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Infectious Disease II (P3 Spring) > Exam 1: Gastrointestinal Infections (OBrien) > Flashcards

Exam 1: Gastrointestinal Infections (OBrien) Flashcards

1
Q

What type of pathogens can cause GI infections? Majority are caused by?

A
  • viral (majority caused by)
  • bacterial
  • parasitic
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2
Q

What is the biggest symptoms of GI infections that is responsible for MORBIDITY and MORTALITY?

A

vomiting and diarrhea–> leads to dehydration

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3
Q

ACUTE diarrhea:

  • ______ in CONSISTENCY of bowel movements (loose/uniformed stool)
  • _______ in frequency of stools to _____ per day
A

decrease in consistency

increase in frequency; greater than or equal to 3

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4
Q

PERSISTENT diarrhea:

*diarrhea lasting between _______ days

A

14-30 days

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5
Q

What is inflammation f the lining of the GI tract?

A

infectious diarrhea= gastroenteritis

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6
Q

T/F Most of those who die of diarrheal illness in the U.S. are elderly

A

TRUE

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7
Q

Groups at risk for GI infections (4)

A
  • Travelers and campers
  • Patients in chronic care facilities
  • Military personnel overseas
  • Immunocompromised patients
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8
Q

T/F The etiologic agent of GI infections is RARELY IDENTIFIED

A

TRUE

  • Infrequency of stool samples collected
  • Inability of many laboratories to detect full range of pathogens [especially viruses]
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9
Q

Etiology of SECRETORY Diarrhea (4)

A
  • virus (norovirus OR rotavirus)
  • ETEC (enterotoxigenic E.coli)
  • Vibrio cholerae
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10
Q

Etiology of INFLAMMATORY Diarrhea (5)

A
  • shigella
  • salmonella
  • C.diff
  • Campylobacter
  • EHEC (enterohemorrhagic E.coli)
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11
Q

______ virus is more common in CHILDREN vs _____ virus being more common in ADULTS

A

rotavirus; notovirus

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12
Q

What is the most common cause of traveler’s diarrhea?

A

ETEC

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13
Q

How are BACTERIAL GI infections mostly transmitted?

A

contaminated food or water

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14
Q

SECRETORY VS. INFLAMMATORY

Organisms cause altered movement of ions and water

A

secretory

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15
Q

SECRETORY VS. INFLAMMATORY

Severe watery diarrhea

A

secretory

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16
Q

SECRETORY VS. INFLAMMATORY

toxin production; INCREASE in Cl secretion; DECREASE Na absorption

(increase colonic secretion)

A

secretory

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17
Q

SECRETORY VS. INFLAMMATORY

Organism adhere to intestinal mucosa

A

inflammatory

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18
Q

SECRETORY VS. INFLAMMATORY

Ulceration of; death to intestinal epithelium —>DYSENTERY diarrhea

A

inflammatory

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19
Q

________= passing grossly blood stools

A

dysentery

not all stools may contain visible blood

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20
Q

SECRETORY VS. INFLAMMATORY

watery 
INCREASED volume (+)
less stools
NO blood
few PMN
A

secretory

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21
Q

SECRETORY VS. INFLAMMATORY

blood
INCREASED volume
more stools (greater than 10)
BLOOD
many PMN
A

inflammatory

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22
Q

What are complications of secretory diarrhea? (3)

A
  • severe dehydration
  • shock
  • electrolyte imbalance
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23
Q

What are complications of inflammatory diarrhea ?

A
  • mild dehydration
  • seizures
  • sepsis
  • toxic megacolon
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24
Q

When is it recommended to obtain stool cx? (3)

A
  • dysenteric diarrhea
  • diarrhea lasting longer than 7 days
  • diarrhea where outbreak is suspected
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25
Q

When is it NOT recommended to obtain stool cx? (3)

A

mild to moderate watery diarrhea

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26
Q

What are routinely checked in stool cx? (3)

A
  • campylobacter
  • salmonella
  • shigella
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27
Q

T/F Correcting fluid and electrolyte imbalances to prevent dehydration is the CORNERSTONE of management

A

TRUE

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28
Q

What is used to assess the degree of dehydration?

A

percentage of body weight LOST

BP, HR, breathing, skin fold, etc

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29
Q

What are the types of rehydration therapy?

A

oral rehydration

-IV fluid therapy

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30
Q

What is recommended for mild to moderate dehydration?

A

oral rehydration therapy (ORT)

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31
Q

What are the necessary components of ORT? (5)

A
  • Carbs
  • Na
  • K
  • Cl
  • water
32
Q

What can help prevent over hydration?

A

oral rehydration therapy

33
Q

advantages of ORT (2)

A
  • inexpensive and non-invasive

- does not require hospitalization

34
Q

What is recommended for severe dehydration?

A

IV fluid therapy

35
Q

T/F Lactated ringer’s solution is preferred for IV fluid therapy over normal saline

A

TRUE

36
Q

When is ANTIMICROBIAL therapy NOT recommended? (2)

A
  • mild to moderate diarrhea (b/c most are viral)

- EHEC diarrhea

37
Q

When is ANTIMICROBIAL therapy recommended? (2)

A
  • febrile dysenteric diarrhea (Shigella, Campylobacter, Salmonella)
  • traveler’s diarrhea (ETEC)
38
Q

SEVERITY of diarrhea

mild

A

3 or less stools per day

39
Q

SEVERITY of diarrhea

moderate

A

4 or more stools per day

40
Q

SEVERITY of diarrhea

severe

A

6 or more stools per day

fever
presence of blood

41
Q

When deciding antimicrobial therapy, what should be taken into consideration?

