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CPD II > Gastroenteritis > Flashcards

Gastroenteritis Flashcards

0
Q

Hx of gastroenteritis?

A

ask about ingestion of potentially contaminated food or water, travel, contact w/similarly ill person,medication use (abx use recently)

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1
Q

What is gastroenteritis?

A

inflammation of lining of stomach, SI & colon (from infxns most commonly)
typically self-limiting but can be serious in young, elderly, immunocompromised

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2
Q

Normal intestinal microflora? Where do you find the least amount of bac, why?

A

typically GI tract in habited by 500 different bac species

find least amount of bac in stomach & proximal small bowel b/c of acidity

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3
Q

Ssxs of gastroenteritis?

A

character & severity vary

sudden onset of NV anorexia, abd cramps & diarrhea mb malaise & myalgia

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4
Q

PE of gastroenteritis?

A

distended abd, enderness, borborygmi

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5
Q

Possible w/u of gastroenteritis?

A

stool testing, CBC, CMP

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6
Q

5 things that can cause gastroenteritis?

A

viruses, bacteria, parasites, fungal overgrowth & drug & chemical-related

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7
Q

Viral gastro makes up what percentage of infectious diarrhea in US? What is viral gastroenteritis? What does it cause?

A

30-4% of infectious diarrhea in US
viruses infect enterocytes in SI villi= transudate of fluid/salt into lumen
cause watery diarrhea stools rarely contain blood or mucus

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8
Q

What are the 5 types of viral gastro?

A

rotavirus, norovirus, astrovirus, enteric adenovrirus, CMV & enteroviruses in immunocompromised pts

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9
Q

Occurence of rotavirus? When does it peak? Ssxs?

A

most common cause of infectious diarrhea worldwide
33% of hospitalizations & 20% of deaths assoc w/infectious gastroenteritis
highly contagious (fecal-oral route)
prevalent throughout yr peaks in winter
ssxs: vomiting, fever >102, sxs can last 5-7 d

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10
Q

Who does norovirus affect & when? When can it become epidemic? contagious? Ssxs:?

A

older children & adults, year round
epidemic w/water & food-borne outbreaks
HIGHLY CONTAGIOUS
ssxs: acute onset vomiting, abd cramps, diarrhea, fever, HA, lasts 1-2 d

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11
Q

Who does astrovirus usu infect? when? route? Ssxs?

A

infants & young kids
winter months
fecal-oral route
ssxs: acute onset vomiting, abd cramps, diarrhea, fever HA, lasts 1-2 d

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12
Q

Who gets enteric adenovirus? when? route? ssxs?

A

kids <2 yo
year-round/summer
fecal-oral route
ssxs: diarrhea followed by mild vomiting, diarrhea that lasts 1-2 weeks

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13
Q

3 mechanisms utilized by bacteria to cause gastroenteritis?

A

exotoxins, enterotoxins, mucosal invasion

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14
Q

What is an exotoxin? what ssxs do they cause within how many hrs & sxs abate w/in how many hours? what is not in the stool?

A

toxin secreted by microorganism & released into enviro then ingested and causes N/V, watery diarrhea in 12 h of ingestion, sxs abate w/in 36 hrs, stools have no blood or WBCs

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15
Q

4 bugs that utilize exotoxins to cause bacterial gastroenteritis?

A

stapholococcus aureus, bacillus cereus, clostridium perfringens, clostridium botulinum

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16
Q

s. aureus gastroenteritis is usu caused by? common in what things? ssxs? course?

A

food poisoning w/toxin introduced by food-handlers
common foods involved: custard, milk products, potato salad, salad dressing, coleslaw, processed meat/fish at room temp
ssxs: sudden, abrupt, severe vomiting 2-6 hr post-ingestion, explosive diarrhea, abd cramps, rarely fever
course: 3-6 hrs, usu complete recovery

17
Q

Where doe sone find bacillus cereus? fcommon things to find contaminated? ssxs? course?

A

spore-forming organism in soil, contamination of food before cooking which survive high heat
common foods: contaminated rice or meat
ssxs: 2 distinct syndromes: emesis (2-6 hrs after ingestion severe vomiting, abd pain w/ or w/o diarrhea, afebrile, no systemic sxs) & diarrhea (8-16 hrs, foul smelling, profuse w/nausea, abd pain, tenesmus)
course: resolves in 12-24 hrs

18
Q

where do you find clostridium perfringens? most toxin synthesis occurs when? after ingestion of what things? ssxs? course?

