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ICM - Infectious Disease > Infectious Diarrhea > Flashcards

Infectious Diarrhea Flashcards

1
Q

Differentiate diarrhea from…

A

Pseudodiarrhea - Rectal urgency, infection related
Fecal incontinence - Sudden, surprise discharge, NM related
Overflow incontenence - So packed up, liquid distends and flows around and leaks out

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2
Q

Amount of fluid entering Small Intestine?
Entering Large Intestine?
Exiting in normal stool?

A

9 L
2 L
0.1 L

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3
Q

Diarrhea reflects increased water in stool from…

A
  1. Increased Intestinal Secretion of Water

2. Decreased intestinal reabsorption of water

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4
Q

Duration of Acute, Persistent, and Chronic Diarrhea

A

Acute - Less than 14 days
Persistent - 14-30 days
Chronic - More than 30 days

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5
Q

Three primary types of Chronic Diarrhea

A

Watery
Fatty
Inflammatory

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6
Q

Common causes of Watery Chronic Diarrhea

A

Secretory (Colitis, Laxatives)
Osmotic (Laxatives)
Functional (Irritable Bowel)

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7
Q

Way of differentiating between Secretory and other causes of chronic watery diarrhea

A

Secretory will persist despite fasting

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8
Q

Causes of chronic fatty diarrhea

A

Malabsorption (Giardiasis, Celiac)

Maldigestion (Pancreatitis, Cystic Fibrosis)

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9
Q

What should you look for as an identified of chronic fatty diarrhea from maldigestion

A

Meat fibers in the stool

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10
Q

Causes of inflammatory chronic diarrhea (pus/blood in stool)

A

IBD (Ulcerative Colitis, Crohn’s)
Invasive (C Diff)
Neoplasia (Colon carcinoma)

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11
Q

Causes of Acute Diarrhea

A
  1. Usually viral
  2. Bacteria (esp. w/ blood, pus, fever, abdom. pain)
  3. Rarely Protozoa
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12
Q

Value of Stool Cultures?

A

Rarely valuable, consider in cases in which other results aren’t seen

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13
Q

Enteric pathogens that have preformed toxins

Site of Action?

A

Small Bowel – C. perfringens, S. Aureus, B. cereus

Colon – None

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14
Q

Enteric pathogens with enterotoxin?

Site of Action?

A

Small – Vibrio Cholerae

Colon – None

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15
Q

Enteric pathogens that are enteroadherent?

Site of Action?

A

Small – Giardia lamblia

Colon – None

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16
Q

Enteric pathogens that act with a cytotoxin?

Site of Action?

A

Small – None

Colon – E. Coli 0157:H7

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17
Q

Enteric Pathogens that cause dysentery?

A

Small – Salmonella, E. Coli

Colon - Campylobacter, Shigella, Entamoeba histolytica

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18
Q

Viruses that affect the Small Bowel

A

Rotovirus

Norovirus

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19
Q

Viruses that affect the colon

A

CMV
Adeno
Herpes

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20
Q

Common Associations – Vomiting. Cream Pie/Potato Salad at a picnic

A

S. aureus

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21
Q

Common Associations – Vomiting. Leftover Fried Rice.

A

B. cereus

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22
Q

Common Associations – Vomiting. Cruise Ships.

A

Norwalk-like viruses

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23
Q

Common Associations – Inflammatory Diarrhea. Hamburgers at a picnic.

A

Salmonella

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24
Q

Common Associations – Inflammatory Diarrhea. Hamburgers, Spinach

A

E. Coli 0157:H7

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25
Q

Common Associations – Inflammatory Diarrhea. Sushi

A

V. parahemolyticus

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26
Q

Common Associations – Inflammatory Diarrhea. Raw oysters in a place they probably shouldn’t be serving them.

A

V. vulnificus

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27
Q

What happens if you eat C. perfringens toxin. (Think home canned foods)

A

Toxin mediated acute GI symptoms

Gastroenteritis

28
Q

What happens if you eat C. perfringens bacteria.