A

local susceptibility patterns

42
Q

antimicrobial therapy

ETEC- watery diarrhea

A

Capri x 1-3 days

43
Q

antimicrobial therapy
ETEC- watery diarrhea
alternative

A

Zpak OR
Rifaximin

(x3days)

44
Q

antimicrobial therapy

shigella

A

Cipro x 1-3 days

45
Q

antimicrobial therapy

salmonella

A

Cipro OR Levo x 7-10 days

46
Q

antimicrobial therapy

campylobacter

A

Zpak x 3 days

47
Q

Due to increased rates of resistance ____ cant be used for Campylobacter

A

FQs

use Zpak

48
Q

Salmonella is very resistant; what can be used inpatient?

A

ceftriaxone

49
Q

Antibiotic therapy is NOT recommend for _____ due to potential for worsened outcomes. They increase the risk of HEMOLYTIC UREMIC SYNDROME (HUS)

A

EHEC

inflammatory diarrhea

observed in children and elderly

HUS: acute renal failure; thrombocytopenia; hemolytic anemia

50
Q

Anti motility agents ARE NOT recommended in patients with_____? Why?

A

dysenteric diarrhea

  • slows fecal transit time and extend toxin associated damage
  • puts pt at risk of HUS
51
Q

What 2 ANTI-MOTILITY agents are used for WATERY diarrhea? Which is used more often?

A
  • Loperamide (more commonly used)

- Bismuth subsalicylate (pepto bismol)

52
Q

When should Pepto Bismol NOT be used? (3)

A
  • in children
  • allergy to salicylate
  • anticoagulant pts
53
Q

T/F There is a vaccine for ROTAVIRUS

A

TRUE

infants beginning at age 2 months

54
Q

Campylobacter is more common in ____ countries and causes traveler’s diarrhea

A

Asian

55
Q

When do the onset of traveler’s diarrhea usually occur?

A

during the first week of travel

56
Q

Although prophylaxis is NOT indicated for traveler’s diarrhea, what can be used?

A

Cipro (has collateral damage though)

  • Pepto Bismol
  • Rifaximin for ETEC
57
Q

T/F For traveler’s diarrhea usually self treatment

-take the medication when you first have symptoms

A

TRUE

or single dose of FQ (Cipro x1 day)

58
Q

C.diff is a gram __________ bacteria

A

positive spore-forming ANAEROBIC

59
Q

What is C.diff resistant to?

A
  • heat
  • drying
  • pressure
  • many disinfectants

(due to spores)

60
Q

What are CLASSIC RISK factors for C.diff? (3)

A
  • exposure to antibx
  • prolonged stay in healthcare facility
  • elderly

additional: PPI use, GI surgery, immunosuppression; inflammatory bowel disease

61
Q

High Risk Antibx for C.diff

A

CCCF

  • clindamycin
  • 3rd and 4th gen cephalosporins
  • Carbapenems
  • FQ
62
Q

T/F Toxin production is essential for C.diff manifestation

A

TRUE

only see C. diff infection in pts that produce the toxin

antibx disrupt the normal flora allowing C.diff to colonize

63
Q

What is the primary mode of transmission of C.diff?

A

person to person spread through the fecal-oral route

64
Q

________ w/ _______ = you should think C.diff

A

diarrhea w/ antibx OR healthcare exposure

65
Q

Testing options for C.diff (3)

Patients with unexplained and new-onset diarrhea

A
  • PCR
  • GDH plus toxin
  • PCR plus toxin
66
Q

PCR

A
  • most commonly used in hospitals
  • highly SENSITIVE, so risk for false positive
  • ONLY test if unexplained new onset diarrhea
67
Q

What is used to determine the SEVERITY OF CDIFF? (4)

A
  • fever (greater than 38.5)
  • WBC (greater than 15,000)
  • SCr (greater than 1.5)
  • Albumin (less than 3)
68
Q

Clinical Def of C.diff:

WBC less than 15,000 OR SCr less than 1.5

A

initial episode, NON-SEVERE

69
Q

Clinical Def of C.diff:

WBC greater than 15,000 AND Scr greater than 1.5

A

initial episode, SEVERE

70
Q

T/F Metronidazole associated with higher treatment failure rates when used for severe or complicated CDI

A

TRUE

risk factors:

  • age ((greater than 60)
  • hypoalbuminemia
  • ICU stay
71
Q

SE of Flagyl? (4)

A
  • disulfam-like rx w/ alcohol (N and V/ face flushing)
  • GI intolerance
  • metallic taste
  • peripheral neuropathy
72
Q

_____ should be avoided in pts with macrolide allergy

A

fidaxomicin

73
Q

_______ in comparison to Vanco caused fewer recurrences at 25 days after therapy for CDI

A

fidaxomicin

its the same as vanco w/ first occurence

74
Q

T/F There are high cure rates w/o relapse for C.diff patients treated w/ FMT

A

TRUE

75
Q

Zinplava (Bezlotoxumab)

A
  • monoclonal antibody bind to C.diff toxin B
  • NOT used to treat, but given w/ antibx
  • INCREASED rate of cardiac failure

Infectious Disease II (P3 Spring) (13 decks)

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