GI Infections Flashcards
what is the main manifestation of gastroenteritis?
diarrhea
how is gastroenteritis transmitted?
fecal-oral
what virus is the leading cause of hospitalization and mortality of gastroenteritis in US children?
norovirus
what medication increases gastroenteritis risk?
PPIs
a patient presents with V/D, abdominal pain, mucus/blood in stool, fever of 102, dehydration, malnutrition, borborygmi, and perianal erythema. Dx?
gastroenteritis
how to make a definitive diagnosis of gastroenteritis? when should we get it?
stool culture
if patient comes back and has not improved
what is the treatment for gastroenteritis?
rehydration
what is the 3rd leading cause of acute diarrhea worldwide? what is it also known as?
campylobacter jejuni
Traveler’s diarrhea
what is the most common mode of transmission of campylobacter jejuni?
chicken consumption
a patient presents with bloody diarrhea, abdominal pain, periumbilical cramping, fever, and nausea. Dx?
campylobacter jejuni
what are 2 late onset complications of campylobacter jejuni?
reactive arthritis
Guillain-Barre syndrome
what is the gold standard to diagnose campylobacter jejuni in a patient that returns with symptoms that do no go away?
stool culture
what is the treatment for mild campylobacter jejuni?
rehydrate
what antibiotic can be used for campylobacter jejuni in patients who have severe disease, elderly, pregnant, or immunocompromised?
azithromycin
how is salmonellosis transmitted?
orally
what are the 2 patterns of infection of salmonellosis?
typhoid fever
salmonella gastroenteritis
a patient presents with increasing malaise, headache, cough, sore throat, abdominal pain, constipation, ascending fever that is sustained. On day 7, patient has pea soup diarrhea and doesn’t want to move. Dx?
typhoid fever
what are 2 physical findings of typhoid fever?
bradycardia
rose spot rash on trunk that fades with pressure
what is an important stage of typhoid fever to remember?
can carry it without symptoms for over 12 months
which patients can become chronic carriers of typhoid fever?
cholelithiasis (gallbladder issues)
what are 2 complications of typhoid fever and what 2 symptoms signal them?
intestinal hemorrhage
intestinal perforation
leukocytosis
tachycardia
what are 2 diagnostics for typhoid fever?
blood cultures
stool/urine cultures
what diagnostic can be considered for typhoid that is unresponsive to antibiotic therapy?
bone marrow culture
what is the first line treatment for typhoid fever?
fluoroquinolones (levofloxacin/cipro)
azithromycin if above doesn’t work
how to diagnose salmonella gastroenteritis?
stool culture
what is the treatment for salmonella gastroenteritis? (2)
rehydration (self-limiting)
fluoroquinolones for immunocompromised patients
what is the 3rd most common cause of diarrhea in the US?
shigella
how is shigellosis transmitted?
fecal-oral
a patient presents with fever, abdominal pain, mucoid, bloody, watery diarrhea, and vomiting. patient also has tenesmus. Dx?
shigellosis
what is the definitive diagnosis for shigellosis?
stool culture
what is the treatment for shigellosis? (2)
rehydration
fluoroquinolone or azithromycin
what is cholera known as?
acute secretory diarrheal illness
a patient presents with normal diarrhea that progresses to rice water stools with a fishy odor, has watery emesis, abdominal cramping, sunken eyes, dry mouth, cold clammy skin and decreased skin turgor indicating hypovolemia. Dx?
cholera
what is the treatment for cholera? (3)
oral/IV fluids
zinc/vit A in children
antibiotics
what 3 antibiotics can be used to treat cholera in adults?
doxycycline
tetracycline
azithromycin
what antibiotic can be used to treat cholera in children?
azithromycin
what 2 antibiotics can be used to treat cholera in pregnant women?
azithromycin
erythromycin
what is the most common form of botulism?
infant botulism
the most powerful neurotoxin known that blocks acetylcholine-mediated neurotransmission
clostridium botulinum
how is infant botulism contracted?
honey spores are ingested
when ingested, C. botulinum colonizes in the large intestine and produces botulinum toxin which blocks the release of acetylcholine at the neuromuscular junction, leading to what? (3)
symmetrical, descending generalized weakness
bulbar palsy
constipation
a patient presents with fixed dilated pupils, ptosis, cranial nerve palsies with impairment of EOM, diplopia, loss of accommodation, and blurred vision. Dx?
botulism
what makes the definitive diagnosis of botulism?
isolating the C. botulinum toxin
what is the treatment for botulism in non-infants?
equine heptavalent botulinum antitoxin (HBAT)
what is the treatment for botulism in infants?
babyBIG (human serum)
what is the treatment for wound botulism?
