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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
When is it NOT recommended to obtain stool cx? (3)
mild to moderate watery diarrhea
26
What are routinely checked in stool cx? (3)
- campylobacter - salmonella - shigella
27
T/F Correcting fluid and electrolyte imbalances to prevent dehydration is the CORNERSTONE of management
TRUE
28
What is used to assess the degree of dehydration?
percentage of body weight LOST | BP, HR, breathing, skin fold, etc
29
What are the types of rehydration therapy?
oral rehydration | -IV fluid therapy
30
What is recommended for mild to moderate dehydration?
oral rehydration therapy (ORT)
31
What are the necessary components of ORT? (5)
- Carbs - Na - K - Cl - water
32
What can help prevent over hydration?
oral rehydration therapy
33
advantages of ORT (2)
- inexpensive and non-invasive | - does not require hospitalization
34
What is recommended for severe dehydration?
IV fluid therapy
35
T/F Lactated ringer's solution is preferred for IV fluid therapy over normal saline
TRUE
36
When is ANTIMICROBIAL therapy NOT recommended? (2)
- mild to moderate diarrhea (b/c most are viral) | - EHEC diarrhea
37
When is ANTIMICROBIAL therapy recommended? (2)
- febrile dysenteric diarrhea (Shigella, Campylobacter, Salmonella) - traveler's diarrhea (ETEC)
38
SEVERITY of diarrhea mild
3 or less stools per day
39
SEVERITY of diarrhea moderate
4 or more stools per day
40
SEVERITY of diarrhea severe
6 or more stools per day fever presence of blood
41
When deciding antimicrobial therapy, what should be taken into consideration?
local susceptibility patterns
42
antimicrobial therapy | ETEC- watery diarrhea
Capri x 1-3 days
43
antimicrobial therapy ETEC- watery diarrhea alternative
Zpak OR Rifaximin (x3days)
44
antimicrobial therapy | shigella
Cipro x 1-3 days
45
antimicrobial therapy | salmonella
Cipro OR Levo x 7-10 days
46
antimicrobial therapy | campylobacter
Zpak x 3 days
47
Due to increased rates of resistance ____ cant be used for Campylobacter
FQs use Zpak
48
Salmonella is very resistant; what can be used inpatient?
ceftriaxone
49
Antibiotic therapy is NOT recommend for _____ due to potential for worsened outcomes. They increase the risk of HEMOLYTIC UREMIC SYNDROME (HUS)
EHEC inflammatory diarrhea observed in children and elderly HUS: acute renal failure; thrombocytopenia; hemolytic anemia
50
Anti motility agents ARE NOT recommended in patients with_____? Why?
dysenteric diarrhea - slows fecal transit time and extend toxin associated damage - puts pt at risk of HUS
51
What 2 ANTI-MOTILITY agents are used for WATERY diarrhea? Which is used more often?
- Loperamide (more commonly used) | - Bismuth subsalicylate (pepto bismol)
52
When should Pepto Bismol NOT be used? (3)
- in children - allergy to salicylate - anticoagulant pts
53
T/F There is a vaccine for ROTAVIRUS
TRUE infants beginning at age 2 months
54
Campylobacter is more common in ____ countries and causes traveler's diarrhea
Asian
55
When do the onset of traveler's diarrhea usually occur?
during the first week of travel
56
Although prophylaxis is NOT indicated for traveler's diarrhea, what can be used?
Cipro (has collateral damage though) - Pepto Bismol - Rifaximin for ETEC
57
T/F For traveler's diarrhea usually self treatment | -take the medication when you first have symptoms
TRUE or single dose of FQ (Cipro x1 day)
58
C.diff is a gram __________ bacteria
positive spore-forming ANAEROBIC
59
What is C.diff resistant to?
- heat - drying - pressure - many disinfectants (due to spores)
60
What are CLASSIC RISK factors for C.diff? (3)
- exposure to antibx - prolonged stay in healthcare facility - elderly additional: PPI use, GI surgery, immunosuppression; inflammatory bowel disease
61
High Risk Antibx for C.diff
CCCF - clindamycin - 3rd and 4th gen cephalosporins - Carbapenems - FQ
62
T/F Toxin production is essential for C.diff manifestation
TRUE only see C. diff infection in pts that produce the toxin antibx disrupt the normal flora allowing C.diff to colonize
63
What is the primary mode of transmission of C.diff?
person to person spread through the fecal-oral route
64
________ w/ _______ = you should think C.diff
diarrhea w/ antibx OR healthcare exposure
65
Testing options for C.diff (3) Patients with unexplained and new-onset diarrhea
- PCR - GDH plus toxin - PCR plus toxin
66
PCR
- most commonly used in hospitals - highly SENSITIVE, so risk for false positive - ONLY test if unexplained new onset diarrhea
67
What is used to determine the SEVERITY OF CDIFF? (4)
- fever (greater than 38.5) - WBC (greater than 15,000) - SCr (greater than 1.5) - Albumin (less than 3)
68
Clinical Def of C.diff: | WBC less than 15,000 OR SCr less than 1.5
initial episode, NON-SEVERE
69
Clinical Def of C.diff: | WBC greater than 15,000 AND Scr greater than 1.5
initial episode, SEVERE
70
T/F Metronidazole associated with higher treatment failure rates when used for severe or complicated CDI
TRUE risk factors: - age ((greater than 60) - hypoalbuminemia - ICU stay
71
SE of Flagyl? (4)
- disulfam-like rx w/ alcohol (N and V/ face flushing) - GI intolerance - metallic taste - peripheral neuropathy
72
_____ should be avoided in pts with macrolide allergy
fidaxomicin
73
_______ in comparison to Vanco caused fewer recurrences at 25 days after therapy for CDI
fidaxomicin its the same as vanco w/ first occurence
74
T/F There are high cure rates w/o relapse for C.diff patients treated w/ FMT
TRUE
75
Zinplava (Bezlotoxumab)
- 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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