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General Medicine & Family Medicine > General Surgery/GIT _ Diarrhoea > Flashcards

General Surgery/GIT _ Diarrhoea Flashcards

1
Q

what is encopresis?

A
  • faecal soiling - often occurs with constipation as loose stools moves around impaction
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2
Q

Common cause of diarrhoea in infacnts

A

Rotavirus

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3
Q

Rotavirus mechanism of transmission

A

Faecal - oral

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4
Q

Rotavirus infection is most common when ___

A

winter season

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5
Q

Symptoms of Rotavirus infection

A
  • watery diarrhoea
  • fever
  • vomiting
  • +/- abdomainal pain
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6
Q

Prevention of Rotavirus infection

A
  • RV5 (Rotateq)
    • oral vaccine
    • given at 2,4 and 6 months
  • RV1 (Rotarix)
    • oral vaccine
    • given at 2 and 4 months
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7
Q

What are contraindication to Rotavirus vaccine?

A
  • severe allergic reaction to the vaccine
  • immunocompromiesd
  • infants with acte moderate to severe GIT illness at time of vaccination
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8
Q

Do the new approved vaccines cause intussusception?

A

Ongoing safety reports indicate there may be a risk of 0-4 cases in 100,000 people within the first 30 days of the vaccine, with most happening within the first week. However, the vaccine is still recommended while monitoring is ongoing.

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9
Q

Complication to rule out when seeing a patient with diarrhoea

A
  • dehydration
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10
Q

What are signs of dehydration in an infant?

A
  • Elevated heart rate
  • lethargy
  • poor capillary refill
  • skin tenting
  • decreased urination
  • dry mucus membranes (eyes, oral mucosa)
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11
Q

What is the treatment for mild-to-moderate dehydration secondary to diarrhea?

A
  • Oral rehydration therapy (ORT)
  • avoid sports drinks
  • sodas, and other sugary items
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12
Q

How do you usually administer ORT?

A
  • 50-100 mL/kg over 4 hours initially
  • then 10 mL/kg for each additional stool
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13
Q

What are some signs of severe dehydration?

A
  • Rapid/weak pulses
  • decreased blood pressure
  • no urine output
  • very sunken eyes/fontanelles
  • dry mucus membranes
  • tented or mottled skin
  • delayed capillary refill
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14
Q

When are intravenous (IV) fluids required to treat dehydration secondary to diarrhea?

A
  • Severe dehydration
  • uncontrollable vomiting
  • inability to drink because of extreme fatigue or decreased level of consciousness
  • GI distention
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15
Q

What are some noninfectious causes of diarrhea in children?

A
  • Overfeeding
  • malabsorption
  • necrotizing enterocolitis (NEC)
  • strangulated hernia
  • ovarian/testicular torsion
  • mesenteric thrombus
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16
Q

What factors in a patient’s history suggest that diarrhea is infectious in etiology?

A
  • Ingestion of raw food, seafood, or picnic food
  • recent travel (foreign or camping)
  • hospitalization
  • nursing home care, or day care
  • anal intercourse
  • IV drug use
  • sick contacts
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17
Q

What time course of a patient’s diarrhea usually reflects an infectious etiology?

A

Acute diarrhea, with duration less than 2 weeks

18
Q

What are the major bacterial causes of diarrhea?

A
  • Salmonella
  • Shigella
  • Staphylococcus aureus
  • Campylobacter
  • Escherichia coli
  • Yersinia enterocolitica
  • Vibrio parahaemolyticus
  • Vibrio cholerae
  • Bacillus cereus
  • Clostridium difficile
19
Q

What are the major viral causes of diarrhea?

A
  • Rotavirus and caliciviruses (such as Norwalk virus)
20
Q

What are the major parasitic causes of diarrhea?

A
  • Giardia
  • Entamoeba histolytica
  • Cryptosporidium
21
Q

What is the usual etiologic agent of “traveler’s diarrhea”?

A

Bacteria such as enterotoxigenic E. coli

22
Q

How can travelers reduce their risk of developing diarrhea?

A
  • Avoid tap water, fruits, salads, uncooked or under-cooked foods, and other foods that may be contaminated
  • use of antibiotic prophylaxis is controversial
23
Q

What is dysentery?

A

Bloody diarrhea containing mucus and polymorphonuclear leukocytes (inflammation of the colonic or ileal mucosa by invasion of organisms or toxin-induced injury)

24
Q

What organisms cause dysentery?

A
  • Campylobacter
  • Salmonella
  • Shigella
  • E. coli O157:H7
25
Q

Most cases of acute diarrhea are infectious and self-limited in nature. True or false?

A

True

26
Q

How is acute diarrhea treated?

A
  • Patients without signs of systemic toxicity may be treated symptomatically antidiarrheals, such as loperamide or bismuth subsalicylate) and
  • oral fluid and electrolyte replacement
27
Q

What is the BRAT diet?

A
  • It is used to transition from liquid to solid diet after diarrhea
    • bananas
    • rice
    • applesauce
    • toast.
28
Q

How should you manage patients with bloody diarrhea, high fever, or signs of systemic toxicity?

A
  • Avoid antimotility agents
  • order stool studies (fecal leukocytes, bacterial culture, C. difficile toxin, and ova and parasites)
  • start antibiotics
29
Q

What is hemolytic uremic syndrome (HUS)?

A
  • Dysentery
  • renal failure
  • microangiopathic hemolytic anemia
  • thrombocytopenia
30
Q

What causes hemolytic uremic syndrome?

A
  • A shiga-like toxin produced by the E. coli O157:H7 strain, which has been linked to contaminated foods (animal feces)
31
Q

What patient populations are typically affected?

A

Children and elderly

32
Q

How is HUS treated?

A
  • Supportive measures.
  • Avoid antibiotics and antimotility agents (use in HUS has been associated with increased morbidity and mortality)
33
Q

What is the differential diagnosis of chronic diarrhea in an HIV patient?

A
  • Protozoal infection,
  • MAC
  • CMV colitis
  • HIV colitis
  • highly active antiretroviral therapy (HAART)-related
34
Q

What is the name for the infection caused by C. difficile ?

A

Pseudomembranous colitis

35
Q

When is the intestinal tract most susceptible to overcolonization with C. difficile?

A
  • After alteration of normal gut flora by antibiotics or chemotherapy, classically clindamycin
36
Q

What does C. difficile toxin cause?

A

Secretory or bloody diarrhea and an inflammatory response

37
Q

How is C. difficile typically diagnosed?

A

Identification of C. difficile toxin in stool and pseudomembranes on colonoscopy

38
Q

How is C. difficile treated?

A
  • Cessation of implicated antibiotic.
  • Metronidazole is the drug of choice for treatment, but vancomycin given orally is an alternative
39
Q

Using alcohol-based antibacterial hand gels will kill C. difficile . True or false?

A

False

You must wash your hands with soap and water.

40
Q

What is the diagnosis when a patient presents with chronic abdominal pain, altered bowel habit (diarrhoea or constipation), and abdominal bloating, but with no identifiable structural or biochemical disorder?

A

Irritable bowel syndrome (IBS)

41
Q

What class of medications can be helpful in reducing the symptoms of IBS compared with placebo in the short term?

A

Antidepressants (amitriptyline, clomipramine, desipramine, doxepin, mianserin, trimipramine)

General Medicine & Family Medicine (150 decks)

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