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Clin Med II > Infections of the GI tract (Schoenwald) > Flashcards

Infections of the GI tract (Schoenwald) Flashcards

1
Q

Is infectious diarrhea acute or chronic in onset?

A

Acute

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2
Q

How long does infectious diarrhea last for?

A

Lasts less than 2 weeks

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3
Q

What should be part of the history in patients with infectious diarrhea?

A

Travel history

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4
Q

What suggests a viral etiology of infectious diarrhea?

A

Community outbreaks in nursing homes, schools, cruise ships, or common food source

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5
Q

Watery, non-bloody diarrhea is characteristic of what kind of diarrhea?

A

Non-inflammatory

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6
Q

What are the sxs of non inflammatory diarrhea?

A

Cramping, bloating, nausea, vomiting- disrupts normal absorption in the small bowel

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7
Q

Will you see fecal leukocytes on a smear in non-inflammatory diarrhea?

A

No, no fecal leukocytes will appear on the smear because tissue invasion does not occur in non inflammatory diarrhea

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8
Q

What types of diarrhea accompanies fever and bloody diarrhea

A

Inflammatory

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9
Q

What type of diarrhea will you have colonic tissue damage from invasion of bacteria or toxin?

A

Inflammatory diarrhea, which is why it is bloody

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10
Q

What part of the colon is primarily involved in inflammatory diarrhea?

A

Lower colon

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11
Q

What sxs will you see in inflammatory diarrhea?

A

Lower quadrant cramping, urgency

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12
Q

Will there be fecal leukocytes present in inflammatory diarrhea?

A

Yes, because of invasion of mucosa

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13
Q

What should your differential include when diagnosing inflammatory diarrhea?

A

Ulcerative colitis

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14
Q

Diarrhea lasting longer than 14 days is most likely…

A

NOT due to an infectious agent (except c diff!)

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15
Q

What is the major difference between inflammatory and non inflammatory diarrhea?

A

Colonic tissue invasion by the organism and/ or toxin

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16
Q

Why is it important to classify the diarrhea as inflammatory vs non inflammatory?

A

Helps to differentiate when it is “okay” to use anti motility agents such as Imodium

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17
Q

What is Imodium?

A

Anti motility agent- helps with diarrhea

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18
Q

When should you absolutely not use antimotility agents?

A

In inflammatory diarrhea- this traps the organism in the colon, causing more damage, perpetuating the sxs, and prolonging the infection

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19
Q

What are some typical stool pathogens?

A 
Salmonella 
Shigella 
Campylobacter
Vibrio 
E Coli O157:H7 
Clostridium difficile
Norovius 
Enterovirus 
Parasites- giardia, amoeba, cryptosporidium
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20
Q

What organism should you suspect with previous antibiotic usage?

A

Cdiff

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21
Q

What causes non inflammatory diarrhea?

A 
Enterotoxin production- 
Staph aureus 
B cereus 
Enterotoxigenic E. coli 
Vibrio cholerae
& 
Norovirus 
Rotavirus 
Giardia 
Cryptosporidium 
Listeria monocytogenes
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22
Q

What causes inflammatory diarrhea?

A 
Cytotoxin production...
Enterohemorrhagic E. coli 0157:h7
C diff 
Mucosal invasion...
Campylobacter 
Shigella 
Salmonella

Cytomegalovirus
Entamoeba histolytica

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23
Q

What agents cause enterotoxin production in non-inflammatory diarrhea?

A

Staph aureus
Bacillus cereus
Enterotoxigenic E. coli
Vibrio cholerae

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24
Q

What agents cause cytotoxin production in inflammatory diarrhea?

A

Enterohemorrhagic E. coli 0157:H7

C diff

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25
Q

What agents cause mucosal invasion in inflammatory diarrhea?

A

Campylobacter
Shigella
Salmonella

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26
Q

What is the new name for C diff?

A

Clostridioides difficile

Previously clostridium difficile

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27
Q

What agents cause inflammatory diarrhea?

A 
C diff 
Salmonella 
Shigella 
Campylobacter 
E. coli 0157:h7
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28
Q

What is the main symptom in a c diff infection?

A

Diarrhea

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29
Q

What are the major risk factors to an infection with c diff

A

Previous antibiotic usage
Advanced age
Previous hospitalization
Nursing home resident

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30
Q

What antibiotics are known for causing a c diff infection

A

Clindamycin
Penicillins
Cephalosporins
Fluroquinolones

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31
Q

What makes the diagnosis under the new guidelines for c diff?

