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Infectious Disease > Exam 2 - Diarrhea > Flashcards

Exam 2 - Diarrhea Flashcards

1
Q

host defenses - physical barriers to GI tract

A

gastric acidity, bile, mucosal layer, intestinal motility, normal enteric flora

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2
Q

host defenses - innate immune system GI tract

A

antimicrobial peptides, acids

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3
Q

host defenses - adaptive immune system GI tract

A

mucosal IgA antibodies, T cells, Peyer’s patches

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4
Q

where is an exotoxin secreted

A

into the environment

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5
Q

what is an enterotoxin

A

a toxin that acts on intestine, often secretory

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6
Q

what is a cytotoxin

A

a toxin that acts on cells, causing cell damage - often inflammatory

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7
Q

characteristics of inflammatory diarrhea

A

invasive, bloody stools, systemic symptoms, fever

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8
Q

characteristics of secretory diarrhea

A

non-invasive, non-bloody, larger volumes, may have N/V, no systemic symptoms or fever

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9
Q

diarrhea definition

A

3 loose stools in 24 hours or greater than 200 grams/day

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10
Q

acute diarrhea timeline

A

less than 2 weeks

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11
Q

persistent diarrhea timeline

A

2-4 weeks

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12
Q

chronic diarrhea timeline

A

greater than 4 weeks

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13
Q

secretory diarrhea mechanism

A

enterotoxin/adherence

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14
Q

inflammatory diarrhea mechanism

A

cytotoxin/invasion

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15
Q

stool findings in secretory diarrhea

A

no fecal leukocytes

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16
Q

stool findings in inflammatory diarrhea

A

fecal leukocytes

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17
Q

secretory diarrhea pathogens

A

viruses, travelers diarrhea pathogens, b. cereus, giardia, vibrio cholerae, some e. coli, most parasites

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18
Q

inflammatory diarrhea pathogens

A

c diff, shigella, salmonella, campylobacter, yersinia, some e. coli, entamoeba histolytica

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19
Q

when to test for stool pathogens

A

persistent symptoms after 7 days

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20
Q

what GI infections can be detected with PCR

A

viral infections (norovirus, enterovirus, adenovirus), salmonella, shigella, campylobacter, EC0157

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21
Q

what GI infections can be detected with EIA

A

giardia, cryptosporidium, rotavirus, e. histolytica

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22
Q

when to perform O&P

A

only if immunocompromised or foreign travel is documented

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23
Q

what GI infections can be detected using toxin assay

A

c diff, shiga-toxin producing e coli (0157)

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24
Q

what GI infections are detected using histology

A

Hepatitis A IgM, entamoeba histolytica

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25
Q

antibiotic associated diarrhea pathogen

A

c diff

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26
Q

daycare-associated diarrhea pathogens

A

giardia, rotavirus, norovirus

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27
Q

waterborne secretory diarrheas

A

cryptosporidium, vibrio cholera

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28
Q

waterborne inflammatory diarrheas

A

plesiomonas, vibrio vulnificus

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29
Q

foodborne secretory diarrheas

A

hep A, B. cereus (rice)

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30
Q

foodborne inflammatory diarrheas

A

E. coli 0157, campylobacter, yersinia, listeria

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31
Q

E coli 0157 food

A

ground beef

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32
Q

campylobacter food

A

poultry, milk

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33
Q

yersinia food

A

pork

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34
Q

listeria food

A

deli meats

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35
Q

travel associated diarrhea

A

norowalk virus, giardia, ETEC

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36
Q

immunocompromise-associated diarhea

A

cyclospora, cryptosporidium

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37
Q

animal associated diarrhea

A

giardia, salmonella

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38
Q

immunocompromised associated diarrhea

A

cyclospora, cryptosporidium

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39
Q

diarrhea pathogen associated with fried rice

A

bacillus cereus

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40
Q

diarrhea pathogen associated with salad dressing/custards

A

staph aureus

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41
Q

diarrhea pathogen associated with poultry, beef, gravy

A

clostridium perfringes

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42
Q

diarrhea pathogen associated with poultry, eggs, milk, beef, turtles

A

salmonella

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43
Q

diarrhea pathogen associated with salads, raw vegetables, contaminated water, undercooked meats

