GI ID@ Flashcards by Paul Estrada

Main features of ciguatera

3-6 hrs - N/V, nonbloody diarrhea, cramping

3-72 hrs - paresthesias, blurred vision, nerve palsies cold dysesthesia, bradycardia, hypotn, hrt block

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What causes ciguatera?

dinoflagellate toxin in fish skin - cannot be prevented with freezing or cooking

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What sxs of scromboid?

Histamine poisioning sxs - 1 to few hrs after ingestion - warmth, flushing, rash, pruritis, palpitations, tachycardia, HA, blurred vision, resp distress

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What causes scromboid?

Not freezing fish fast enough - tuna, mackarel, or swordfish

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How to tx ciguatera?

Supp cares

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How to tx scromboid?

Antihistamines if needed but usu better by 12 hours o own

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What is tetrodotoxin?

Puffer fish neurotoxin - leads to rapid and fatal NM weakness

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What is the tx of campylobacter?

flouroquinolone or azithromycin

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How to tx Listeria?

ampicillin and if CNS sxs, ICed, or IE add gentamicin

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Which bact cause of meningitis can lead to high LCs?

Listeria

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What is D latum?

A tapeworm

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How to tx all tapeworms?

Praziquantel

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Sxs of D latum?

megaloblastic anemia (B12 def), eosinophilia, fatigue, diarrhea

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MC org to cause travelers diarrhea?

ETEC

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When to tx travelers diarrhea?

4+ stools/d, fever, blood, mucus in stool

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How to tx travelers diarrhea?

Azithro for kids, preg F, Asian travel; flouroquins otherwise

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Where is E histo prevalent?

India, Africa, Mexico, C/SA, Asia

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Who tends to get E histo infxn when traveling?

MSM

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What is E histo?

A parasite

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Where does E histo mainly affect?

Cecum/Asc colon

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HIV pts with E histo can get what complication?

Liver abscess

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Strongyloides sxs?

Mild waxing and waning GI sxs, cutaneoues, pulm sxs, eos

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Best way to dx strongyloides?

Duod aspirate or strong test (Enterotest)

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How to tx strongyloides?

Ivermectin or albendazole

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Who gets cryptospor?

HIV pts

Sxs of cryptospor

Mild diarrhea, severe enteritis, biliary tract dz, wasting

How to dx cryptospor?

microscopy - oocysts pink or red with acid fast stain

How to tx cryptospor in HIV pt?

HAART

Which infxn AW iron overload (HCTosis)?

Yersinia

Infxn and RLQ pain...

Yersinia or campylobacter

Yersinia/CB - which can also cause pharyngitis?

Yersinia

Yersinia tx

None

Yersinia tx in ICed

Flouroquin

What is cystoisospora belli?

Protozoal infxn

Who gets CIS belli?

AIDS

Sxs of CIS belli?

Watery diarrhea, wt loss, EOS

T/F: CIS causes esoinophilia?

True - only protozoa that does

Tx of CIS belli?

Bactrim

Viral GI infxns typically cause what sx predominantly?

Vomiting

What is the tx of cholera?

ORT & doxy, single dose 300 mg

What is the rea of the GIT affected by cholera?

Duod/jejunum

How does cholera produce diarrhea?

TPers in the SI altered so large fluid secreted in SI, colon cannot compensate for it

Which blood group more likely to get severe cholera infxn?

Blood group O

How to differentiate ciguatera from paralytic shellfish poisoning?

PSP - rapid onset of weakness and paralysis

Sxs of botulism

vomit, diarrhea, Cranial nerve dysfxn, descending paralysis in hours to days

List of exclusions to stool donors

IBS, IBD, Abx exposure, metab syndrome, neuropsych dz, live in UK > 3 months, inc age

T/F: Stool TP from related donor is safer than nonrelated?

False

Which tests to obtain from stool donors?

Hep A, B, C, HIV, syphilis, C diff, bact panel, giardia, rotavirus

SB biopsy of strongyloides?

Larvae within wall

Ascaris vs stronglyloides

Both very similar but ascaris only in ppl who travel outside of US; also most ascaris pts asxatic

Best tx of strongyloides?

Ivermectin

Why can strongyloides have high burden and cause SIRS?

Can complete entire life cycle in humans

T/F: Strongyloides hyperinfxn can be fatal in ICed pts

True

Vibro vulnificus from what?

Oysters

VVul more common in who?

Liver dz, alcoholism

Typical VVul tip off

Bullous skin lesions

How to tx campylobacter?

Usually nothing but if severe dz can use azithromycin or FQ

What is a nonTB bact cause of lymphocytic meningitis?