A

Presence of symptoms in the form of three or more unformed stool over 24 hours for 2 consecutive days in conjunction with positive stools for pseudomembranes
Prior antibiotic usage in not included in making the diagnosis with the new guidelines

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32
Q

What are the clinical findings in a c diff infection?

A 
Water diarrhea 
15-30 bowel movements per day 
Abdominal pain or cramps 
Low grade fever 
Can lead to toxic mega colon and Colectomy
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33
Q

What are the lab findings in c diff?

A

Leukocytosis- often with bandemia (left shift)
Hypoalbuminemia
Positive stool c diff test

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34
Q

What are the lab tests for c diff?

A

Molecular test- PCR
Antigen detection
Toxin testing

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35
Q

What lab test for c diff is highly sensitive and specific and can be positive in asymptomatic patients?

A

Molecular test PCR

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36
Q

Which lab test for c diff is nonspecific?

A

Antigen detection

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37
Q

Which lab test for c diff is associated with high rates of false negatives?

A

Toxin A and B testing, used for screening

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38
Q

For an initial episode of c diff that is mild/moderate what do you expect to see on labs?

A

Leukocytosis <15,000, creatinine <1.5

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39
Q

For an initial episode of c diff with mild to moderate symptoms, what should you use to treat?

A

Vancomycin 125mg po qid X 10 days OR

Fidaxamin 200 mg po bid X 10 days

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40
Q

For an initial episode of c diff that is severe, what labs would you expect to see?

A

Leukocytosis >15,000, creatine >1.5 prior to CDI

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41
Q

For an initial episode of c diff with complications, what clinical signs will you see?

A

Hypotension
Shock
Perforation
Megacolon

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42
Q

What should you use to treat an initial episode of c diff that is complicated?

A

Vancomycin 500mg po qid or via NG tube and or metronidazole 500-750 mg IV q 8 hours

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43
Q

What should you use to treat the 1st recurrence of c diff?

A

Vancomycin oral taper or Fidaxamin 125mg po qid

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44
Q

What should you use to treat a 2nd recurrence of c diff?

A

Vancomycin oral taper or Fidaxamin

Fecal mircobiota transplant

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45
Q

What can be done to prevent c diff infections?

A

Antibiotic stewardship

Environmental control, hand hygiene

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46
Q

When wanting to prevent c diff, it is important to remember that spores can live up to ___ months on a surface

A

5

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47
Q

When thinking about preventing a c diff infection, it is important to remember that _____ can be a vector

A

Health care workers

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48
Q

Are alcohol hand preps effective for preventing c diff?

A

No

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49
Q

What should be used on surfaces to prevent the transmission of c diff?

A

Chlorine based disinfectants

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50
Q

Salmonella is a gram negative/ positive rod

A

Gram negative rod

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51
Q

Salmonella is carried in the GI tract of….

A

Reptiles and birds

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52
Q

How many cases of salmonella infections yearly in the US?

A

3.7 million

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53
Q

How do most cases of salmonella occur?

A

From eating contaminated meat or eggs or from infected food handlers
Also associated with handling reptiles

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54
Q

Patients with a salmonella infection can remain culture positive for ___ months after treatment, making them a long term carrier

A

1 month

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55
Q

How long is the incubation for salmonella?

A

6-48 hours

56
Q

What are the clinical sxs of salmonella?

A

Fever and diarrhea most common sxs
Usually self limited
Bloody stools uncommon

57
Q

Where can salmonella spread to?

A

Vascular grafts, joints, kidneys and liver common in bacteremic patients

58
Q

What is the treatment of salmonella?

A

Most cases are self-limiting, if uncomplicated no antibiotic treatment is necessary
Ciprofloxacin treatment of choice
Bactrim (trimeth/sulfa) alternate

59
Q

What agent causes typhoid fever?

A

Salmonella typhi

60
Q

What is important to making the diagnosis of typhoid fever?

A

Typhoid fever is NOT endemic to the US- travel history is vital for diagnosis

61
Q

Where are high risk areas for typhoid fever?

A

India
Pakistan
Caribbean
Mexico

62
Q

How is typhoid fever transmitted?

A

By contaminated food, sewage, and infected food handlers (could be asymptomatic carriers)

63
Q

What are the symptoms of typhoid fever?

A 
Diarrhea 
Constipation 
Skin rash on torso and back 
Fever 
Abdominal pain 
Weakness
64
Q

How is the diagnosis of typhoid fever made?

