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Clin Med > GI: diarrhea > Flashcards

GI: diarrhea Flashcards

1
Q

S/s for osmotic diarrhea

A

abdominal pain
blaoting
flatuence due to incr colonic gas production

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2
Q

s/s secretory diarrhea

A

high volume (1>L/day)
watery diarrhea
dehydration
electrolyte imbalance

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3
Q

s/s inflamm diarrhea

A

abd pain
fever
wt loss
hematochezia

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4
Q

s/s malabsoprtion syndromes

A

wt loss
osmotic diarrhea
steatorrhea
nutritional deff

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5
Q

drugs that cause diarrhea

A 
Cholinesterase inhibitors
Selective serotonin reuptake inhibitors
Angiotensin II-receptor blockers
Proton pump inhibitors
Nonsteroidal anti-inflammatory drugs
Metformin
Allopurinol
Orlistat
Lactulose
Antacids
Rx’s for constipation
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6
Q

s/s and causes of acute diarrhea

A
  1. FEVER:
    * invasive pathogens
    * peds: initially present in the majority of kids with rotavirus diarrhea
  2. BLOODY STOOLS: invasive and cytotoxin-prod pathogen
    * suspect EHEC infection in absence of fecal leukocytes
    * NOT SEEN in viral agents or enterotoxin prod bacteria
  3. VOMITING
    * freq in viral diarrhea and illness caused by ingestion of bacterial toxin (Staph. A)
    * common in cholera
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7
Q

bloody diarrhea + absence of fecal leukocytes

*suspect what pathogen

A

Enterohemorrhaigc E. col or EHEC

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8
Q

Food-borne outbreaks causing acute diarrhea

*what organisms are responsible (4)

A

Salmonella
Shiga-Toxigenic E. Coli
Yersinia
Cyclospora

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9
Q

water-borne outbreak microorganisms

A

vibrios
Giardia
Cryptosporidium

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10
Q

Seafood + shellfish outbreak organisms

A

Vibrio
Norovirus
Salmonella

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11
Q

Poultry outbreak organisms

A

campylobacter

Salmonella

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12
Q

Beef, raw seed sprout outbeaks organisms

A

Shiga-toxin producing E. coli (STEC)

Enterohemorhagic E. coli

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13
Q

Eggs outbreak culprit?

A

Salmonella

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14
Q

Mayo and cream outbreak culprit?

A

Staphylococcus
Clostridium perfringeins
Salmoella

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15
Q

person to person transmission causing acute diarrhea

A

shigella

rotavirus

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16
Q

MCC of acute diarrhea in kids

A

rotavirus

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17
Q

causes of acute bloody diarrhea

-infectious and non infectious

A

INFECTIOUS:

  • Campylobacter
  • Shigella dysentry
  • non-typhoidal salmonella
  • enterohemorrhagic or enteroinvasive E . coli
  • C. Diff
  • Virbiro
  • Entamoeba histolytica

NON-INFECTIOUS

  • Diverticualr dz
  • rectal or colonic malig
  • IBD
  • hemorrhois
  • anal fissue
  • ischemic colitis
  • intussusception
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18
Q

list the non-invasive micrboes causing infectious diarrhea

  • virus
  • bacteria
  • protozoa
A

PRODUCE ENTEROTOXIN

VIRUS:

  • norovirus gastroenteritis (Norwalk-like virus)
  • Rotavirus

BACTERIA:

  • Staphylococcus Aureus
  • Bacillus Cerus
  • Enterotoxic E. Coli (aka travelers diarrhea)
  • Vibrio Cholera
  • C. diff
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19
Q

List the invasive micrboes causing infectious diarrhea

A 
Yersinia enterocolitia
Campylobacter 
Enterohemorrhagi E. Coli 0157:H7
Salmonella--Typhoid and non-typhoid 
Shigellosis
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20
Q

list the protozoa that can cause infectious diarrhea

A

Giardia Lamblia

Entamoeba Histolytica

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21
Q

non-invasive diarrheas

  • patho
  • affected areas
  • vomitinng?
  • fecal blood/WBC/mucus present?
  • ex
A

enterotoxins increase GI secretion of electrolytes–>causing a secretory diarrhea

  • *no cell destruction
  • *no mucosal invasion
  • **vomiting is MC predominant symptom
  • **absent fecal blood/WBC/mucus
  • **MC affects the small bowel
  • *large voluminous stool

