GI- Diarrhea Flashcards
24 y/o male comes to clinic with a CC of abrupt onset of watery diarrhea, abdominal cramping, and vomiting. He has just returned 2-days ago from Tijajuna, Mexico and states he did not drink the local tap water but did have ice in his cocktails. During physical exam the patient has normal appearing skin, good skin turgor, has a blood pressure of 102/88. His lip appear dry and cracked. What organism is the most likely cause?
A. Norovirus
B. Enterotoxigenic E. Coli
C. Vibrio Cholerae
D. Shigella
B. Enterotoxigenic E. Coli
Explanation: The patient has Traveller’s diarrhea. He has recently traveled to an area with known poor sanitation standards and poor drinking water quality. Although he did not directly drink local tap water he ingested water from ice cubes in his cocktails. All forms of diarrhea can present with dehydration however V. Cholerae will present with severe dehydration.
17 y/o girl presents with sudden onset of abdominal pain, nausea, vomiting, and bloody diarrhea. She has no significant past medical history. She is currently using benzoyl peroxide for her ance. She was recently prescribed clindamycin becasue her acne was refractory to benzoyl peroxide treatment. She has a temperature of 100.6 deg. F, heart rate of 98, respiration of 20, skin signs appear normal, and her blood pressure is 102/72.
What organism is the most likely cause?
A. Shigella
B. Salmonella
C. Campylobacter
D. Clostridium Difficle
D. Clostridium Difficle
Explanation: The was recently prescribed clindamycin as concomittant therapy with benzoyl peroxide for her ance. Clindamycin is a known cause for c-diff.
Watery diarrhea, abdominal cramps, bloating, and flatulence after ingesting milk and dairy products.
Lactose intolerance
Watery diarrhea caused from eating rice. Typical board question is a person whom was eating rice at a buffet or restaurant.
B. Cereus
Watery diarrhea which later turns mucioid and bloody. It is spread through the fecal/oral route and caused from contaminated water, poor sanitation, overcrowding, daycares, and/or shelters. It can cause febrile seizures in kids, toxic megacolon and Reiter’s syndrome
Shigella
Spread via the fecal-oral route with greater incidence in summer months. Causes mucous streaked bloody diarrhea. Mainly caused by undercooked poultry products, exotic pets (reptiles, turtles).
Salmonella
24 y/o male comes to clinic with a CC of frequent bouts of watery diarrhea that is grey in color with no odor. He has just returned 2-days ago from Tijajuna, Mexico and states he did not drink the water but did have ice in his cocktails. During physical exam the patient looks pale, has poor skin turgor, and has a blood pressure of 88/68. What organism is the most likely cause?
A. Norovirus
B. Enterotoxigenic E. Coli
C. Vibrio Cholerae
D. Shigella
C. Vibrio Cholerae
Explanation: The patient has recently traveled to an area with known poor sanitation standards and is overcrowded. Although he did not directly drink water he ingested water from ice cubes in his cocktails. He is also severely dehydrated as shown with his low blood pressure and poor skin signs. “Rice water stools” is a classic presentation of vibrio cholerae and is described as grey with no odor, blood, or pus.
Bloody diarrhea after chicken and uncooked eggs
Salmonella
Caused watery stool which later turns bloody. Usually caused by ingestion of undercooked ground beef and unpasteurized milk, and contaminated water.
Enterohemmorrhagic E. Coli
Watery diarrhea caused by unsanitary drinking water Main cause of Traveller’s diarrhea.
Enterotoxigenic E. Coli
Medication contraindicated with invasive and bloody diarrhea?
Loperamide (anti-motility). may cause toxicty
Remote stream, dam, backpacker’s diarrhea, beaver fever
Giardia Lamblia
Wasting illness characterized by arthralgias, arthritis, fever, and watery steatorrhea diarrhea. Weight loss, statorrhea, and joint pain are characteristics of this disease.
Whipple’s disease:
Shigella Tx in > 18 y/o
Cipro or fluroquinolones
Symptoms mimic acute appendicitis with fever, and watery diarrhea. Sources include contaminated pork and tofu. Sometimes contaminated water and milk.
