GI Viral diarrhea Flashcards
Whats the most common cause of diarrhea in little kids
viral illness: rotovirus pretty common norovirus more in adults
What is the best tx with a kid that has diarrhea and is vomiting from viral illness?
oral rehydration!!! – Intestinal glucose absorption via sodium-glucose cotransport remains intact. – Intestine able to absorb water if glucose and salt are also present.
Why is it important to have both Na and glucose in solutions for hydration?
the Na/GLU co transporter (SGLT-1) is non-ATP co transporter that requires both to be present and water will follow
4 days of diarrhea, tired and weak with abdominal pain and now bloody stool. She’s orthostatic, with hyperactive bowel sounds and no peritoneal signs, Ddx?
Bacterial, infectious (inflammatory colitis) or non-infectious like Crohns or UC
Do we treat bloody diarrhea with antibiotics or anti-diarrheals?
nope
Most common cause of GI illness in children and how do we tx it?
viral hydration
Causes of bloody diarrhrea
infectious: inflammatory mediated like shigella, E coli or campylobacter non-infectious: UC or crohns
Pt with blood diarrhea has confirmed E.coli 0157:H7 and tx w/ cipro
now she is jaundiced, sceral icterus, difficulty breathing, rash, bilateral edema and anemic. What happened?
HUS
– Travellers’ diarrhea and post infectious IBS
Enterotoxigenic E. coli
– Guillain Barre Syndrome
– Crohn’s Mimic
– Pseudoappendicitis
Campylobacter
– pet turtles
– Osteomyelitis in sickle cell/asplenic patients
Salmonella
– Day care/institutions
– HUS, but less common (primarily S. dysenteriae)
– Seizures
– Reactive arthrit
Shigella
– Shellfish contamination
vibrio cholerae
– Most common cause world wide
– Cruise ships
Norovirus
– Most common pediatric cause of GI illness
Rotavirus
Pt is Acute, non-toxic appearing, non-bloody diarrhea, do we test?
– No testing is needed
Key for stool cultures
- Bacterial pathogens generally are excreted :
- Negative culture usually not a :
- Repeat specimens are :
continuously.
false negative
rarely required
When is it important to order a stool sample?
Severely ill
Outbreaks
Require hospitalization
Immunocompromised patients, e.g. HIV
Patients with co-morbidities (e.g. IBD)
Some employees, such as food handlers or daycare providers, may require negative stool cultures to return to work
WHen and how do we provide emperic tx for travelers diarrhrea?
Moderate to severe travelers’ diarrhea
– > four stools daily, fever, blood, pus, or mucus in the stool.
Prompt treatment with fluoroquinolone or TMP-SMZ
– can reduce the duration from 3-5 to 1-2 days.
When can we proved empiric antibiotics to pts with GI illness?
Greater than eight stools per day, volume depletion, symptoms >one week, hospitalized patients, and immunocompromised hosts
Fluoroquinolone for three to five days
Azithromycin and erythromycin are alternative agents particularly if fluoroquinolone resistance is suspected.
When is it okay to use anti-motility agents for diarrhea
Only if fever is absent and stools not bloody – Bacterial translocation
– C. diffToxic megacolon
• These drugs may facilitate the development of the (HUS) in EHEC.
- Neither the small intestine nor the colon can maintain an osmotic gradient
- Unabsorbed ions that remain in the lumen
– Retain water
– Maintain an intraluminal osmolality = 290 mOsm/kg (same as serum)
Osmotic diarrhea
Causes of osmotic diarrhea
Ingestion of poorly absorbed ions or sugars or sugar alcohols
– Mannitol, sorbitol
– Magnesium, sulfate, and phosphate.
Monosaccharides—but not disaccharides—can be absorbed intact across the apical membrane of the intestine.
– Disaccharidase (lactase) deficiency will prevent absorption.
– “lactose intolerance”
- Disappears with fasting Or cessation of the offending substance.
- Electrolyte absorption is not impaired in osmotic diarrhea
- Electrolyte concentrations in stool water are usually quite low
Secreatory Diarrhea
