GI: diarrhea Flashcards
S/s for osmotic diarrhea
abdominal pain
blaoting
flatuence due to incr colonic gas production
s/s secretory diarrhea
high volume (1>L/day)
watery diarrhea
dehydration
electrolyte imbalance
s/s inflamm diarrhea
abd pain
fever
wt loss
hematochezia
s/s malabsoprtion syndromes
wt loss
osmotic diarrhea
steatorrhea
nutritional deff
drugs that cause diarrhea
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
s/s and causes of acute diarrhea
- FEVER:
* invasive pathogens
* peds: initially present in the majority of kids with rotavirus diarrhea - BLOODY STOOLS: invasive and cytotoxin-prod pathogen
* suspect EHEC infection in absence of fecal leukocytes
* NOT SEEN in viral agents or enterotoxin prod bacteria - VOMITING
* freq in viral diarrhea and illness caused by ingestion of bacterial toxin (Staph. A)
* common in cholera
bloody diarrhea + absence of fecal leukocytes
*suspect what pathogen
Enterohemorrhaigc E. col or EHEC
Food-borne outbreaks causing acute diarrhea
*what organisms are responsible (4)
Salmonella
Shiga-Toxigenic E. Coli
Yersinia
Cyclospora
water-borne outbreak microorganisms
vibrios
Giardia
Cryptosporidium
Seafood + shellfish outbreak organisms
Vibrio
Norovirus
Salmonella
Poultry outbreak organisms
campylobacter
Salmonella
Beef, raw seed sprout outbeaks organisms
Shiga-toxin producing E. coli (STEC)
Enterohemorhagic E. coli
Eggs outbreak culprit?
Salmonella
Mayo and cream outbreak culprit?
Staphylococcus
Clostridium perfringeins
Salmoella
person to person transmission causing acute diarrhea
shigella
rotavirus
MCC of acute diarrhea in kids
rotavirus
causes of acute bloody diarrhea
-infectious and non infectious
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
list the non-invasive micrboes causing infectious diarrhea
- virus
- bacteria
- protozoa
PRODUCE ENTEROTOXIN
VIRUS:
- norovirus gastroenteritis (Norwalk-like virus)
- Rotavirus
BACTERIA:
- Staphylococcus Aureus
- Bacillus Cerus
- Enterotoxic E. Coli (aka travelers diarrhea)
- Vibrio Cholera
- C. diff
List the invasive micrboes causing infectious diarrhea
Yersinia enterocolitia Campylobacter Enterohemorrhagi E. Coli 0157:H7 Salmonella--Typhoid and non-typhoid Shigellosis
list the protozoa that can cause infectious diarrhea
Giardia Lamblia
Entamoeba Histolytica
non-invasive diarrheas
- patho
- affected areas
- vomitinng?
- fecal blood/WBC/mucus present?
- ex
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
Invasive diarrhea
- patho
- affected areas
- vomitinng?
- fecal blood/WBC/mucus present?
- ex
**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
list the fluoroquinilones
ciprofloaxcin
ofloxacin
norfloxcin
list the ABX used for empiric tx of acute diarrhea
- Fluoroquinolones
- Third gen cephalsosporins
- Trimethoprim-sulfamethoxazole
- doxycycline
do all acute diarrhea need abx?
NO
when is ABX not needed?
nontyphoid Salmonella, Campylobacter, Aeromonas, Yersinia, or Shiga-toxin producing E coli infection
what is the MCC of gastroenteritis in US?
Norovirus
Norovirus -tranmission -invasie or non invasie -cm -very common in who? Management
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
Rotavirus
- transmission
- MC seen in?
- CM for kids and adults
- tx
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
what microbe can cause decreased disaccardide activity?
rotavirus
Staph. A
- what does it produce?
- sources
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
Bacillus Cereus
-produces?
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
Enterotoxigenic E. Coli MCC of? produces? sources? TX
- 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
travelers diarrhea is RF for development of?
IBS
Vibrio Cholerae
- type of bac?
- when do outbreaks occcur
- produces?
- CM
- tx: mild, severe (1st 2nd 3rd), prevention
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:
- PO rehydration and electrolyte replacement***** usualy self limiting
- If severe
* *1st: Tetracycline
* *2nd: Fluoroquinolones
* *3rd: Azithromycin - prevention: use bottled waters, wash hands, use chemical toilets and cook food well
Clostridium Difficile
- type of bac
- RF
- CM
- complications
- diagnossi—toc
- labs
- TX
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::
- discontinue offending ABX— INITITAL STEP
- contact precautions + hand hygiene (spores resistant to alcohol based sanitizers)
- PO PO PO PO PO PO PO vancomycin or Fidaxomicin
- recurrance— fecal transplant
unexplained leukocytosis in a PT?
C. Diff!!!!
C diff invasive or not invasive?
non-invasive
general s/s for invasive diarrheas
+high fever
+blood and fecal leukocutes
+mucus in stool
Yersinia Enterocolitica -desc bacteria? trans CM TX: mild and severe
Gram - Cocobacillus, safety-pin apperance
Transmission- MC pork****, milk, water tofus
CM:
- Fever
- 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
Campylobacter Jejuni Campylobacter Jejuni -MC in? CM sources Associated with?? diagnosis
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:
- fluid and elec. repalcemet=mainstay (MC mild and self lim)
- Severe or high risk PT:
* **macrolides=1st line—Azithromycin
MCC of bacterial enteritis in US?
C. jejuni
what is the MC antecedent event in post-infectious GBS?
C. jejuni
Enterohemorrhagic E. coli 0157:H7
Sources MC in who? produces? CM complication? TX
*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
Hemolytic uremic syndrome
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
Salmonella Typhi -causes? -Trans -can also colonize where? CM TX
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
- oral rehydration + electrolytes– first line
- ABX
* 1st: Fluoroquinoloines (-xacin)
* 2nd: macrolides
3rd: ceftriaxone
explain Typhoid mary
chronic carriier state in some salmonella strains
chronic carrier of typhoid gets what tx
Cirpofloxacin x1 mo
MCC of foodborne dz in us?
salmonella
Non typhoidal salmonella
-sources
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
Giardia Lambia
-assoc with?
-CM
tx
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
Shigellosis
- bacteria?
- MC in us?
- which strain produces the most toxin?
- who is at highest risk
- what is produced/properties
- CM
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
Amebiasis
- bacteria
- assoc with
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
