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Clin Med 2 > GI Tract Infections > Flashcards

GI Tract Infections Flashcards

1
Q

Gastroenteritis

A

diarrhea or vomiting involving either non-inflammatory infection of the upper small intestine or inflammatory infection of the colon

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2
Q

Acute diarrheal episode

A

increased frequency of defecation”
3+ times per day
<14 days duration

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3
Q

Persistent diarrhea

A

> 14 day duration

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4
Q

Chronic diarrhea

A

> 30 day duration

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5
Q

What is the onset of food poisoning?

A

1-6 hours

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6
Q

What defenses do the host have against GI infections?

A 
gastric acidity (pH <4) 
intestinal motility 
normal enteric flora (mostly anaerobes) 
Intestinal immunity 
breast milk 
personal hygiene (wash your hands)

70% of your immune system lives in your gut

H. Pylori can get past the acidity of your stomach

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7
Q

What is the most common bacterial pathogens of enteric infections?

A

gram negative rods

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8
Q

What viruses are most common pathogens of enteric infections?

A

norovirus

rotovirus

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9
Q

What parasites are most common enteric infections?

A

protozoa (giardia, cryptoporidium)

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10
Q

What are non infectious causes of diarrhea?

A 
IBD 
IBS 
Malignancy 
Ischemic colitis 
Diverticulitis 
Malabsorption (celiac, lactose intolerance)
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11
Q

Which pathogens are more common in tropical climates?

A

Enterotoxigenic E. Coli (ETEC)

parasites

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12
Q

Which pathogens are more common in temperate zones?

A

viruses

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13
Q

Which pathogens are common in day care settings?

A

rotavirus

norovirus

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14
Q

How do H2 blockers increase your risk of GI infections?

A

reduce gastric acidity

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15
Q

Which pathogen is commonly see with uncooked poultry?

A

Campylobacter

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16
Q

What are the major microbial virulence factors?

A

Toxins
attachment
invasiveness

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17
Q

Enterotoxins

A

direct effect on intestinal mucosa to elicit net fluid and electrolyte secretion

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18
Q

Cytotoxins

A

mucosal destruction

C. diff

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19
Q

Neurotoxins

A

pre-formed toxins

food poisoning

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20
Q

What causes the watery diarrhea present during food poisoning?

A

Enterotoxins

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21
Q

Staph Areus

A

good poisoning
more common during summer months
room temp incubation
high salt content foods

  • ham
  • poultry
  • baked goods
  • salads
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22
Q

What sxs and time frame do you see with food poisoning from staph?

A 
4.4h for roughly 20h
vomiting 
diarrhea
abd pain 
\+/- fever, chills, HA
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23
Q

Bacillus cereus

A

food poisoning

Emetic syndrome

  • Associated with fried rice
  • onset 1-6 hours
  • N/V

Diarrheal syndrome

  • associated with rice, powdered milk, macaroni
  • 10-12 hour incubation
  • cramps, N, watery diarrhea
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24
Q

Clostridium botulinum

A

an extremely potent neurotoxin produces lassitude, progressive weakness and vertigo

infant: honey, dust, water
Foodborne: meat, canned vegtables, seafood
Wound
Iatrogenic: too much BoTox

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25
Q

Secretory diarrhea

A

acute, non-inflammatory
enterotoxin mediated
proximal small bowel
watery diarrhea

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26
Q

Vibrio Cholerae

A

secretory diarrhea
curved gram negative rod
food/waterborne
reservoir: aquatic environments and humans

incubation: 14h - 5d
hallmark: abrupt onset of profuse watery diarrhea with flecks of mucus (“rice water stool”)

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27
Q

What is the hallmark of vibrio cholerae?

A

rice water stool

abrupt onset of profuse watery diarrhea with flecks of mucus

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28
Q

What is the treatment for vibrio cholerae?

A

rehydration: fluid/electrolyte
ABX -shorten duration of illness and shedding of organism
-doxycycline (300mg single dose)
-azithromycin if pregnant (1gm single dose)

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29
Q

Vibrio parahemolyticus

A

secretory diarrhea

acquired from raw/undercooked shellfish - Gulf Coast
mild, self-limited water diarrhea

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30
Q

What is the most common cause of travelers diarrhea?

A

ETEC

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31
Q

Travelers diarrhea

A

secretory diarrhea
ETEC
incubation 1-3 days

watery diarrhea, abdominal cramps, low-grade fever
self-limited 2-4 days

Contaminated food or water

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32
Q

What is the treatment for traveler’s diarrhea?

A

ABX and antimotility agents

antimotility - loperamide
ABX - Fluoroquinolones (cipro 500mg twice a day for 1-3 days_
Azithromycin (500mg daily x 1-3 days)
Instructions: don’t take the meds unless you have had sxs >24 h

Self-limited (sxs resolve in 2-4 d)

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33
Q

Loperamide

A

antimotility agent used for traveler’s diarrhea

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34
Q

Which type of virus is more likely to occur on a cruise ship?