EX:

  • staph A
  • Bacilus Cereus
  • Vibrio cholera
  • Enterotoxigenic E coli
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22
Q

Invasive diarrhea

  • patho
  • affected areas
  • vomitinng?
  • fecal blood/WBC/mucus present?
  • ex
A

**cytoxotins cause mucosal invasion and cell damage
***large bowel–>many small volume stools, high fever
**vomiting not as comong as non-invasive
+fecal blood
+WBCs
+mucus

EX:

  • enterohemorrhagic E coli
  • Shigella
  • Salmonella
  • Yersinia
  • Campy
23
Q

list the fluoroquinilones

A

ciprofloaxcin
ofloxacin
norfloxcin

24
Q

list the ABX used for empiric tx of acute diarrhea

A
  1. Fluoroquinolones
  2. Third gen cephalsosporins
  3. Trimethoprim-sulfamethoxazole
  4. doxycycline
25
Q

do all acute diarrhea need abx?

A

NO

26
Q

when is ABX not needed?

A

nontyphoid Salmonella, Campylobacter, Aeromonas, Yersinia, or Shiga-toxin producing E coli infection

27
Q

what is the MCC of gastroenteritis in US?

A

Norovirus

28
Q 
Norovirus 
-tranmission 
-invasie or non invasie 
-cm 
-very common in who? 
Management
A

fecal-oral (cruise ships, hospitals, restaurants, etc)

CM: NON INVASIVE 
*vomiting******* predominant symp 
-nausea 
NON BLOODY diarrhea (-mcus, -wbcs) 
very generalized s/s but the vomtiing is the main one

MC in kids, during winter months,

TX: supportive

29
Q

Rotavirus

  • transmission
  • MC seen in?
  • CM for kids and adults
  • tx
A

fecal-oral

MC seen in young unimmunized children b/w 6MO-2YP

CM:

kids: vomiting, nonbloody dia, LG fever
adults: s/s lesss severe than kids

TX:
*oral rehydration mainstay

30
Q

what microbe can cause decreased disaccardide activity?

A

rotavirus

31
Q

Staph. A

  • what does it produce?
  • sources
A

produces a heat-stable enterotoxin B

Sources: food contamination–dairy, mayo, eggs, meats, salads ESP room temp

CM:
*prominent V/N
*abd cramp
rarely will have fever, HA, diarrhea— seen in small numner of cases

TX:
*fluid replacement PO preferred
IV if cannot tolerate PO

32
Q

Bacillus Cereus

-produces?

A

prod: enterotoxin–sim. to Staph A.
* heat stable

Sources: food….. FRIED RICE

CM:
*prominent V/N
+abd cramps
rarely will have fever, HA, diarrhea— seen in small numner of cases

TX:
fluid replacement PO pref
IV if cant do PO

33
Q 
Enterotoxigenic E. Coli 
MCC of? 
produces? 
sources? 
TX
A
  • MCC travelers diarrhea
  • Produces: heat stable toxins and heat labile toxins
  • Sources: contam food and water—unpeeled fruits, untx drinking water/ice

TX:

  • oral rehydration 1st line—usually self limiting
  • Loperamide
  • Bismuth subsalicylate
34
Q

travelers diarrhea is RF for development of?