A

spore-forming anaerobe in feces, soil, air, water
most toxin synthesized before ingestion, additional in GI
after ingesting contaminated beef, beef products, poultry, food inadequately pre-cooked & then reheated before served
ssxs: watery diarrhea, foul-smelling w/severe crampy abd pain, 8-16 hrs after ingestion
course: self-limited, resolves in 24-36 hrs

19
Q

clostridium botulinum has hat 3 eotoxin types? causes waht serious complication? what 2 types are assoc w/improperly prepared home-canned non-acidic fruits & veggies? what type assocaited w/smoked freshwater fish? doing what can inactivate exotoxin?

A

A, B, E
responsible for 1/3 OF DEATHS from food borne dz
A & B associated w/improperly prepared home-canned non-acidic fruits & veggies
E smoked freshwater fish
boiling in water for 15 min can inactivate exotoxin

20
Q

SSxs of clostridium botulinum?

A

incubation 4 hr- 8 d after ingestion
phase 1= vague, short period of fatigue, N/V, abd cramps, diarrhea
phase 2- visual, diplopia, decreased acuity, PERRLA, ptosis
phase 3- neuro, descending weakness or paralysis, dysarthria, dysphagia, weakness of trunk & extremities, sensorium unaffected normal or low temp, blood, urine, CSF normal

21
Q

course of c. botulinum?

A

65% mortality 29 d following ingestion, w/tx <10% supportive to prevent respiratory impairment

22
Q

ddx of c. botulinum gastroenteritis?

A

polio, encephalitis, M. gravis, curare, belladonna poisoning

23
Q

What is an enterotoxin? specific for what? impair what? cause what?

A

cytotoxin produced by bac, specific for mucous membrane of intestine (in vivo)
toxins impair intestinal absorption, increases secretion of water & electrolytes causing watery diarrhea

24
Q

What 3 bugs utilize enterotoxins to cause gastroenteritis?

A

cholera & non-cholera vibrio, enterotoxigenic escherichia coli & clostridium difficile

25
Q

where are cholear & non-cholera vibrio endemic? dt what? incubation? in US dt what? ssxs?

A

endemic in Asia
any fecal contaminated water or food, in US from contaminated saltwater crabs & freshwater shrimp
incubation 1-3 d after ingestion
ssxs: sudden, painless, profuse, large volume, watery diarrhea, no blood or mucus, usu no fever, abd pain, vomiting, tenesmus, water & electrolyte loss leads to thirst, oliguria, muscle cramps, weakness, cold cyanotic skin, dehydration, hypotension, tachycardia

26
Q

Course of cholera & non-cholera vibrio?

A

recover in 7-10 d if rehydration is adequate, fatal in over 50% of untreated severe cases

27
Q

What does enterotoxigenic e.coli cause? route? incubation? ssxs?

A

diarrhea caused by tissue invasion or via its enterotoxin
fecal/oral route of contaminated water or food, traveler’s pathogen
incubation: 1-3 d
ssxs: profuse, watery diarrhea, 3-5 d

28
Q

How does c diff cause gastroenteritis? ssxs?

A

overgrowth of intrinsic organisms (post abx) or infxn by external source (soil, water, household pets)
cytotoxin & enterotoxin cause pseudomembranous colitis
commonly nosocomial dz, in hospital stay or nursing home or iatrogenic dz after abx use
ssxs: watery diarrhea, cramping abd pain, N/V=RARE

29
Q

what is a complication of c. diff? Describe the complication. PE, W/U, complication of it? what procedure is contraindicated?

A

TOXIC MEGACOLON
dilated colon w/fever, abd pain, tachycardia
PE: tender abd, absent bowel sounds
W/U: elevated WBC distended bowel on xray, colonoscopy is CONTRAINDICATED
risks of: perforation, sepsis, septic shock
other possible causes: UC, Crohn’s, entamoeba histolytica, yersinia infxn

30
Q

What is mucosal invasion? what’s in the stool? difference b/w watery & bloody stool?

A

ingested organism causes microscopic ulceration, bleeding, exudates, secretion of electrolytes & water
stool has WBCs, RBCs, possibly gross blood, fever & prostration common, diarrhea may be watery or bloody
watery: >1 L/d, usu no fever, HA, myalgia, arthralgia
bloody: usu w/abd pain, tenesmus, N/V, fever, malaise

31
Q

what 5 bugs use mucosal invasion to cause gastroenteritis?