A

shigella

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44
Q

diarrhea pathogen associated with poultry, unpasteurized milk

A

campylobacter

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45
Q

diarrhea pathogen associated with undercooked beef

A

E. coli 0157:H7

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46
Q

diarrhea pathogens with incubation period < 12 hours

A

bacillus cereus, staph aureus, clostridium perfringens

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47
Q

diarrhea pathogens with medium incubation period (hours-days)

A

salmonella, shigella, E coli 0157

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48
Q

diarrhea pathogen with long incubation period (days)

A

campylobacter

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49
Q

b cereus clinical characteristics

A

preformed toxin causes emesis, and later heat tolerant spores cause diarrhea

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50
Q

staph aureus clinical characteristics

A

ingestion of preformed enterotoxin causes emesis>diarrhea of 1-2 days duration

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51
Q

clostridium perfringens clinical characteristics

A

spores germinate and then release toxin leading to water diarrhea of 1 day duration

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52
Q

salmonella clinical characteristics

A

invasive inflammatory diarrhea

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53
Q

shigella clinical characteristics

A

invasive inflammatory diarrhea with very low inoculum required

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54
Q

campylobacter clinical characteristics

A

invasive inflammatory diarrhea, most common food pathogen

55
Q

E coli 0157 clinical characteristics

A

shiga toxin causing diarrhea

56
Q

salmonella treatment

A

no abx unless there is associated bacteremia

57
Q

why no abx for salmonella

A

they increase shedding of bacteria in stool

58
Q

what abx to use for salmonella if bacteremia is present

A

azithromycin or cipro

59
Q

shigella tx

A

azithromycin or cipro

60
Q

e coli 0157 tx

A

supportive, no abx

61
Q

why no abx for e coli 0157

A

increase risk of HUS

62
Q

campylobacter tx

A

azithromycin

63
Q

tx for cholera

A

hydration, doxycycline, azithromycin, cipro

64
Q

yersinia tx

A

only if ssx are severe, cipro, bactrim

65
Q

c diff tx

A

PO vanc, fidaxomicin, metronidazole

66
Q

giardia tx

A

metronidazole

67
Q

cryptosporidium tx

A

no abx unless severely immunocompromised

68
Q

viral diarrhea tx

A

supportive

69
Q

entamoeba histolytica tx

A

paromomycin plus metronidazole

70
Q

which diarrhea pathogens have azithromycin as primary treatments (if abx indicated)

A

salmonella, shigella, campylobacter, cholera

71
Q

which diarrhea pathogens have metronidazole as a primary treatment if abx indicated

A

c diff (not first line), giardia, entoamoeba histolytica (with paromomycin)

72
Q

which diarrhea pathogens have abx contraindicated

A

salmonella (unless associated bacteremia), E coli 0157, yersinia (unless ssx are severe), cryptosporidium (unless severely immunocompromised)

73
Q

when to use antimotility agents

A

patients 2 and over with secretory diarrhea that is not toxin-producing

74
Q

1st line antiemetic agent

A

ondansetron

75
Q

first step of treatment for any diarrheal illness

A

address dehydration with oral rehydration solution or IV fluids if severe

76
Q

general principle of abx treatment for diarrhea

A

not generally used as ssx are usually self-limiting; if used they are for a short course (1-3 days)

77
Q

H. pylori morphology

A

gram-negative, microaerophilic, spiral

78
Q

H. pylori transmission

A

saliva, vomit, feces, contaminated water

79
Q

H. pylori diagnostics

A

stool antigen test, urea breath test, endoscopy with biopsy

80
Q

H. pylori testing considerations

A

stop PPIs and bismuth 1-2 weeks prior to testing, test for eradication 4 weeks after abx are finished