Listeria

Comm acquired C diff in which type of pts?

Younger, female, fewer other illnesses, less abx exposure, less severe clinical course

Which pt has higher risk of CAP while on PPI tx?

Older age, shorter duration of tx

Sushi/freshwater fish inc risk of which infxn?

D latum

How to tx D latum?

Praziquantel

What is MC viral gastroenteritis in kids and adults?

Kids - rotavirus | Adults - norovirus

Which infxns work by secreting enterotoxins?

ETEC and vibrio cholera

Which infxn adheres to mucosa and effaces it causing diarrhea?

EHEC and EPEC

Which infxn penetrates gut mucosa and spreads causing ulcers and damage?

Shigella, C jejuni, EIEC

T/F: Uncomplicated yersinia infxn does not need tx?

True

Classic hookworm findings?

IDA, peripheral eos, pruritis rash before sxs, hypoalbuminemia

Name types of hookworms

Necator americanus, ancylostoma duodenale

How to tx hookworm?

3 days of albendazole

How to tx vibrio cholera infxn?

Single dose of doxy

What are classic words for vibrio cholera?

Rice water stools

Classic findings of shiga toxin producing E coli

abdominal pain, diarrhea, NO fever, rare leuks in stool

How to dx shiga toxin producing E coli (O157:H7)

Stool EIA for shigatoxin

How to distinguish paralytic shellfish poisioning from ciguatera?

Shellfish poisoning has rapid onset of neuro sxs and no bradycardia

What does scromboid poisoning PW?

IgE related sxs - flushing, face/neck rash, warmth, erythematous rash, palpitations, tachycardia

What is Chinese liver fluke?

Clonorchis sinensis

How to treat clonorchis sinensis?

Praziquantel

What percent of C diff infxn is comm acquired?

30-40%

T/F: Test of cure should be performed in C diff pts regardless of if they have continued sxs.

False, do not retest if no sxs

What percent of pts with neg C diff testing will have positive result if retested within 2 weeks?

<5%

Strongyloides most typically affects which part of the gut?

Small intestine

Where is strongyloides most prominent in the US?

Southeast

List the MC protozoal infxns

``` Giardia intestinalis Entamoeba histolytica Cyclospora cayetanenensis Cryptosporidium Microsporidium Schistosomiasis ```

List the MC worm (helminth) infxns

``` Ascaris lumbricoides (roundworm) Trichiuris trichiuria (whipworm) Ancylostoma duodenale (hookworm) Necator americanicus (hookworms) Strongyloides (threadworm) D latum (tapeworm) ```

WHat is used for tx of C jejuni when indicated?

Azithro or levofloxacin

T/F: C jejuni is AW post infxous IBS

True

T/F: 30% of pts with GBS need ventilator support.

True

How long after C jejuni infxn does GBS set in?

1-2 weeks

What is the MC source of yersinia infxn?

Pig intestine (chitterlings)

Common findings in Salmonella typhi infxn?

Skin rash, temp-pulse disassociation (fever with bradycardia), RLQ pain

Where is Salmonella common?

India

If see CMV on colon bx, what should be done?

Immunostaining for CMV to check burden to see if innocent bystander or if true infxn

Foamy macs on SI bx seen in what?

Whipples dz

How to tx Whipples dz?

Ceftri followed by 1 yr of bactrim

How to distinguish MAC from WHipples dz?

Both have foamy macs in SI on PAS stain | MAC in pts with HIV and Acid fast + in MAC, neg in WHipples

What is the mechanisms of scromboid?

High histamine leads to sxs

Fish in scromboid

Tuna, mahi mahi, mackrel

How to tx tropical sprue?

Tetracycline + folate for 6-13 months

Where one gets tropical sprue?

DR, PR, Cuba, Haiti, India, Middle East

What is mechanism of tropical sprue?

Thought to be infxous but not 100% sure

Which infxn can cause partial villous blunting?

Giardia

How long after exposure to giardia do sxs start?

1 week

How to tx giardia?

Metronidazole, nitazoxanide, quinacrine, tinidazole

With tx, what % of giardia pts relapse?

20%

Associations: 1. Heart block/brady 2. Temp-pulse disassociation 3. Megaloblastic anemia + eos 4. IDA + Hypoalb + rash

1. Ciguatera 2. Salmonella typhi 3. D latum (tapeworm) 4. Hookworm

3 days of albendazole treats what?

Hookworm or Whipworm

Bactrim used to tx what?

CIS belli

FQ or azithro used to tx what?

Campylobacter (when needed), Travelers diarrhea

FQ only used to tx what?

Yersinia in ICed pt