A

Norovirus

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35
Q

Who is more likely to get astrovirus?

A

children <3

immunocompromised

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36
Q

Giardia

A

secretory diarrhea

1-4 week incubation 
acute vs chronic 
acute: 
loose, FOUL SMELLING stools 
steatorrhea
anorexia 
no blood in stools

chronic: steatorrhea, growth impairment

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37
Q

How do you dx giardia?

A

fecal examination
fecal antigen test (EIA)

enterotest –pt swallows gelatin capsule on end of string –removed after 4-6 hours

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38
Q

Enterotest

A

“used” to help dx giardia

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39
Q

What is the treatment for giardia?

A

Metronidazole 250 mg PO three times daily fo 7-10 days
Tinidazole
Nitazoxanide

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40
Q

Inflammatory diarrhea

A 
cytotoxin mediated
colon 
invasive
blood diarrhea
fever
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41
Q

What are the major differences between inflammatory and secretory diarrhea?

A

secretory is in the proximal small intestine, mediated by enterotoxin

inflammatory is in the colon and is cytotoxin mediated

42
Q

Shigellosis

A 
inflammatory diarrhea
gram negative rod
reservoir: asymptomatic human carriers 
transmission: fecal-oral, food-borne, or water-borne 
4 species
43
Q

What are the sxs of shigellosis?

A 
FEVER 
abdominal cramps
watery diarrhea progressing to blood 
mucoid stools
tenesmus
44
Q

Tenesmus

A

cramping rectal pain

45
Q

Shiga toxin

A

only in Shigellosis dysenteriae
enters cell via receptor mediated endocytosis
binds 60S ribosome –inhibits protein synthesis
cytotoxin

46
Q

What is the treatment for shigellosis?

A

rehydration

fluoroquinolones - cipro 500mg twice daily for 305 days or 2gm single dose

47
Q

Campylobacter

A 
inflammatory diarrhea 
comma-shaped gram negative rod 
C. Jejuni = poultry 
-self limited 
C. fetus = cattle, sheep 
-BAD - bacteremia, meningitis, may be fatal in immunocompromised
48
Q

What is the treatment for Camylobacter enterocolitis?

A

azithromycin or ciprofloxacin

resistance to fluoroquinolones in SE asia

49
Q

“Hamburger disease”

A

inflammatory diarrhea

STEC - shiga toxin producing E. coli

ground beef, salami, spinach, apple cider, yogurt

50
Q

What are the sxs for STEC?

A

prodrome: abdominal cramps and mild fever

non-blood diarrhea within hours that progresses to blood diarrhea within 1-2 days

51
Q

What are the possible complications of STEC?

A

HUS - hemolytic uremic syndrome
commonly < 5 years of age
NO TX –just supportive

52
Q

How do you dx STEC?

A

stool antigen test

53
Q

Salmonella enteroclolitis

A

inflammatory diarrhea

foodborne - eggs, PB, pistachios, fruit, cantaloupe
exotic pets

incubation 6-48 hours

self-limited to 3-7 days

54
Q

Amoebiasis

A

inflammatory diarrhea

common in tropical areas with crowded living conditions

sxs include liver abscess

55
Q

What are the sxs of ameobic colitis?

A 
location
GRADUAL onset 
diarrhea
dysentery (blood and mucus in diarrhea) 
abdominal pain 
weight loss 
fever
56
Q

When do you see amoebic liver abscess?

A 
Amoebiasis sxs > 4 weeks
M > F 
fever
hepatomegaly
jaundice
weight loss
57
Q

How do you dx ameobiasis?

A

stool microscopy
stool antigen detection
stool PCR
serology

58
Q

What is the treatment for ameobiasis?

A

Metronidazole

followed by luminal agent (acts on cysts)

59
Q

Clostridium difficile sxs

A

inflammatory diarrhea

watery diarrhea 
fever 
loss of appetite
nausea
abdominal pain/tenderness

hx:
ABX, PPI

60
Q

What are the possible complications of C. diff?

A 
pseudomembranous colitis
toxic megacolon 
colonic perforation (sepsis)
61
Q

How do you dx C. diff?

A

NAAT -nucleic acid amplification

on stool for sxs pts

62
Q

What is the treatment for C. diff?

A

D/C ABX
mild to moderate: metronidazole 500mg 3 times daily for 10 -14 days
Severe: PO Vanco 125-500 mg 4 times daily for 10 -14 days

63
Q

Enteric fever

A

penetration of distal small bowel with intracellular replication of organisms in reticuloendothelial system and subsequent systemic dissemination

64
Q

What is the mainstay of therapy for infectious gastroenteritis?

A

rehydration

65
Q

Which deficiencies put you at a greater risk for gastroenteritis?

