GI Re-Up #7 Flashcards
Noninvasive Infectious Diarrhea has general symptoms of….
Vomiting, water voluminous diarrhea (no fecal WBC’s or blood)
MC overall cause of gastroenteritis in adults in North America and MCC of viral gastroenteritis worldwide.
Where is an outbreak of this found (transmission route, etc.)
-Norovirus Gastroenteritis
-Fecal-oral route transmission (outbreaks on cruise ships, hospitals, restaurants)
Symptoms of Norovirus Gastroenteritis
-Treatment?
-Vomiting predominant symptom. Nausea, non-bloody diarrhea that lacks mucus, and fecal leukocytes.
-Fluid replacement (orally) is the treatment
Rotavirus Gastroenteritis is MC seen in __________
Treatment?
-Young, unimmunized children ages 6 months - 2 years old
Oral rehydration
Staphylococcus Aureus Gastroenteritis is an infection due to a heat-stable enterotoxin B. This incubation period is ________.
How do you get this type of gastroenteritis?
-Short (within 6 hours)
-Food contamination MC source (dairy products, mayo, meats, eggs, salads) at room temperature
Again, treatment for Staph A Gastroenteritis is _______
Who should you consider this condition in?
oral fluid replacement
Those who attend a picnic, as food it outside at room temperature
On the same note, Bacillus Cereus Gastroenteritis also has a short incubation period of about 6 hours. What is one common contaminated food that this bacteria comes from?
Fried rice
The MCC of traveler’s diarrhea is
Risk factors for this type of gastroenteritis
-Enterotoxigenic E. Coli
-Contaminated food and water. Unpeeled fruits washed in the water, untreated drinking water, etc.
What is the treatment for Enterotoxigenic E. Coli Gastroenteritis?
Oral rehydration first line
-Loperamide, Bismuth if needed
What area is non-invasive diarrhea usually affecting?
Small bowel (large voluminous stool)
Vibrio Cholerae is a gram-negative comma-shaped rod transmitted via __________.
Outbreaks may occur during poor sanitation and overcrowding conditions (especially abroad).
Explain the pathophysiology of this type of gastroenteritis
Contaminated food and water
Exotoxin causes a secretory diarrhea which may cause profound dehydration and hypovolemia
Symptoms of vibrio cholerae gastroenteritis
-Vomiting
-Copious watery diarrhea
-Rice water stools: grey with flecks of mucus and may have a fishy odor but no blood or pus
Treatment for vibrio cholerae gastroenteritis
-Oral rehydration and electrolyte replacement
-Tetracyclines first line if needed
Vibrio Parahaemolyticus and Vulnificus are transmitted via ________________
Symptoms of both kinds
What should be remembered about Vulnificus?
-Raw or undercooked shellfish consumption and seawater
-Parahaemolyticus: gastroenteritis
-Vulnificus: gastroenteritis, necrotizing fasciitis, cellulitis.
Vulnificus is the MCC of death from seafood consumption in the US
Risk factors for bacteremia in vibrio Parahaemolyticus and Vulnificus?
-Underlying liver disease (cirrhosis, alcoholism, hemochromatosis)
-Immunocompromised (DM)
If the patient has cellulitis from Parahaemolyticus and Vulnificus, what medication class should you use?
Tetracyclines
Clostriodiodes Difficile (C. Diff) is a spore-forming toxin-producing Gram-positive anaerobic bacteria. What are some risk factors for this type of gastroenteritis?
Symptoms of this type
-RF: Recent antibiotic use (Clindamycin), advanced age gastric suppression therapy (PPI, H2 blockers)
-Watery, non-bloody diarrhea, cramps, fever, tenderness
-Complications include: toxic megacolon, bowel perforation
Initial test of choice for C. Diff
What is also seen on labs?
What is seen on sigmoidoscopy which is only performed in select patients?
-C. Difficile toxin (stool)
-Leukocytosis and increased WBC count
Pseudomembranes
Treatment for C. Diff
-Discontinue offending ABX
-Contact precautions and washing hands with soap
-Oral Vancomycin or Oral Fidaxomicin (Metronidazole is alternative)
What are some general symptoms of invasive infectious diarrhea?
What part does invasive diarrhea affect?
-high fever, blood and fecal leukocytes in diarrhea, not as voluminous, mucus
Large intestine (many, small volume stools)
Yersinia Enterocolitica is a gram-negative coccobacillus with what unique shape?
Sources of this bacteria
Bipolar staining (safety pin appearance)
Contaminated pork MC in US, milk, water, tofu
Symptoms of Yersinia Enterocolitica diarrhea
Treatment
-Fever, abdominal pain pain mimic acute appendicitis
-Can cause mesenteric lymphadenitis (producing guarding and abdominal tenderness)
-Fluid and electrolyte replacement
-Severe: Fluoroquinolones (-oxacin)
Campylobacter Jejuni is the MCC of bacterial enteritis in the US. It is also the MC antecedent event in post-infectious _________.
What is one source of this condition?
