersinia, Rotavirus, Norovirus, CMV, Adenovirus, Giardia, Cryptosporidium, Cyclospora, Clostridium perfringens, Staph aureus, Bacillis cereus
75
Pathogens that affect _large bowel,_ will present w/ which sxs?
freq, small volume stools _fevers, **blood/wbc in stool**, fecal leukocytes (+)_ =Campylobacter, Salmonella, Shigella, Yersinia, EIEC, EHEC, C. diff, Vibrio parahaemolyticus, E. histolytica, CMV, Adenovirus, Herpes simplex
76
What pathogens are common in AIDs (\< 200 CD4)
Opp infxns: *Mycobacterium species* Certain viruses: *CMV, adenovirus, and herpes simplex* Protozoa: *Cryptosporidium, Cystoisospora belli, Microsporida, and Blastocystis hominis)* **Agents transmitted venereally per rectum** -- \>(e.g., *Neisseria gonorrhea, Treponema pallidum, Chlamydia*) ==\> **proctocoltis**

GI/GU II Exam 1 (16 decks)

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