A

Vitamin A and Zinc deficiency

66
Q

Beaver fever

A

Giardia duodenalis

Protazoan from water (fresh water stream)

67
Q

What is the onset for giardia?

A

Gradual onset — 1-4 week incubation

Incubation is occurring in the duodenum (that is why it has fat in the poo)

68
Q

What do you tell your pts you are prescribing Metronidazole?

A

Don’t drink EtOH —it will cause bad GI upset

Tx for giardia duodenalis
Most azoles are antifungals but not this one

69
Q

HUS is a complication of ______

A

Hemolytic-uremic syndrome

STEC and Shigellosis

70
Q

Comma-shaped gram negative rod

A

Campylobacter

71
Q

What is the treatment for STEC?

A

NOTHING
You want the pt to get rid of this asap by giving them fluids
This means they will continue to have diarrhea but that will get the bug out faster

72
Q

Which pathogens do we NOT treat with ABX?

A

Salmonella

STEC

73
Q

When do you treat salmonella?

A

For pts at risk of invasive disease

Treat with Ceftriaxone IM

74
Q

What are the different types of amoebiasis syndromes?

A

Asymptomatic colonization
Dysentery
Colitis
Liver abscess

75
Q

How do you treat the asymptomatic colonization of amoebiasis?

A

Luminal agent alone

Paromomycin, lodoquinol

76
Q

Rose spots

A

Faint salmon colored maculopapular rash on the trunk of pts with TYPHOID FEVER

77
Q

How do you dx Typhoid fever?

A

Blood culture

78
Q

How do you treat typhoid fever?

A

Fluoroquinolone (cipro), 3rd gen ceph (ceftriaxone)

79
Q

BRAT diet

A

Bananas
Rice
Apple sauce
Toast

This is one of the first symptomatic therapies you do

80
Q

When do you advance to a stool culture?

A

If the pt has had diarrhea > 1 day, especially if they have a fever, bloody stool, or systemic sxs

81
Q

We have vaccines for some of these GI infections, which ones?

A

Rotavirus

  • Rotarix
  • RotaTeq
  • expensive
  • live, oral

Typhus

  • Live-attenuated (PO)
  • heat killed shot (IV)
  • for long-term travel to rural areas
82
Q

90% of enteric infection deaths are in pts ____y/o

A

<5 years old

83
Q

What toxins cause food poisoning?

A

Pre-formed neurotoxins and enterotoxins

84
Q

Fried Rice

A

B cerus

85
Q

Clinical presentation of Giardia?

A

Loose, foul smelling stools
Steatorrhea -fat malabsorption
Anorexia
No blood in stools

86
Q

What is the treatment for Shigellosis?

A

Rehydrate

Flouroquinolones - ciprofloxacin

87
Q

What is the clinical presentation of campylobacter enterocloitis?

A

Loose stools to massive watery or grossly blood diarrhea

Severe abdominal cramping relieved by defecation

Usually self limited but 10-20% have sxs >7 days

88
Q

How do you treat STEC?

A

Supportive only

NO ABX or antimotility agents

89
Q

NTS

A

Nontyphoidal salmonella entercolitis

Foodborne/ contact with exotic pets

Incubation period: 6-48 hours

90
Q

Signs of NTS

A 
Fever 
Abdominal cramping 
N/V
Chills
Watery diarrhea

Self limited to 3-7 days

91
Q

What are complications of NST?

A

Bacteremia

92
Q

What is the treatment for NTS?

A

Typically you dont treatment because the ABX could prolong carriage

Diarrhea might resolve but the bacteria is excreted in feces for 4-5 weeks

Only treat those at high risk of invasive disease
Ceftriaxone

93
Q

What are the signs and sxs of amoebic liver abscess?

A 
History of sxs >4 weeks 
M > F 
Immigrant/traveler from endemic area
Fever
Abdominal pain 
Hepatomegaly 
Jaundice
Diarrhea
Weight loss 
Cough (diaphragm irritation)
94
Q

For which enteric infections would a blood culture be positive?

A

Enteric fever
Or
Invasive NTS

95
Q

Antigen detection (EIA0

A

Rotavirus

Giardia

96
Q

When should you get a stool culture?

A

If pt has had diarrhea >1 day, especially if fever, bloody, or systemic sxs

If the pt is a food handler

Get NAAT if pt was on ABX in the last 2 weeks

97
Q

When do you get ova and parasites (O and P)?

A

If persistent diarrhea > 7 days

98
Q

Dukoral

A

Vaccine for ETEC + cholera

Not licensed in US

99
Q

Rotarix

A

One of the 2 vaccines for rotavirus

RotaTeq

CDC/ACIP recommends for all infants

100
Q

What vaccines do they have for Salmonella Typhi?

A

Oral (Ty21a) -live attenuated

Injectable (Vi) - heat killed

Recommended for long term travel to rural areas of endemic countries

Clin Med 2 (13 decks)

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