Evaluation of Diarrhea Lecture Powerpoint

Question 1

2nd leading worldwide cause of death in children under 5, and leading cause of malnutrition in this group

Answer 1

diarrhea

Question 2

Diarrhea

Answer 2

Passage of frequent (3 or more a day) small volume loose stools

Question 3

Acute vs chronic diarrhea

Answer 3

Acute is a day up to 2 weeks, usually due to infection and self limiting or drugs, chronic is at least 4 weeks and is more often associated with irritable bowel syndrome, inflammatory bowel disease, intolerances, certain medications

Question 4

Osmotic diarrhea

Answer 4

Occurs when too many solutes retained in the intestines which inhibits water absorption, often due to sugar malabosrption (lactose, fructose, etc) however electrolyte absorption is NOT impaired, often resolves upon cessation of ingestion of irritating substance

Question 5

Secretory diarrhea

Answer 5

Diarrhea that occurs when excretion of water in intestine exceeds absorption, frequently involves electrolyte loss, usually does not resolve if fasting, infections are the #1 cause

Question 6

Functional diarrhea

Answer 6

Diarrhea that is variable but improves with fasting and is most typically associated with irritable bowel disease

Question 7

Fatty diarrhea

Answer 7

Often steatorrhea, caused by malabsorption (damage or loss of absorptive ability either due to surgery, giardia, mesenteric ischemia, or maldigestion, etc.

Question 8

Factitious diarrhea

Answer 8

Self induced via laxative use diarrhea seen in patients with munchausen’s or bulimia

Question 9

Inflammatory/exudative diarrhea

Answer 9

Sees occult or frank blood or pus as well as mucus in the stool, can be due to IBD, infection, etc

Question 10

Acute diarrhea treatment (2)

Answer 10

• hydration (electrolytes and glucose)

- BRAT diet

Question 11

Infectious diarrea transmission (2)

Answer 11

• fecal oral route or contamination

- hand contamination

Question 12

1 cause of parasitic diarrhea in US and how to you test for it? How do you treat it?

Answer 12

-Giardia, stool ova and parasite, metronidazole

Question 13

Entamoeba histolytica infection and how do you treat it?

Answer 13

• Causes diarrhea, fever, stomach pain, cramping

- treated with metronidazole

Question 14

Cryptosporidiosis infection, diagnosis, and treatment

Answer 14

Can survive chlorine disinfectants and be a cause of chronic diarrhea in HIV/immunocompromised, diagnosed via stool culture, treated with nitazoxanide

Question 15

2 most common viral causes of gastroenteritis

Answer 15

• norwalk virus

- rotavirus (foul smelling excessive diarrhea)

Question 16

Staphylococcus food poisoning characteristics

Answer 16

• often ingesting foods contaminated with toxin
• lasts 24 hours
• lacks fever
• cannot be passed to others
• self limiting
• n/v/d

Question 17

Clostridium perfringens infection characteristics

Answer 17

• foods kept warm before serving (catering)
• fever absent
• lasts 24 hours

Question 18

E coli 0157 enterohemorrhagic (shiga toxin producing) infection characteristics

Answer 18

• usually raw foods or contaminated water
• can spread person to person
• mild to severe diarrhea
• may cause hemolytic uremic syndrome (anemia, uremia, thrombocytopenia)
• do NOT use antibiotics

Question 19

Enterotoxigenic e coli (ETEC) infection characteristics

Answer 19

-Most common cause of travelers diarrhea, food and water contaminated with feces, incubates 1-2 days and resolves in 3-4 days

Question 20

Salmonella enterica infection characteristics

Answer 20

• contaminated picnic foods
• diarrhea can last several days
• self limiting

Question 21

Salmonella typhi infection characteristics

Answer 21

• severe form of salmonella
• life threatening, progressive fever, abdominal pain, rose spots
• stool culture/blood culture
• treatment needed with cipro or ceftriaxone otherwise severe complications
• can be asymptomatic carriers

Question 22

Shigella infection characteristics

Answer 22

• spread thru any contact with stool that has shigella germs
• greatest risk children under 5 in daycare centers
• highly infectious
• usually self limiting

Question 23

Yersinia enterocolitica infection characteristics

Answer 23

• contaminated meat or dairy products
• may mimic appendicitis
• can cause reactive arthritis

Question 24

Camplyobacter jejuni infection characteristics

Answer 24

• common bacterial cause of diarrhea in the US from undercooked meats, dairy, freshwater
• very high fever
• sea gull wing rods on gram stain
• reactive arthritis or guillan barre syndrome

Question 25

Vibrio cholera infection characteristics

Answer 25

• normally uncomplicated
• rice stool, can get from shellfish
• need to keep hydrated

Question 26

Toxic megacolon and treatment options (2)

Answer 26

Rare but severe complication of colonic inflammation, characterised by distension of total or segment of colon and associated with systemic toxicity, treated with antibiotics or surgery

Question 27

C diff has to be treated with what type of administration?

Answer 27

PO

Question 28

Patient presents with acute onset of watery, nonbloody, volumous diarrhea accompnaied by nausea and vomiting, does not have a fever. What organism?

Answer 28

-enterotoxigenic E coli

Question 29

Patient has had chronic diarrhea. Stool cultures grow out cryptosporidium. What is important to do next?

Answer 29

-test patient for HIV

Question 30

Treatment of choice for diarrhea caused by giardia?

Answer 30

Metronidazole (flagyl)

Question 31

What is the most common cause of travelers diarrhea

Answer 31

-e coli