A

Stool culture

65
Q

What is the treatment for typhoid fever?

A

Antibiotic resistance is an issue
Historic treatment is fluoroquinolones- cipro
Ceftriaxone resistance is developing
Due to resistance issues, current recommendation is azithromycin for mild, carbapenems for more severe cases with history of travel to SE Asia

66
Q

What is the prognosis of typhoid fever?

A

It is a serious infection that can be fatal, especially if ineffective treatment due to antibiotic resistance

67
Q

Shigella is a gram…

A

Gram negative rod

68
Q

What organism is commonly referred to as “dysentery” ?

A

Shigella

69
Q

Carriers of shigella are symptomatic/asymptomatic

A

Asymptomatic

70
Q

Is shigella virulent?

A

Yes, only 10-100 organisms can cause infection

71
Q

How is shigella spread?

A

Person to person

Fecal to oral spread, also flies and inanimate objects

72
Q

How many worldwide deaths per year can be attributed to shigella?

A

650,000 deaths worldwide

73
Q

What is the incubation period for shigella?

A

12 hours to 4 days

74
Q

What are the symptoms of shigella?

A 
Diarrhea that is bloody, watery, pus and mucus- secretory 
Fever
Stomach cramps 
Nausea
Vomiting 
Dehydration
75
Q

What should be on your differential when making the diagnosis of shigella?

A

Other bacterial infections such as vibrio
Viral
Parasites

76
Q

What is the treatment for shigella?

A

Rehydration
Ciprofloxacin
Bactrim or azithromycin alternate (recent strains show high rate of resistance)

77
Q

Campylobacter is a gram…

A

Negative rod

78
Q

What is the #1 cause of food-borne illness in the US?

A

Campylobacter- sausages and hard meats, undercooked chicken

79
Q

What illness often has a prodrome of fever, headache, myalgia, and malaise?

A

Campylobacter

80
Q

What are the sxs of campylobacter?

A

Prodrome- fever, headache, myalgia, and malaise
Diarrhea
Fever
Symptoms are often low grade

81
Q

What is the treatment for campylobacter?

A

Ciprofloxacin 1st

Azithromycin 2nd

82
Q

What are some complications from a campylobacter infection ?

A

Bacteremia in <1%
Guillian Barre
Reactive arthritis

83
Q

What is the main cause of HUS in the US?

A

E. coli 0157: H7

84
Q

What is an infection with E. coli 0157:H7 linked to?

A

Undercooked ground beef, drinking of unpasteurized juices and milk, working with cattle (1% of cattle in the US are carriers)

85
Q

What are the symptoms of an infection with E. coli 0157:H7?

A

Bloody diarrhea
Severe cramping
Fever 0-30% of the time
Nausea vomiting common

86
Q

What are you going to see in hemolytic uremic syndrome?

A

Acute renal insufficiency
Hemolytic anemia
Thrombocytopenia

87
Q

What populations is HUS severe in?

A

Children and elderly

88
Q

HUS can/cannot be fatal?

A

Can be fatal

89
Q

What test differentiates TTP from HUS?

A

ADAMTS 13 test differentiates TTP from HUS

+ in TTP

90
Q

What labs are you going to see in HUS?

A 
Blood cultures are often negative 
Anemia 
Decreased haptoglobin and increased LDH 
Negative Coombs (nothing coating RBCs) 
Thrombocytopenia 
Elevated creatinine 
Hematuria, proteinuria
91
Q

What is the treatment for HUS?

A

Supportive

Antibiotic use is controversial

92
Q

What is the mortality rate associated with HUS?

A

5-20% mortality

93
Q

What agents are responsible for non inflammatory diarrhea?

A 
Staph toxin 
Bacillus cereus 
Listeria monocytogenes 
Enterotoxigenic e Coli 
Vibrio cholera 
Norovirus 
Protozoal infections such as giardia, amoeba
94
Q

Staph food poisoning is actually from the ____ not the bacteria

A

Toxin

95
Q

Staph food poisoning is more common in foods with….

A

High salt or sugar content (cream sauces, custard, hams, canned meat)

96
Q

Staph food poisoning onset is fast/ slow

A

Fast onset- 4-8 hours

97
Q

What are the symptoms of staph food poisoning?

A

Cramping, diarrhea, nausea, vomiting

98
Q

What is the treatment for staph food poisoning?

A

Usually self limited- antibiotics are not recommended, resolves quickly

99
Q

Listeria monocytogenes is/ is not foodborne

A

Is typically food borne

100
Q

What populations are more susceptible to a listeria monocytogenes infection?