Symptoms
-Guillain-Barre Syndrome
Raw or undercooked poultry MC, raw milk, dairy cattle, contaminated water, PUPPIES
-Fever, crampy pain, may mimic appendicitis, nausea
-Diarrhea watery then progressing to bloody
On Stool Culture, what is seen in C. Jejuni?
What is the treatment for this type?
-Gram-negative “S, comma or seagull shaped” organisms.
-Fluid and electrolyte replacement
-Macrolides (Azithromycin) first line
Enterohemorrhagic E. Coli 0157:H7 diarrhea
-Sources
-Pathophysiology
-Symptoms
-Treatment
-Sources: undercooked ground beef, unpasteurized milk or apple cider, day care centers, and contaminated water.
-Shiga-like toxin causes endothelial damage leading to hemorrhage
-Watery diarrhea progressing to bloody. Cramps, vomiting, fever absent or low-grade
-Treatment: Fluid replacement
What is one thing that should be avoided in E. Coli 0157:H7 and why?
Avoid ABX in children due to increased incidence of Hemolytic Uremic Syndrome
Typhoid (Enteric) Fever is caused by __________ and is likely in someone with a history of _________.
Symptoms (unique)
-Salmonella typhi
-Travel to areas where sanitation is poor (South-Central Asia)
-Headache, intractable fever, chills, abdominal pain, constipation –> non bloody diarrhea –> pea soup green diarrhea
What are some unique exam findings in a patient with Typhoid Fever?
-Hepatosplenomegaly
-Fever with bradycardia
-Rose spots (faint pink or salmon colored macular rash that spreads from trunk to extremities)
Treatment for Typhoid Fever
-Oral hydration and electrolyte repletion first line
-Fluoroquinolones (Ciprofloxacin, Ofloxacin)
On the other hand, nontyphoidal salmonella is one of the MC food borne diseases in the US. What are some sources of this bacteria?
Symptoms are similar to that of Typhoid Fever. What are they?
Treatment?
-Poultry, eggs, fresh produce, mild products, contact with REPTILES
-Nausea, vomiting, fever, diarrhea (pea soup green in color), malaise, headaches
-Oral rehydration and electrolyte replacement
-Fluoroquinolones if needed
Shigellosis is MCC by _________
Who is at the highest risk for this condition?
This condition is highly virulent from fecal-oral contamination. The Shiga enterotoxin is neurotoxic, cytotoxic, and enterotoxin. Therefore, what are the symptoms?
-Shigella sonnei
-Children < 5 years old in daycares
-Lower abdominal pain, explosive watery diarrhea that progresses to mucoid and bloody.
-Febrile seizures
-High fever
Treatment for Shigellosis
-Oral rehydration and electrolyte replacement
Patients with HLA-B27 may develop _______ from a Shigellosis infection
Reactive Arthritis (Reiter Syndrome)
__________ is a protozoan parasite associated with sporadic or episodic diarrheal illness. It comes from contaminated water from remote streams/wells AKA Beaver’s Fever or Backpacker’s Diarrhea.
What are some symptoms?
-Giardia Lamblia
-Symptoms: frothy, greasy foul-smelling diarrhea (steatorrhea) with no blood or pus, cramps, bloating, malabsorption.
What is the treatment for Giardiasis?
-Rehydration mainstay
-Metronidazole
Amebiasis, from entamoeba histolytica, has symptoms that include….
-Mild diarrhea to severe dysentery
-Liver abscess: fever, RUQ pain, anorexia.
Management for Amebiasis if:
-Colitis:
-Liver abscess:
-Colitis: Metronidazole followed by intraluminal parasitic such as Parmomycin
-Liver abscess: Metronidazole + Paromomycin + Chloroquine
Whipple’s Disease, caused by Tropheryma whipplei, has symptoms such as (think of the stomach and neuro)
-Malabsorption: chronic diarrhea, fever, LAD, non deforming arthritis
-Neuro Sx: memory impairment, confusion, rhythmic motion of the eye while chewing
What is seen on duodenal biopsy for Whipple’s Disease?
-Periodic acid-Schiff (PAS)-positive macrophages, dilation of lacteals
Treatment for Whipple’s Disease
-Prolonged ABX therapy (usually 1-2 years)
–Penicillin or Ceftriaxone followed by oral Bactrim as maintenance therapy
Phenylketonuria (PKU) is an autosomal recessive disorder of amino acid metabolism associated with phenylketonuria neurotoxicity due to accumulation of phenylalanine in the urine and blood.
Symptoms
-Presents after birth with vomiting, mental delays, increased DTR’s, intellectual disability.
-Children often blonde haired, blue eyed with fair skin.
Diagnostics for PKU
-Increased serum phenylalanine
-Urine with musty (mousy) odor
-Newborn screening performed at 24 weeks GA
Management for PKU
-Lifetime dietary restriction of phenylalanine + increase tyrosine supplementation
-Avoid foods high in phenylalanine (milk, cheese, nuts, chicken, meats, eggs, legumes, diet sodas)