81
Q

triple therapy components

A

amoxicillin, clarithromycin, PPI

82
Q

H pylori abx duration

83
Q

quadruple therapy components

A

tetracycline, metronidazole, PPI, bismuth subsalicylate

84
Q

clinical presentation cholecystitis/cholangitis

A

charcot’s triad, murphy’s sign

85
Q

cholecystitis/cholangitis lab findings

A

leukocytosis, elevated alk phos and direct bili

86
Q

cholecystitis/cholangitis pathogens

A

EEK (e coli, klebsiella, enterococcus), less commonly anaerobes

87
Q

cholecystitis/cholangitis abx

A

ampicillin/sulbactam or cipro and metronidazole. ertapenem

88
Q

cholangitis complications

A

hypotension, bacteremia, AMS

89
Q

cholecystitis complications

A

perforation/peritonitis, bacteremia, liver abscess, emphysematous cholecystitis

90
Q

pyogenic liver abscess labs findings

A

leukocytosis, elevated alk phos

91
Q

pyogenic liver abscess causes

A

cholangitis, bacteremia, IBD, pancreatitis, diverticulitis, penetrating trauma

92
Q

pyogenic liver abscess diagnostics

A

fine need aspiration for gram stain/culture, blood cultures

93
Q

pyogenic liver abscess pathogens

A

polymicrobial

94
Q

pyogenic liver abscess tx

A

surgical drainage plus 4-6 weeks of antibiotics

95
Q

amebic liver abscess presentation

A

bloody diarrhea, anchovy paste aspirate from abscess

96
Q

amebic liver abscess cause

A

ingestion of contaminated food/water with cysts of entamoeba histolytica

97
Q

amebic liver abscess diagnostics

A

imaging, serum antibody test, O/P (not reliable)

98
Q

amebic liver abscess pathogen

A

entamoeba histolytica

99
Q

amebic liver abscess tx

A

metronidazole and paromomycin +/-surgery

100
Q

what happens if you treat amebic liver abscess with metronidazole only

A

it will recur (metronidazole only treats the abscess, need paromomycin to eliminate it in the gut)

101
Q

hydatid cyst presentation

A

may be asymptomatic, eosinophilia, elevated alk phos, anaphylaxis when it ruptures

102
Q

hydatid cyst cause

A

ingestion of food/water contaminated by the feces of a tapeworm-infected dog

103
Q

hydatid cyst CT findings

A

solitary large liver cyst with multiple daughter cysts

104
Q

hydatid cyst diagnostics

A

CT, serology (ELISA), pathology

105
Q

hydatid cyst pathogen

A

cysts of the tapeworm echinococcus granulosis

106
Q

hydatid cyst treatment

A

surgical removal, albendazole x 30 days

107
Q

spontaneous bacterial peritonitis risk factors

A

cirrhosis with ascites, peritoneal dialysis

108
Q

spontaneous bacterial peritonitis route of infection

A

hematogenous, lymphogenous, transmural migration via intestinal lumen

109
Q

spontaneous bacterial peritonitis infectious cause

A

cirrhosis: enteric gram negatives. Dialysis: Staph aureus, coagulase negative staph

110
Q

spontaneous bacterial peritonitis treatment

A

ceftriaxone for GNR, vanc/nafcillin for staph

111
Q

secondary bacterial peritonitis risk factors

A

intra-abdominal source of infection (bowel perforation/ischemia, PID)

112
Q

secondary bacterial peritonitis pathogen

A

polymicrobial

113
Q

secondary bacterial peritonitis treatment

A

source control, metronidazole plus ceftriaxone or cipro, ampicillin/sulbactam

114
Q

intraperitoneal abscess risk factors

A

peritonitis, wound (appendicitis, perforated peptic ulcer, surgical complication)

115
Q

intraperitoneal abscess infectious cause

A

polymicrobial

116
Q

intraperitoneal abscess diagnosis

117
Q

intraperitoneal abscess tx

A

drainage, metronidazole plus ceftriaxone or cipro

118
Q

which is more common, spontaneous bacterial peritonitis or secondary bacterial peritonitis

119
Q

which hepatitis is fecal-oral

120
Q

which hepatitis has no possibility of chronic infection

121
Q

what is true about hepatitis B and risk of chronic infection

A

far greater in infants than adults

122
Q

how to test for acute hep A and hep E infections

A

Hep A IgM, Hep E IgM

123
Q

test for acute hep C infection

A

positive HCV viral load (antibody may or may not be positive)

124
Q

test for acute Hep B infection

A

HBV surface antigen

125
Q

test results indicating resolved hep B infection

A

core antibody positive, surface antigen negative

126
Q

test results indicating hep B immunity

A

HBV surface antibody positive

127
Q

test for hep A immunity

A

hep A total antibody (IgM and IgG)

128
Q

test results indicating hep B immunity from vaccine

A

core antibody negative, surface antibody positive

129
Q

test indicating high infectivity of Hep B

A

positive Hep B e antigen

130
Q

initial test for HCV infection

A

HCV antibody

131
Q

what to do if HCV antibody is positive

A

proceed to HCV RNA test

132
Q

treatment for hep A

133
Q

treatment for hep B

A

antivirals (lamivudine, etc), interferon

134
Q

treatment for hep C

A

ribavarin, directly acting agents, interferon

Infectious Disease (5 decks)

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