GI Infectious Diarrhea and Hernias Flashcards
what three things could Rotavirus cause?
small bowel intussusception, bowel obstruction, severe dehydration
who gets rotavirus?
children < 2yo who are not immunized MC
labs for rotavirus?
look for rotavirus in stool sample (PCR)
what are good rehydration liquids vs bad?
good ones have good electrolyte and osmolarity profile (ex: pedialyte vs gatorade or apply juice)
what is the #1 cause of foodborne illness in the US?
Salmonella
both of these types of diarrhea can present with “pea soup” diarrhea so how do you tell the difference
salmonella: poultry, eggs, milk products, REPTILES
typhoid: history of travel where sanitation is poor, constipation that turns into diarrhea
why is Salmonella so hard to get rid of?
Forms a thick coating on equipment used for food processing
what foodborne pathogen causes explosive watery diarrhea that progresses to mucous, bloody diarrhea?
Shigella
where is shigella illness usually found? why?
in developing world. The US doesn’t have the bacteria that take Shigella and make the Shigella Toxin
common sxs type of shigella in children
neuro manifestations (i.e febrile seizures)
important lab value related to diagnosis of shigellosis?
leukemoid reaction (WBC >50K)
Abx for those with shigella?
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.
FQs, bactrim
where does one get giardia from ?
ingestion of contaminated water from remote streams/wells (“beaver’s fever” or “backpacker’s diarrhea”)
how is Giardia transmitted?
fecal-oral transmission
diarrheal symptoms of giardia ?
frothy, greasy, foul-smelling diarrhea NO BLOOD OR PUS
dx and txt for giardia
dx: ova and parasites stool exam (see trophozoites and cysts)
tx: supportive- oral rehydration + ABX azoles (metronidazole aka flagyl)
what does Cdiff come from ?
frequently part of normal flora, colonizes GI tract after normal gut flora have been altered by Abx therapy
risk factors (3) for Cdiff?
recent ABX use (clindamycin classic in adults), elderly, gastric suppression therapy (PPI, H2 blockers)
the presence of Cdiff in stool means what?
Does NOT mean you have the Cdiff infection (colitis). Cdiff is present in almost everyone at some level.
3 complications of C. Diff
pseudomembrane colitis, bowel perforation, toxic megacolon
how to diagnose C dif. What do you see on testing?
presence of severe diarrhea or ileus AND either positive stool test, OR endoscopic or histologic findings of pseudomembranous colitis
*c diff toxin in stool usually initial test
what is pseudomembranous colitis look like?
thick, gunky, white layer inside the colon
looks like cottage cheese
how to manage C diff infection?
1) . stop offending ABX if cause
2) . contact precautions and hand hygiene
3) . Oral vanc or fidaxomicin (dificid) 1st line (Flagyl less common due to increasing resistance)
how to treat frequently recurring C diff (>3 recurrences)
fecal microbiota transplant (90% cure rate)
fecal transplants for Cdiff can be given via ___ or ____ . who are the best donors?
enema or NG tube
donor: family members, family dog, etc.
what pathogen is traveler’s diarrhea from?
- most commonly ENTEROTOXIGENIC E.Coli (not the enterohemorrhagic E coli from Jack in the Box)
- Cholera possibly in endemic area but v different presentation
what are the four steps in managing infectious diarrhea?
1) . fluid repletion: MAINSTAY, oral repletion
2) . diet: bland, low-residue (BRAT)
3) . anti-motility agents (bismuth, opioid agonists, anticholinergics) **DON’T GIVE TO INVASIVE DIARRHEA pts
4) . anti-emetics: serotonin or dopamine blockers
difference between non-invasive and invasive diarrheas: PP, bowel location, common sxs, what is seen in the stool
non-invasive: enterotoxins increase GI secretion of electrolytes, which leads to secretory diarrhea (no cell destruction or mucosal invasion), location = small bowel (large volume stool), no WBCs, blood or mucus, VOMITING
invasive: cytotoxins cause mucosal invasion and cell damage, location = large bowel (many small-volume stools, HIGH fever), + WBC, blood, or mucus
6 types of non-invasive diarrhea
1) . norovirus
2) . rotavirus
3) . S. aureus gastroenteritis
4) . Enterotoxigenic E. coli
5) . vibrio cholerae
6) . C. Diff
5 types of invasive diarrhea
1) . campylobacter
2) . enterohemorrhagic E. coli
3) . typhoid fever
4) . non-typhoidal salmonella
5) . shigellosis
MC cause of adult gastroenteritis in US and viral gastroenteritis worldwide
norovirus
what is norovirus most often associated with
OUTBREAKS (cruise ships, hospitals, restaurants)
3 physical exam findings of typhoid fever
1) . fever with relative bradycardia
2) . rose spots (pink/salmon rash that spreads trunk to extremities)
3) . hepatosplenomegaly
how to treat typhoid fever?
first= oral rehydration and electrolyte replacement
FQ ABX 1st line
how to treat salmonella?
same tx (oral rehydration + electrolyte replacement) and FQ abx when needed
who gets cholera and where does it commonly occur?
vibrio cholerae: contaminated food and water, outbreaks of poor sanitation/overcrowding (usually abroad)
what diarrheal illness: copious watery diarrhea (“rice water stools”) with flecks of mucus, may have fishy odor
cholera
which diarrheal illness is most likely after eating contaminated dairy products, mayo, eggs, salads?
staph aureus gastroenteritis?
what ABX do you give someone with cholera if severe infection?
TETRACYCLINE (unique)
which diarrheal illness is most likely to precede Guillain-Barre syndrome?
C. jejuni
source of C. jejuni infection
contaminated food (raw or undercooked poultry most common, raw milk, dairy cattle) OR puppies in children
how do you dx and tx C. jejuni infection
dx: stool culture (gram-negative “S”, comma or seagull shaped organisms)
tx: supportive stuff like usual + macrolide ABX prn
enterohemorrhagic E coli source of infection. what two age groups is this most commonly seen in?
undercooked ground beef, unpasteurized milk/apple cider, DAY CAREs, contamined water
children + elderly
characteristics between direct vs indirect inguinal hernia
1). indirect: overall MC type of hernia in all people (originates lateral to inferior epigastric artery, may force intestines through internal inguinal ring into canal and follow testicle into scrotum)
PP: often congential due to persistent patent processes vaginalis
2). direct: originates medial to the inferior epigastric vessels (hesselbach’s triangle) and protrudes through floor of inguinal canal
sxs for AS hernia, incarcerated and strangulated hernia
AS: swelling/fullness at site, enlarged with increased intrabdominal pressure
incarcerated: painful, enlarged, IRREDUCIBLE hernia
strangulated: ischemic incarcerated hernia with systemic toxicity
tx for hernia
inguinal often require surgical repair
strangulated hernias are surgical emergencies
where does a femoral hernia occur? who does it most commonly occur in?
protrusion of contents through femoral canal (below inguinal ligament)
- MC in women
- OFTEN BECOME INCARCERATED OR STRANGULATED
management of umbilical hernias in kids vs adults
usually observe in kids because most resolve by 2 years old
*maybe surgical repair if still persistent by 5 years old
adults = usually repair to prevent complications
what does enterohemorrhagic E coli infection cause in kids?
hemolytic uremic syndrome (acute renal failure)
