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clin med > GI infections > Flashcards

GI infections Flashcards

1
Q

what does Rotavirus cause?

A

small bowel intussusception/obstruction, severe dehydration

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2
Q

what is intussusception?

A

Intussusception occurs when a portion of the intestine folds like a telescope, with one segment slipping inside another segment. … The result can be a blocked small bowel or colon

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3
Q

is there a risk for intussusception with the rotavirus vaccine?

A

not with the newer vaccine!

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4
Q

who gets rotavirus?

A

children < 2yo (at highest risk)

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5
Q

labs for rotavirus?

A

look for rotavirus in stool sample

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6
Q

txt for rotavirus

A

supportive & oral rehydration (with proper electrolyte liquids)

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7
Q

what are good rehydration liquids vs bad?

A

good ones have good electrolyte and osmolarity profile (ex: pedialyte vs gatorade or apply juice)

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8
Q

salmonella, shigella and Enterotoxic E.Coli are all ____ illnesses

A

food-borne

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9
Q

what is the #1 cause of foodborne illness in the US?

A

Salmonella

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10
Q

Salmonella is the ___ most common cause of death from foodborne pathogens in the US

A

2nd

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11
Q

why is Salmonella so hard to get rid of?

A

Forms a thick coating on equipment used for food processing

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12
Q

what foodborne pathogen causes bacillary dysentery and acute watery diarrhea?

A

Shigella

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13
Q

what is bacillary dysentery

A

a certain kind of intestinal infection from shigella

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14
Q

where is shigella illness usually found? why?

A

outside the US, in developing world. The US doesn’t have the bacteria that take Shigella and make the Shigella Toxin

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15
Q

presenting symptoms of shigella

A

sudden high fever, bloody diarrhea of a small volume, acute watery diarrhea.

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16
Q

avoid what kind of drugs with shigella?

A

antimotility drugs- may prolong the duration of symptoms

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17
Q

Abx for those with shigella?

A

only for those who are VERY sick, indicated for children and adolescents with culture-proven shigella and who …
have bacteremia, require hospitalization, at risk, etc.

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18
Q

where does one get giardia from ?

A

water-born or food-borne diarrhea, day-care outbreaks, international travelers, adoptees

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19
Q

how is Giardia transmitted?

A

fecal-oral transmission

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20
Q

what are the common symptoms of giardia ?

A

major ones; malaise, diarrhea (very bad smelling!), steatorrhea

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21
Q

txt for giardia

A

supportive- oral rehydration

Abx: azoles (metronidazole aka flagyl)

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22
Q

giardia may cause a temporary _____ ______

A

lactose intolerance

23
Q

prevention for giardia

A

avoid daycare, water purification

24
Q

Cdiff AKA …

A

Abx- associated colitis

25
Q

what does Cdiff come from ?

A

frequently part of normal flora, colonizes GI tract after normal gut flora have been altered by Abx therapy

26
Q

whose at risk for Cdiff?

A

elderly

27
Q

the presence of Cdiff in stool means what?

A

Does NOT mean you have the Cdiff infection (colitis). Cdiff is present in almost everyone at some level.

28
Q

what is the cardinal clinical symptom of Cdiff?

A

watery diarrhea

29
Q

Cdiff symptoms range from ____ to ____

A

asymptomatic to fulminant disease with toxic megacolon

30
Q

____% of hospitalized adults are Cdiff carriers, up to ___% in longterm care centers.

A

20- hospital

50- LTCs

31
Q

Cdiff may occur during _____ or ______

A

Abx administration or following, up to several weeks

32
Q

biggest culprit of causing Cdiff?

A

Clindamycin

- also fluoroQs, cephalosporins, PCNs

33
Q

Cdiff- exam generally demonstrates …

A

lower abd tenderness

34
Q

endoscopy for Cdiff can show …

A

spectrum of findings, from patchy erythema to severe pseudomembranous colitis

35
Q

if someone doesnt have watery diarrhea will you send a stool sample to lab?

A

NO, no point, likely not Cdiff

36
Q

The Dx of Cdiff infection requires…

A

presence of severe diarrhea or ileus AND either positive stool test, OR endoscopic or histologic findings of pseudomembranous colitis

37
Q

what is pseudomembranous colitis look like?

A

thick, gunky, white layer inside the colon

looks like cottage cheese

38
Q

what does an enzyme immunoassay (EIA) for Cdiff show?

A

shows toxins A&B and for glutamate dehydrogenase ( the best indicator)

39
Q

GDH antigen does or does not distinguish toxigenic form nontoxigenic strains?

A

does not!

40
Q

dont want to treat benign Cdiff with Abx, why?

A

cause you can cause Cdiff infection!

41
Q

what is the order of labs to draw for Cdiff?

A
  1. test the 2 EIA types: if both + then txt for Cdiff, if both - then dont txt for Ciff
  2. If on is + and one - , then do NAAT testing
42
Q

what does PCR/NAAT testing do for Cdiff?

A

tests for toxin A and B, does not test for the presence of actual toxin.
(nucleic acid testing)

43
Q

PCR/NAAT has high sensitivity and therefore will lead to …

A

frequent identification of incidental carriers. its too sensitive, does not discriminate between infection and carriers.

44
Q

Txt regiment for Cdiff (4 parts)

A
  1. stop inciting Abx
  2. infection control (contact precautions)
  3. if more than mild, txt with 10-14 days ORAL vancomycin or Dificid (second line flagyl)
  4. surgery if severe (partial or total colectomy)
45
Q

relapse is ___% with Cdiff

A

25

46
Q

recent 3 phase study suggests ____ is “noninferior” to vancomycin for Cdiff (actually that its better! )

A

fidaxomicin

47
Q

what abx is good for refractory Cdiff?

A

Rifaximin

48
Q

imaging for Cdiff?

A

if very sick, consider CT

49
Q

fecal transplants for Cdiff have a ___% cure rate.

A

90

50
Q

fecal transplants for Cdiff can be given via ___ or ____ . who are the best donors?

A

enema or NG tube

donor: family members, family dog, etc.

51
Q

tests for Cdiff must have Cdiff bacteria AND what?

A

the cdiff toxin!

52
Q

what pathogen is traveler’s diarrhea from?

A
  • most commonly enterotoxigenic E.Coli (not the enterohemorrhagic E coli from Jack in the Box)
  • Cholera possibly in endemic area
53
Q

Traveler’s diarrhea causes….

A

usually benign and self-limited but can cause severe dehydration.

54
Q

txt for traveler’s diarrhea

A
  1. single dose azithromycin
  2. antimotility agents (imodium) - but should ALWAYS be combined with an Abx
  3. pepto bismol good but need very large doses for txt

clin med (88 decks)

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