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MJ- F3E3: GI > IBS 2 > Flashcards

IBS 2 Flashcards

1
Q

Most cases of diarrhea are what?

A

self-limited

(esp. when associated with N/V)

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2
Q

Diarrhea:

  • Acute= < ___days
  • Persistent= > ____ days but < ____
  • Chronic= >____ days
A
  • Acute= < 14days
  • Persistent= > 14 days but < 30
  • Chronic= >30days
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3
Q

Most cases of acute diarrhea are _____

A

viral

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4
Q

What 3 viruses are common causes of acute diarrhea

A
  1. Rotavirus
  2. Adenovirus
  3. Norwalk-like virus

“RAN”

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5
Q

Bacterial causes of diarrhea tend to be _______ than viral causes

A

more severe- cause inflammatory diarrhea

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6
Q

What are the 6 common bacterial causes of acute diarrhea

A
  1. Campylobacter
  2. Salmonella
  3. Shigella
  4. Enterohemorrhagic E coli (E. coli 0157-H7)
  5. Vibrio (seafood)
  6. Listeria
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7
Q

What are the 2 protozoa to cause acute diarrhea?

A
  1. Giardia- MC
  2. Crytosporidium (HIV)
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8
Q

Presentation of inflammatory or non-inflammatory diarrhea?

  • Diffuse, watery diarrhea
  • abdominal cramping
  • N/V
  • Fever
A

Non-inflammatory

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9
Q

What are the 3 causes of non-inflammatory diarrhea

(“NAG”)

A
  1. Norwalk-like virus
  2. Adenovirus
  3. Giardia
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10
Q

Presentation of inflammatory or non-inflammatory diarrhea?

  • Bloody diarrhea
  • Fever
  • LLQ pain
  • tenesmus
A

Inflammatory

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11
Q

What are the 5 causes of inflammatory diarrhea

A
  1. Shigella
  2. Salmonella
  3. Campylobacter
  4. Enterohemorrhagic E coli
  5. C- diff
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12
Q

Which cause of noninflammatory diarrhea?

  • < 2y/o
  • sxs < 1wk
  • Present with V/D and F
A

Rotavirus

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13
Q

How do you treat noninflammatory diarrhea caused by Rotavirus?

A

Supportive

(can progress to dehydration or be fatal)

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14
Q

Bloody diarrhea is MCly associated w/ what

A

Enterohemorrhagic E coli

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15
Q

Noninflammatory diarrhea with vomiting suggests what

A

Viral enteritis or food poisoning

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16
Q

Recent antibiotic ingestion or hospitalization suggests what

A

C. difficile

17
Q

Acute Diarrhea clues:

  • Proctitis and rectal discharge suggest what 2 causes
A

Gonorrhea, LGV (lymphogranuloma venereum)

18
Q

The following are classic sxs of what cause of acute diarrhea?

  • NO FEVER
  • Bloody stool
  • abdominal tenderness
A

Enterohemorrhagic E. coli (EHEC)

(E coli 0157:H7 MC serotype in US)

19
Q

Acute diarrhea caused by Enterohemorrhagic E. coli (EHEC) is associated with what syndrome?

A

Hemolytic Uremic Syndrome

20
Q

What are the 3 components of Hemolytic Uremic Syndrome associated with acute diarrhea caused by EHEC?

A
  1. Hemolytic anemia
  2. Renal failure
  3. Thrombocytopenia
21
Q

What cause of acute diarrhea is associated with contaminated water (camping)

A

Giardia

22
Q

Classic sxs of what cause of acute bacteria:

  • Persistent Diarrhea >7days
  • fatty stools
A

Giardia

23
Q

A routine stool culture tests for what 4 causative agents

A
  1. shigella
  2. salmonella
  3. Campylobacter
  4. Enterotoxigenic E. coli
24
Q

What 3 causative agents of acute diarrhea must you order a separate test for?

A
  1. EHEC (culture of E coli 0157:H7 and stool test for shiga toxin)
  2. Stool for C. diff toxin
  3. Stool for Giardia Antigen
25
Q

Enterohemorrhagic E. coli (EHEC) produces which toxin

A

Shiga toxin

26
Q

What test should be ordered when evaluating acute diarrhea

A

stool culture with separate tests ordered for each specific cause (C.diff toxin, Giardia Ag, Shiga toxin & Ecoli 0157:H7)

27
Q

If inflammatory diarrhea is suspected consider ordering what 3 tests

A
  1. Stool for occult blood and for wbc’s (or lactoferrin)
  2. Routine stool culture
  3. Stool culture for E. coli 157:H7 & stool test of shiga toxin
28
Q

What is the main priority of managing Acute diarrhea

A

rehydration

29
Q

What are the 4 components of management for acute diarrhea?

A

1. Rehydration

  1. +/- Loperamide (immodium)- NOT for pts w/ suspected inflam. diarrhea- blood, etc
  2. +/- Bismuth subsalicylate (NOT for kids)
  3. Empiric abx w/ Cipro (if benefits > risks; stool culture before)
30
Q

When should you avoid use of antidiarrheal agents?

A
  • CHILDREN
  • Pts with suspected inflammatory diarrhea (fever, tenesmus, blood/pus in stool)
31
Q

What are the 2 ADEs of Bismuth Subsalicylate

A

turn tongue/stools black

32
Q

Acute Diarrhea:

  • Use caution in patients with what 4 sxs?
A
  1. Fever- NO Immodium
  2. Significant abd. tenderness
  3. bloody diarrhea- NO Immodium or abx
33
Q

What medication should NOT be given if there is acute diarrhea with fever

A

Immodium

34
Q

What 2 medications should not be given if there is bloody diarrhea

A

No immodium or antibiotics

MJ- F3E3: GI (9 decks)

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