A

IBS

35
Q

Vibrio Cholerae

  • type of bac?
  • when do outbreaks occcur
  • produces?
  • CM
  • tx: mild, severe (1st 2nd 3rd), prevention
A

gram-, coma shaped

transmitted via water and food thats contaminated

Outbreaks occur during poor sanitation and overcrowding conditions esp abroad

-produces: EXOtoxin–>secretory diarrhea

CM:

  • vomiting
  • abd pain
  • borborygmi
  • COPIOUS AMT OF WATERY DIARRHEA=rice water stool**** they look gray with flecks of mucus and may have a fishy odor—but no fecal odor, blood or pus
  • can lead to profound dehydration and hypovolemia

TX:

  1. PO rehydration and electrolyte replacement***** usualy self limiting
  2. If severe
    * *1st: Tetracycline
    * *2nd: Fluoroquinolones
    * *3rd: Azithromycin
  3. prevention: use bottled waters, wash hands, use chemical toilets and cook food well
36
Q

Clostridium Difficile

  • type of bac
  • RF
  • CM
  • complications
  • diagnossi—toc
  • labs
  • TX
A

spore forming, toxin producing, gram +, anaerobe

RF:

  • recent ABX use (esp clindamycin)
  • adv age
  • gastric suppression tx–PPIs, H2 blockers)
CM: NON INVASIVE
-watery, NB diarrhea, 
-abd cramps 
-fever 
-abd tenderness 
COMPLIATOINS-->pseudomembranous colitis, bowel perf, TOXIC MEGACOLON******

Diagnosis
+ C. difficile toxin in the stool–TOC
+leukocytosis and incr WBC count
*Sigmoidoscopy will show pseudomembranous colitis

TX::

  1. discontinue offending ABX— INITITAL STEP
  2. contact precautions + hand hygiene (spores resistant to alcohol based sanitizers)
  3. PO PO PO PO PO PO PO vancomycin or Fidaxomicin
  4. recurrance— fecal transplant
37
Q

unexplained leukocytosis in a PT?

A

C. Diff!!!!

38
Q

C diff invasive or not invasive?

A

non-invasive

39
Q

general s/s for invasive diarrheas

A

+high fever
+blood and fecal leukocutes
+mucus in stool

40
Q 
Yersinia Enterocolitica 
-desc bacteria? 
trans
CM 
TX: mild and severe
A

Gram - Cocobacillus, safety-pin apperance

Transmission- MC pork****, milk, water tofus

CM:

  1. Fever
  2. abd pain (can mimic appendicitis bc can cause mesenteric lymphadenitis–causing abd tenderness and gaurding
    * *diarrhea can last for up to 2 weeks

TX:

  • fluid and electrolyte replacement 1st line
  • severe=fluoroquinolones
41
Q 
Campylobacter Jejuni 
Campylobacter Jejuni 
-MC in? 
CM 
sources 
Associated with?? 
diagnosis
A

MC kids and young adults

Soures: raw or undercooked chicken MC, raw milk, contam water, dairy cattle
PUPPIES–>KIDS*** baords question

CM:
-fever
-crampy periumbilical abd pain (may mimic appendicitis)
nausea
diarrhea is initially watery–>progresses to bloody

Diagnosis: stool culture willl show S, comma or seagull shaped organism

TX:

  1. fluid and elec. repalcemet=mainstay (MC mild and self lim)
  2. Severe or high risk PT:
    * **macrolides=1st line—Azithromycin
42
Q

MCC of bacterial enteritis in US?

A

C. jejuni

43
Q

what is the MC antecedent event in post-infectious GBS?

A

C. jejuni

44
Q

Enterohemorrhagic E. coli 0157:H7

Sources 
MC in who? 
produces? 
CM 
complication? 
TX
A

*underck ground beef, unpast. milk or apple cider, day care centers and contam. water

Produces a shiga-like toxin (verotoxin)–causes endothelial damage–>hemorrhaging

MC in kids and elderly

CM:

  • watery diarrhea early on– then becomes grossly bloody
  • usually no fever or very low grade
  • cramp abd pain
  • vomiting

Complication–Hemolytic Uremia Syndrome

TX:

  • fluid replacement main stay— supportive measures
  • *****AVOID ANTI MOTILITY
  • *****AVOID ABX!!!!! —-lysogenic phase: if given ABX… it lyses the cell and these cells ahve the potent toxin in them– can actually directly release the toxin into the BS– making PT more sick
45
Q

Hemolytic uremic syndrome

A

esp happens when ABX is given to kids
most fatal complication from E. coli 0157:H7

