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PANCE 2.0 > GI #10 > Flashcards

GI #10 Flashcards

1
Q

Clostridioides difficile is a spore-forming, _____, _______

A

Toxin-producing, Gram-positive anaerobic bacteria

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2
Q

Risk factors for C-diff

A
  • Recent ABX use (Clindamycin)
  • Advanced age
  • Gastric suppression therapy (PPI, H2 blockers)
  • Amoxicillin in children
  • Chemotherapy also
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3
Q

Symptoms of C-diff

A
  • Watery, non-bloody diarrhea
  • Abdominal cramps, fever, abdominal tenderness
  • Complications: Toxic megacolon, bowel perforation
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4
Q

What is the initial test of choice for C-diff

A

-C. diff toxin (stool)

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5
Q

Other tests for C-diff

A
  • Leukocytosis and increased WBC classic (high WBC count)

- Sigmoidoscopy in select patients: pseudomembranes

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6
Q

Treatment for C-diff

A
  • Discontinue offending agent/ABX
  • Contact precautions and hand hygiene (spores cannot be killed with alcohol)
  • Oral Vancomycin and Oral Fidaxomicin are first line agents
  • -Metronidazole is alternative
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7
Q

If the patient has frequently recurrent C-diff, what treatment should be done?

A

-Fecal microbiota transplant

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8
Q

What medication class should you NOT give with invasive diarrhea?

A

-Anti-motility drugs (may cause toxicity)

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9
Q

Yersinia Enterocolitica is shaped

A

-Gram negative coccobaillus with bipolar staining (safety pin appearance)

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10
Q

Yersinia Enterocolitica comes from

A 
Contaminated pork (MC in the US
-Milk, water, and tofu
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11
Q

Symptoms of Yersinia Enterocolitica

A
  • Fever
  • Abdominal pain (can mimic acute appendicitis)
  • Mesenteric lymphadenitis
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12
Q

How do you diagnose Yersinia Enterocolitica?

A

-Cultures from stool, pharynx, or mesenteric nodes

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13
Q

Treatment for Yersinia Enterocolitica

A
  • Fluid and electrolyte replacement

- Severe: Fluoroquinolones, Bactrim

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14
Q

MCC of bacterial enteritis in the US

A

Campylobacter Jejuni

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15
Q

Campylobacter Jejuni is the MC antecedent event in

A

Post-infectious Guillan-Barre Syndrome

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16
Q

Sources of campylobacter jejuni enteritis

A
  • Contaminated food: raw or undercooked poultry
  • Raw milk, water, dairy cattle
  • Puppies in children!
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17
Q

Symptoms of campylobacter jejuni

A
  • Fever, crampy abdominal pain

- Diarrhea (watery then bloody)

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18
Q

On stool culture, what is shown for campylobacter jejuni?

A

Gram-negative, S (comma or seagull shaped) organisms

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19
Q

Treatment for campylobacter jejuni

A

Fluid and electrolyte replacement is mainstay

Macrolides (Azithromycin) is first choice for those patients who need it

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20
Q

How do you get infected with Enterohemorrhagic E Coli 0157:H7

A

Ingestion of undercooked ground beef, unpasteurized milk or apple cider, day care centers, contaminated water

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21
Q

What is the pathophysiology of Enterohemorrhagic E. Coli

A

-Shiga toxin causes endothelial damage leading to hemorrhage

MC in children and elderly

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22
Q

Symptoms of enterohemorrhagic E. Coli

A
  • Watery then bloody diarrhea

- Abdominal cramps, fever

23
Q

With enterohemorrhagic E. Coli, why should you avoid ABX in children?

A

-Due to increased incidence of Hemolytic uremic syndrome (increased release of Shiga Toxins)

24
Q

What bacteria is Typhoid Fever MC by?

A

-Salmonella typhi

25
Q

How do you get Typhoid Fever?

A

-Travel to areas where sanitation is poor (South-Central Asia) or contact with carrier

26
Q

Symptoms of Typhoid Fever

A
  • Headache, Fever, Chills, Abdominal Pain
  • Constipation, then diarrhea (Pea-Soup Green in color)
  • Malaise
  • Anorexia
27
Q

On physical exam, what are some findings in Typhoid Fever?

A
  • Fever with bradycardia
  • Rose spots (macular rash that spreads from trunk to extremities) in second week
  • Hepatosplenomegaly
  • Delirium, dehydration in later stages
28
Q

Treatment for Typhoid Fever

A
  • Oral rehydration and electrolyte replacement

- ABX: Fluoroquinolones are first line (Ciprofloxacin, Ofloxacin)

29
Q

Nontyphoidal Salmonella is one of the MC cause of food borne disease in the US. What is this from?

