Gut Bugs

Question 1

Viral gastroenteritis can be caused by what viruses?

Answer 1

Rotavirus (most common)
Norovirus
Astrovirus
Enteric Adenovirus (under 2yo)

Question 2

What is an exotoxin

Answer 2

secreted by microorganism and released into the environment then pre-formed toxin ingested in contaminated food. WATERY DIARRHEA - in 12 hrs of ingestion

• staphylococcus aureus
• bacillus cereus
• clostridium perfringens
• clostridium botulinum

Question 3

most common food poisoning, caused by ingestion of picnic foods, potato salad, salad dressing, coleslaw

Answer 3

staphylococcus aureus

Question 4

contaminated rice or beef have this toxin

Answer 4

bacillus cereus

Question 5

inadequately pre-cooked and then reheated before served, beef products

Answer 5

clostridium perfringens

Question 6

associated with improperly canned foods or smoked freshwater fish

Answer 6

clostridium botulinum

Question 7

What are the phases of clostridium botulinum infx?

Answer 7

Ph 1. n/v/d
Ph 2. visual issues - diplopia, ptosis
Ph 3. neurological - weakness, dysphagia

Question 8

what is an enterotoxin?

Answer 8

cytotoxin producing bacteria, specific for the mucus membrane of the intestine - impairing intestinal absorption, increasing secretion of water and electrolytes - causing watery diarrhea

• cholera and non-cholera vibrio
• enterotoxic e.coli (lasts 3-5 days)
• clostridium difficile - “C. Diff”

Question 9

associated with fecal contaminated water or food (worldwide) in the US - most commonly associated with saltwater crabs and freshwater shrimp

Answer 9

cholera and non-cholera vibrio

50% of cases fatal

Question 10

what is a major complication of C. diff?

Answer 10

Toxic Megacolon

pseudomembranous colitis

Question 11

what is the travelers pathogen?

Answer 11

enterotoxic escherichia coli

profuse, watery diarrhea

Question 12

overgrowth of intrinsic organisms (post antibiotic) or infection by external source (household pets)

Answer 12

clostridium difficile

- fever!

Question 13

what is mucosal invasion?

Answer 13

ingested organism causes microscopic ulceration, bleeding, exudates and secretion of electrolytes and water
diarrhea may be watery or bloody

• salmonella
• campylobacter jejuni and fetus
• shigella
• enterohemorrhagic escherichia coli

Question 14

which virus is the most common cause of infectious diarrhea worldwide

Answer 14

rotavirus

Question 15

which virus has year round incidence in older children and adults

Answer 15

norovirus

Question 16

infants and younger kiddos get this, generally in the winter time

Answer 16

astrovirus

Question 17

enteric adenovirus

Answer 17

kids under 2 yo, year round, summer - fecal-oral

Question 18

undercooked chicken or eggs, unpasteurized milk.. creates exudative diarrhea, bloody

Answer 18

salmonella

Question 19

which bacteria is the most common cause of bloody diarrhea in the US

Answer 19

campylobacter jejuni or fetus

Question 20

kiddos are typically infected with this bacteria, highly contagious.

Answer 20

shigella

Question 21

this bacteria produces the Shiga toxin - follows ingestion of undercooked beef or unpasteurized milk. Can lead to HUS and TTP.

Answer 21

enterohemorrhagic escherichia coli

watery diarrhea that turns bloody within 24 hours.

Question 22

This bug mimics appendicitis (RLQ pain, fever, vomiting)

Answer 22

yersinia enterocolitica

Question 23

acute ileitis is caused by which bacteria

Answer 23

yersinia enterocolitica

Question 24

Parasitic infections are which bugs?

Answer 24

giardia lamblia - acute or chronic

cryptosporidium parvum - immune compromised

Question 25

which bug produces a celiac-like lesion that causes lactose intolerance and malabsorption

Answer 25

giardia lamblia

Question 26

this travel associated bug causes ulcerations similar to IBD

Answer 26

entamoeba histolytica

Question 27

fecal lactoferrin can help differentiate which conditions how?

Answer 27

differentiates IBD and IBS
High fecal lactoferrin indicates inflammation - IBD
Low fecal lactoferrin indicates - IBS

Question 28

What are the 6 alarm features or red flags of IBS

Answer 28

1. onset after age 50
2. severe diarrhea (dehydration, electrolyte imbalances)
3. nocturnal symptoms
4. unintended weight loss
5. hematochezia
6. family history of GI disturbances

Question 29

Rome III Criteria is…

Answer 29

for the diagnosis of IBS patients must have recurrent abdominal pain or discomfort at least 3 days/mo in the previous 3 months associated with two or more of the following:

• relieved by defecation
• onset with a change in frequency of stool
• onset with a change in the form or appearance of the stool

Question 30

What are the fermentation gases associated with celiac disease? How are they tested?

Answer 30

hydrogen and methane

tested by glucose breath hydrogen and d-xylose breath test (methane)

Question 31

Which test is best to detect lactose intolerance?

Answer 31

hydrogen breath test

lactose is administered after an overnight fast, after which expired air samples are collected before and at 30 minutes intervals for three hours to assess hydrogen gas concentration. rise greater than 20 ppm over baseline after lactose ingestion indicates lactase deficiency

Question 32

Which antibodies are tested for in celiac disease?

Answer 32

• IgA EMA - serum IgA anti-endomysial antibodies

- tTG antibody - anti-transglutaminase

Question 33

which antibody test is the recommended SINGLE serologic test for celiac disease screening in the primary care setting

Answer 33

tTG antibody

Question 34

what is a zebra for chest pain, splenomegaly and seizures

Answer 34

whipple’s disease