3 million units of IV penicillin
how is enterobiasis pinworms transmitted and who are the only natural hosts?
fecal-oral
humans
where in the GI tract do adult pinworms establish themselves? (2)
cecum
appendix
a patient presents with nocturnal perianal pruritis, insomnia, restlessness, bed-wetting, anorexia, and irritability. Dx?
pinworms
what test can be done to definitively diagnose pinworms?
tape test first thing in the morning
what are 2 treatment options for pinworms? (2)
single dose mebendazole
OR
single dose albendazole
a parasitic blood fluke that lives in freshwater snails
schistosomiasis
how is schistosomiasis transmitted?
swimming in contaminated water; penetrates the skin
a patient presents with swimmers itch and katayama fever. Dx?
acute schistosomiasis (S. japonicum)
which 2 species causing schistosomiasis causes issues in the intestinal tract?
S. mansoni
S. japonicum
which species causing schistosomiasis causes issues in the genitourinary tract?
S. haematobium
what will labs show to diagnose schistosomiasis? (3)
eosinophilia
anemia
hematuria
what is the gold standard to diagnose schistosomiasis?
microscopy shows eggs in stool/urine
what is the treatment for acute schistosomiasis? (2)
prednisolone + praziquantel
what is the treatment for chronic schistosomiasis?
praziquantel
the sheep liver fluke that is caused by ingestion of metacercariae on watercress/aquatic vegetables
fascioliasis
where does fascioliasis migrate? (3)
intestines
liver
bile ducts
what gives a diagnosis of fascioliasis?
microscopy shows eggs in stool
what is the treatment for fascioliasis?
triclabendazole
a fluke caused by consumption of raw, undercooked, or pickled freshwater shellfish
paragonimiasis
a patient presents with fever, malaise, diarrhea, pneumothorax/pleural effusions, chest pain, dyspnea, cough, brown sputum, and hemoptysis. Dx?
paragonimiasis
how to diagnose paragonimiasis?
eggs in sputum
what is the treatment for paragonimiasis?
praziquantel
the beef tapeworm
taenia saginata
the pork tapeworm
taenia solium
the fish tapeworm
diphyllobothrium latum
a patient presents with nausea, anorexia, epigastric pain, with segments of worm in the stool or regurgitated. 2 potential dx?
T. saginata (beef)
T solium (pork)
a patient presents with fatigue, diarrhea, numbness, dizziness, and megaloblastic anemia. Dx?
diphyllobothrium latum (fish)
what is the treatment for cestodes (beef, pork, and fish tapeworms)?
praziquantel
what causes cysticercosis (invasive cestode infection) that invades the lining of the intestine, and migrates to striated muscles, brain, liver, and other tissues; can cause neurocysticercosis?
T. solium (pork tapeworm)
what is the treatment for cysticercosis? (2)
symptomatic based on location of worm
praziquantel
what are the 3 soil transmitted helminths?
ascariasis
trichuriasis
hookworms
the most common helminthic human infection that is transmitted fecal/oral; it inhabits the lumen of the small intestine and matures in the lungs.
ascariasis
what is the treatment for ascariasis?
albendazole
how to diagnose ascariasis?
stool microscopy
a patient presents with loose, mucus stools, nocturnal stooling, dysentery, anemia, and rectal prolapse. Dx?
trichuriasis (whipworm)
how to diagnose trichuriasis (whipworm)?
stool exam for eggs
what are 2 treatment options for trichuriasis (whipworm)?
mebendazole
albendazole
transmitted by larval penetration into human skin through the feet, carried into the lungs, coughed up, and swallowed to go into the GI tract.
hookworm disease
a patient presents with pruritis, cough, pharyngitis, N/V/D, nutritional impairment, and blood loss/anemia. Dx?
hookworm disease
what is the treatment for hookworm?
albendazole
human infection with dog/cat hookworm larvae that penetrates feet, migrates inside the human host for a while but cannot mature, and causes an erythematous migrating line or serpiginous cutaneous track.
cutaneous larva migrans
what are 2 treatment options for cutaneous larva migrans?
ivermectin
albendazole
how is lymphatic filariasis transmitted? and who are the definitive hosts?
mosquito vectors
humans
a patient presents with sudden onset of fever, painful lymphadenopathy, edematous inflammatory plaques, fever, chills, myalgias, and headache. Dx?
lymphatic filariasis
what are 2 diagnostics used for lymphatic filariasis?
circulating filarial antigen (CFA)
blood smears
what is the treatment for lymphatic filariasis?
diethylcarbamazine (DEC) + doxycycline