A

-Poultry, eggs, milk products, fresh produce and contact with reptiles (turtles)

30
Q

Symptoms of nontyphoidal salmonella

A
  • Fever, nausea, vomiting, cramps, diarrhea (pea soup in color) may be bloody
  • Headaches
  • Malaise
31
Q

What is the first line medication class used for Nontyphoidal salmonella?

A

Fluoroquinolones (Cipro and Ofloxacin)

32
Q

What bacteria causes Shigellosis MC in the US?

A

Shigella Sonnei

33
Q

However, what species of Shigella produces the most toxin?

A

Dysenteriae

34
Q

Shigellosis is caused by a highly virulent gram negative rod. What is the transmission of this bacteria?

A

Fecal-oral contamination

35
Q

Symptoms of Shigellosis

A
  • Lower abdominal pain
  • Explosive watery diarrhea that progresses to mucoid and bloody diarrhea
  • Febrile seizures (especially in kids)
36
Q

What are some complications of Shigellosis?

A
  • Reactive arthritis (Reiter Syndrome)
  • HUS (in kids)
  • Toxic megacolon
37
Q

What is shown on a CBC for Shigellosis?

A

-Leukemoid reaction (WBC > 50,000)

38
Q

Although oral and electrolyte repletion and hydration is mainstay, what class of medication is used for treatment of Shigellosis if severe?

A

Fluoroquinolones (Cipro and Ofloxacin)

-Other options: Bactrim, Azithromycin

39
Q

Source of Giardia Lamblia

A

-Contaminated water from remote streams/wells aka Beaver’s fever or Backpacker’s Diarrhea

40
Q

What is the pathophysiology of Giardia Lamblia diarrhea?

A

Beavers are the reservoir for the protozoa. Outbreaks occur due to contaminated water or fecal-oral transmission

41
Q

Symptoms of Giardia Lamblia

A

Frothy, greasy foul-smelling diarrhea (steatorrhea) with no blood or pus
Abdominal cramps
Bloating
Malabsorption with chronic diarrhea

42
Q

Treatment for Giardia Lamblia

A
  • Rehydration

- Metronidazole, Albendazole, Tinidazole

43
Q

However, what treatment is used in children for Giardia Lamblia?

A

-Furazolidone

44
Q

Amebiasis, caused by Entamoeba histolytica, is not common in the US. However, it is also associated with

A

Amebic liver abscesses

45
Q

What are some symptoms of amebiasis?

A

Mild diarrhea to severe dystentery

RUQ pain, fever, anorexia (if abscess)

46
Q

What are some diagnostics that should be done for amebiasis?

A
  • Stool microscopy (Ova and parasites): cysts with ingested RBCs. Do 3 on different days because cysts are not constantly shed
  • Antigen testing (ELISA)
  • Stool PCR: parasitic DNA in stool
  • Liver abscess: US, CT, MRI
47
Q

For amebiasis colitis, what treatment should be given?

A

Metronidazole then Paromomycin, Diloxanide, or Diiodohydroxyquinoline

48
Q

For a liver abscess associated with amebiasis, what treatment should be given?

A

-Metronidazole + intraluminal anti parasitic (Paromomycin, Diloxanide, etc.) then Chloroquine

49
Q

Finally, an asymptomatic infection of amebiasis should be treated with what?

A

-Intraluminal agent alone (Paromomycin, Diloxanide, or Diiodohydroxyquinolone)

50
Q

What are some common etiologies of secretory diarrhea?

A
  • Hormonal: serotonin (carcinoid syndrome), calcitonin (medullary thyroid cancer), gastrin (Zollinger-Ellison Syndrome)
  • Laxative abuse
  • Vibrio Cholerae
51
Q

On a workup, what is seen with secretory diarrhea?

A
  • Normal osmotic gap
  • Large volume
  • No change in diarrhea with fasting
52
Q

What are some common etiologies of osmotic diarrhea?

A
  • Medications: Antacids, Lactulose
  • Bacterial overgrowth
  • Malabsorption: Celiac disease, lactose intolerance
53
Q

On a workup, what is seen with osmotic diarrhea?

A
  • Increased osmotic gap
  • Decreased diarrhea with fasting
  • Increased fecal fat
  • Deficiency in fat soluble vitamins

PANCE 2.0 (62 decks)

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