-destrc of RBC— leads to anemia–destruc of platelets–thrombocytopenia–promotes abd bleeding

Uremic=kidney failure too

46
Q 
Salmonella Typhi 
-causes? 
-Trans 
-can also colonize where? 
CM
TX
A

Typhoid fever

Trans: fecal-oral, contam food/water
-HX of travel to where poor sanitation

can colonize the GB in chronic carriers

CM

  • HA
  • intractable fever (hard to get rid of)
  • abd pain
  • constipation initially– then non-bloody diarrhea–can be “pea soup” green
  • malaise
  • anorexia
PE
\+fever and bradycardia 
\+rose spots: pink salmon colored maclar rahses that spreads from trunnk to extrems (happens in 2nd week) 
\+abd tenderness 
\+splenomegaly
\+GIB
\+s/s dehydration 
\+delirium in later stages

TX

  1. oral rehydration + electrolytes– first line
  2. ABX
    * 1st: Fluoroquinoloines (-xacin)
    * 2nd: macrolides
    3rd: ceftriaxone
47
Q

explain Typhoid mary

A

chronic carriier state in some salmonella strains

48
Q

chronic carrier of typhoid gets what tx

A

Cirpofloxacin x1 mo

49
Q

MCC of foodborne dz in us?

A

salmonella

50
Q

Non typhoidal salmonella

-sources

A 
sources 
-reptiles 
-poultry*
-eggs 
milk
CM 
-N
V
fever
abdomianl cramps 
dirrhea 
"PEA SOUP" bronw-green in color 
\+/- bloody, malaise and HA

TX:
-oral rehydration + electrolytes– mainstay– usually self limigint

-severe: FLuoroquinolones

51
Q

Giardia Lambia
-assoc with?
-CM
tx

A

assoc with sporadic or epidemic diarrheal illness

sources: contam water from remote streams/wells AKA beaver’s fever or BACKPACKERS DIARRHEA

CM: 
FROTHY, greasy foul-smelling diarrhea (steatorrhea) 
NO blood or pus, or fever 
\+abdominal cramps
\+bloating 
\+malabsoprtion w/ chronic dz

tx

  • rehydration mainstay of tx
  • Metronidazole DOC
52
Q

Shigellosis

  • bacteria?
  • MC in us?
  • which strain produces the most toxin?
  • who is at highest risk
  • what is produced/properties
  • CM
A

Shigelli sonnei–MC in US
gram - rod

*Shigella dysenteriae prod most toxin

kids <5 in daycare at most risk

TOXIN=shiga toxin–neurotoxic, cytotoxic and enterotoxic

CM: 
*lower abd pain
\+abd cramps 
HIGH fever 
\+tenesmus 
*EXPLOSIVE watery diarrhea that progresses to mucoid and bloddy 
*febrile seizures in peds

Complications

  • reactive arthritis–Reiter syndrome
  • hemolytic uremic syndrome–>esp kids
  • toxic megacolon

Diagnosis:
-POS fecal WBCs and RBCs
CBC: +leukemoid reaction (>50,000)
sigmoidoscopcy: punctate areas of ulceration

TX:

  • oral rehydration and electrolyte mainstay
  • ABX for severe: Ciprofloxacin Or Ceftriaxone (3rd gen cephalosporins)
  • if isole is susceptilble— Trimethoprim-sulfamethoxazole or Arithromycin
53
Q

Amebiasis

  • bacteria
  • assoc with
A

Entamoeba histolytica

*amebci liver dz

CM:

  • most are asympto
  • GI: 1-3 week subacute onset of a range of mild diarrhea–severe dystentery (abd pain, diarr, bloody stools, mucus in tools, wt loss, fever)
  • liver abscess: fever, RUQ pain, anorexia

Diangosis:
-O&P: cysts with ingested RBCs

TX

1) Colitis– metronidazole + intraluminel parasitic (Paromomycin)
2) Liver Abscess: metronidazole + intraluminal antiparasitic + chloroquine

ASYMPO: must be tx alone with intraluminal tx

Clin Med (52 decks)

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