A

Pregnancy

Immunosuppressed

101
Q

What can happen when a pregnant woman becomes infected with listeria monocytogenes?

A

Spontaneous abortion, sepsis

102
Q

What can result from a listeria monocytogenes infection?

A

Bacteremia and meningitis

103
Q

Listeria is a gram…

A

Positive rod/ bacillus

104
Q

What is a predisposing risk factor to a listeria infection?

A

Previous corticosteroid infection

105
Q

In pregnancy related infections with listeria, ___% of cases end in fetal death

A

Listeria

106
Q

Symptoms of listeria…

A 
Fever
Chills
Muscle aches
Nausea
Diarrhea
107
Q

What is treatment of choice in a listeria infection and why?

A

Ampicillin because it can cross the blood brain barrier to treat meningitis

108
Q

How does Enterotoxigenic E. coli compare to E. coli 0157:h7?

A

Not the same infection

Usually less severe when compared to 0157 infection

109
Q

What organism is the main cause of traveler’s diarrhea?

A

Enterotoxigenic E. coli

110
Q

Enterotoxigenic E. coli can be…

A

A shiga toxin producer but not usually

111
Q

What are the symptoms of an infection with Enterotoxigenic E. coli?

A

Profuse diarrhea, usually not bloody
Fever
Abdominal cramping

112
Q

How is Enterotoxigenic E. coli diagnosed?

A

By stool culture or PCR

113
Q

What are the treatment options for Enterotoxigenic E. coli?

A

Cipro 500 mg po bid X 7 days or
Trimeth/sulfa 180/800 mg po bid x 7 days or
Azithromycin 250mg 2 po on day 1 then 1 po day 2-5

114
Q

Vibrio cholera is a ____borne illness

A

Waterborne

115
Q

The usual cause of vibrio cholera is…

A

Poor water sanitation

116
Q

What food carrier vibrio cholera?

A

Contaminated shellfish - raw oysters

117
Q

What enterotoxin results in a massive secretion from the small bowel?

A

Vibrio cholera

118
Q

What is the incubation time of vibrio cholera?

A

12-72 hours after ingestion

119
Q

What are the symptoms of cholera?

A

Rapid dehydration- profuse watery diarrhea because you lose 1-3 liters per day up to 20 liters per day

120
Q

What infection is associated with “rice water stools” ?

A

Cholera

121
Q

Is fever common with cholera?

A

No, fever is rare

122
Q

What is the mortality rate associated with cholera?

A

1-10%

123
Q

What is the treatment for cholera?

A

Hydration!

Doxycycline or cipro Can limit the duration of the disease but dehydration is the main issue

124
Q

What is viral gastroenteritis?

A

Inflammation of the stomach and intestinal tract

125
Q

How many cases of viral gastroenteritis are there each year?

A

211-375 million

126
Q

What are the sxs of viral gastroenteritis?

A 
Sudden onset, rapid resolution 
Diarrhea 
Nausea 
Vomiting 
Stomach cramping
127
Q

What is the most common cause of non bacterial acute gastroenteritis?

A

Norovirus

128
Q

Norovirus persists in the environment/ does not persist in the environment

A

Persists in the environment and is hard to eradicate

129
Q

Where do outbreaks of Norovirus commonly occur?

A

Nursing homes, hospitals, schools, day cars, military bases, cruise ships, hotels

130
Q

How is Norovirus transmitted?

A

Person to person contact, contaminated food and water, airborne
Small doses can lead to infection
Contagious even after symptoms resolve- may shed up to several weeks

131
Q

What are the clinical findings of Norovirus?

A 
Sudden onset of vomiting, diarrhea 
Nausea 
Fever
Abdominal cramping 
1-3 days
132
Q

What is the treatment for Norovirus?

A

Self limiting- supportive care

133
Q

What is the prevention of Norovirus?

A

Hand washing at least 20 seconds with soap and water
Decontamination of surfaces with beach 10%
Infected food handlers must stay away from work for 48-72 hours after symptoms resolve

134
Q

For all of these GI illnesses, what is the gold standard testing?

A

Stool testing, 48-72 hour turn around time

PCR is now available for GI pathogens- good sensitivity for multiple pathogens but expensive

135
Q

Fever is/ is not always present in diarrheal illnesses

A

Is not

136
Q

What needs to be considered when treating with an anti diarrheal/ anti motility agents?

A

Is the cause inflammatory or non inflammatory

Clin Med II (7 decks)

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