A

salmonella, campylobacter jejuni & fetus, shigella, enterohemorrhagic e. coli & yersinis enterocolitica

32
Q

Where do you find salmonella? sz of inoculum to make infection? ssxs? course?

A

ingestion of undercooked chicken or eggs, unpasteurized milk, contact w/reptiles
large inoculum to produce infxn
can cause exudative diarrhea or secretory
ssxs: watery diarrhea more common, bloody may occur, ha, malaise, N/v, abd pain 6-48 hrs after ingestion may have fever
course: usu self-limited to 7 d

33
Q

What is the most common bac cause of bloody diarrhea in the US? from what? incubation? ssxs? course?

A

cmapylobacter jejuni & fetus
from contaminated pork, lamb, beef, milk products, water, infected pets
incubation= 7-10 d
ssxs: prodrome of HA, myalgia, malaise for 12-24 hrs then severe abd pain, high fever, profuse watery diarrhea, then bloody diarrhea
course: usu self-limited to 7-10 d

34
Q

shigella occurs most commonly in what age? from what? contagious? ssxs?

A

children 6 mos-5 yrs
food, water, milk can be contaminated, person to person
HIGHLY CONTAGIOUS w/ very small incoculum
ssxs: incubation 1-3 d, starts as lower abd pain, diarrhea, fever in 50%, many have biphasic illness starting as fever, abd pain, diarrhea, then 3-5 d rectal burning, tenesmus, small vol blood diarrhea
course: variable- children resolves in 1-3 d, adults resolves in 1-7 d

35
Q

What is enterohemorrhagic e. coli? produces what toxin? from where? ssxs? course? complications?

A

e. coli 0157:H7 produces shiga toxin
bovine reservoir, undercooked beef or unpasteurized milk, fecal-oral esp in daycare
ssxs: acute onset of severe abd cramps, watery diarrhea >16hr after ingestion, becomes bloody w/in 24 hrs!
course: 1-8 d if uncomplicated
complications: HUS: hemolytic anemia, thrombocytopenia, acute renal failure & TTP: HUS, fever, neurological deficits

36
Q

Where do you get yersinia enterocolitica from? ssxs? what can it mimic?

A

undercooked pork, unpasteurized milk, contaminated water

ssxs: watery or bloody diarrhea & fever may mimic appendicitis if infxn in terminal ileum AKA acute ileitis

37
Q

What is traveler’s diarrhea? what is the most common bac cause? most common viral cause? ssxs? onset? course?

A

gastroenteritis caused by contact w/organism endemic to locale visited usu contaminated water or food ingestion
enterotoxigenic e.coli is most common also norovirus
ssxs: N/V, borborygmi, abd pain/cramps, diarrhea
onset: 12-72 hrs after ingestion
course: usu self-limiting, fever & bloody diarrhea suggest more serious dz

38
Q

3 types of parasitic infxns that can cause gastroenteritis?

A

giardia lamblia, cryptosporidium parvus, entamoeba histolytica

39
Q

route for giardia? see in what pts especially? ssxs? course?

A

fecal-oral from contaminated water, person to person (daycare), traveler’s pathogen
esp in pts w/low IgA, hypochlorhydria, malnutrition, ingestion of cysts which break down releasing organism
ssxs: incubation 7 d, mb asx, mild, watery diarrhea, abd bloating, cramps, flatulence for 1-3 wk, stools bulky, foul smelling
course: mb self-limiting or infxn may persist & produce chronic or recurrent dz (celiac-like lesion causing lactose intolerance & malabsorption), fatigue, wt loss

40
Q

What pts usu have cryptosporidium? via what? sxs? in 2 types of pts sxs will be what?

A

high rate of infxn in HIV, immune-compromised, daycare
via contaminated water, food, pets
ssxs: in non-immune compromised pt- profuse, watery diarrhea, anorexia, low-grade fever 5 d after ingestion
course: usu self-limited lasting ~2 wks
in immune compromised pt- mb chronic, watery diarrhea up to 17/d, leads to dehydration

41
Q

Where do you get entamoeba histolytica from?

A

endemic, travel assoc, fecal-oral spread, in institutionalized pts HIV, AIDs, immune-compromised, cysts ingested, released leading to ulceration similar to IBD
ssxs: if mild= crampy, abd pain, intermittent diarrhea; if severe- bloody diarrhea, abd pain, tenesmus, fever, toxic megacolon

CPD II (10 decks)

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