Yersinia Eterocolitica
Prolonged constipation (1-2 weeks) which changes to diarrhea associated with Salmonella and “pea soup” stools (brown and green color). Patient’s will also have an intractable fever and “rose spots,” skin lesions that blanch.
Typhoid fever
Watery diarrhea caused by water contamination in areas with poor sanitation and overcrowding. This will cause extreme dehydration due to “copius” amounts of watery diarrhea. Stools are described as grey with no odor, blood, or pus (“rice water stools”).
Vibrio Cholerae
Watery pea soup stools, rose spots, and intractable fever
Typhoid fever
Watery diarrhea, abdominal cramps, bloating, and flatulence after eating gluten products.
Celiac Sprue (disease): reaction to a-gliadin in loss of villi & absorptive area.
Watery diarrhea caused from eating spoiled mayonnaise , meats, or eggs. Typical question is a person whom gets sick with watery diarrhea at a picnic after eating mayonnaise based product.
S. Aureus
Watery diarrhea resource-limited settings with poor access to clean water sources
Cholera
35-y/o male comes to your clinic with a CC of vomiting, abdominal cramps, HA, and watery voluminous diarrhea 4-hours after attending a BBQ and eating potato salad and macaroni salad that was chilled with ice but left in the sun. What organism is the most likely cause?
A. Bacillus Cereus
B. S. Aureus
C. E. Coli
D. Clostridium Difficle
B. S. Aureus
Explanation: Patient had eaten dairy products (cream and milk in potato and macaroni salads) that had been left out in the sun.
Treatment for Cholera
Ciprofloxacin
45 y/o male comes to clinic with a CC of vomiting, voluminous watery diarrhea 4-hours after eating fried rice and noodles at a Chinese Buffet. What organism is the most likely cause?
A. Bacillus Cereus
B. S. Aureus
C. E. Coli
D. Clostridium Difficle
A. Bacillus Cereus
Explanation: Patient recently ingested rice that had been sitting out at a buffet.
Diarrhea and HIV/AIDS
Ctyptosporidium
Shigella Tx in <18 y/o
Azithromycin
Causes watery, greasy, frothy, and very foul smelling diarrhea with a fever. Source is usually contaminated water from remote streams or wells. Also called “Backpacker’s diarrhea” or “Beaver fever.”
Giardia Lamblia
Anti-diarrheal medication for non-bloody diarrhea?
- Loperamide (anti-motility)
Main cause of diarrhea in children?
Rotovirus
bloody or “pea soup” diarrhea
Salmonella
34 y/o woman comes to clinic with a CC of watery non-bloody diarrhea with nausea and vomiting. She has just returned from a European cruise with her boyfriend whom is experiencing the same symptoms. What organism is the most likely cause?
A. Roto Virus
B. S. Aureus
C. E. Coli
D. Norovirus
D. Norovirus
Explanation: Norovirus is the most common cause of gastroenteritis in adults and this person was just on a cruise ship.
Initial Tx for diarrhea?
- IV Fluid repletion (mainstay of Tx for gastroenteritis)
- “BRAT” diet Bananas, Rice Applesauce Toast
- Loperimide for non-invasive non-blody diarrhea.
- Antiemetics if indicated
- Abx as indicated for invasive diarrhea
Kid in a daycare with gross bloody diarrhea
Shigella Tx with Azithromycin
Watery grey “rice-water” stool w/ fishy odor
Cholera
Watery diarrhea associated with shellfish.
Vibrio parahemolyticus.
Watery diarrhea, abdominal cramps, and vomiting after returning from a tropical area.
Tropical Sprue. Tx with B12 and abx.
Gross bloody diarrhea in daycare centers and in crowded living conditions.
Shigella
Main cause of gastroenteritis in adults?
Norovirus
Acquired usually on cruise ships, hospitals, and restaurants
Norovirus (MC of gastroenteritis in adults)
Diarrhea can be watery or blood and is usually caused by medications/antibiotics.
Clostridium Difficile
bloody diarrhea following ingestion of undercooked hamburger meat
E. Coli
E. coli O157:H7 associated with…
Hemolytic Uremic Syndrome
Watery diarrhea after eating reheated or microwaved meat and chicken
Clostridium