A 
Pig Bel (Necrotizing Enteritis)
(Look for high fever, distended abdomen)
29
Q

Effects of C. botulinum

A

Paralytic neurotoxin released in anaerobic environment

Weakness, diplopia, progresses to paralysis

30
Q

Effects of C. tetani

A

Excitatory neurotoxin formed by bacteria present in wounds

Lockjaw

31
Q

Effects of C difficile

A

Toxin mediated colitis from C dif overgrowth

Pseudomembranous Colitis

32
Q

Virus associated with daycare exposure

A

Rotavirus

33
Q

Virus associated with cruise ships

A

Norovirus

34
Q

Virus associated with MSM, Shellfish, Food workers

A

Hep A

35
Q

Protazoa associated with travel, surface water.

A

Giardia lamblia

36
Q

Bacteria associated with Traveler’s Diarrhea (travels to the developing world)

A

ETEC

37
Q

Bacteria associated with antibiotic use in the past 3-6 months.

A

C. difficile

38
Q

Bacteria associated with Caesar salad, ice cream, ducklings, lizards

A

Salmonella

39
Q

Seven components of a full diarrhea history

A 
Onset
Frequency
Presence of mucous/blood
Getting up at night?
Associated symptoms
Exposures (Travel, Camping, Other sick people, etc.)
Recent AB use?
40
Q

Describe a Bristol Stool Chart Type 1

A

Separate hard lumps, like nuts

Hard to pass

41
Q

Describe a Bristol Stool Chart Type 2

A

Sausage shaped, but lumpy

42
Q

Describe a Bristol Stool Chart Type 3

A

Like a sausage, but with cracks on the surface

43
Q

Describe a Bristol Stool Chart Type 4

A

Like a sausage or snake

Smooth and soft

44
Q

Describe a Bristol Stool Chart Type 5

A

Soft blobs with clear cut edges

45
Q

Describe a Bristol Stool Chart Type 6

A

Fluffy pieces with ragged edges

Mushy

46
Q

Describe a Bristol Stool Chart Type 7

A

Watery, No solid pieces

47
Q

Signs of a surgical abdomen

A

Guarding, Rebound, increased pain/tenderness

Distended, No Bowel Sounds

48
Q

Why should you be looking at the skin in a diarrhea physical exam

A

There are rashes associated with some pathogens.

Ex. Look for a on-blanching rash (Vasculitis)

49
Q

Specifically mentioned piece of information gathered in a rectal exam.

A

Hemoccult

50
Q

Other phrase for hemorrhoids

A

Sentinel Piles

51
Q

What is an anal fissure? How does it happen?

Worry about it?

A

A tear in the anus
Typically associated with trauma (Anal sex, BM) and hematochezia
Usually not super pathological

52
Q

What is hematochezia

A

passage of fresh blood through the anus

53
Q

What is an anal fistula? How does it happen?

Worry about it?

A

Chronic abnormal communication between the epithelialised surface of the anal canal and the perianal skin associated with IBD.
Associated with much higher risk of severe anorectal disease.

54
Q

When a patient comes in claiming to have hemorrhoids, what should you check to make sure it isnt

A

HPV/Anorectal Warts

55
Q

Describe the evaluation steps for an acute diarrhea patient.

A

Initial Eval – Dehydration, inflammation
Symptomatic Therapy
If not severe, wait a week with symptomatic aids
If severe, test for fecal leukocytes, stool culture
Antibiotics if inflammatory, symptomatic if noninflammatory

56
Q

What might be an indicator you need to check for Ova/parasites in stool?

A 
Persistent Diarrhea
Travel (Russia, Nepal)
Exposure to infants in daycare centers
MSM, AIDS
Community Outbreak
Bloody with few/no leukocytes
57
Q

What do you do if you have persistent bloody diarrhea but your bacterial + cultures are getting you nowhere

A

Endoscopy (Look for tricky Inflammatory Bowel Disease)

58
Q

Recipe for oral rehydration mix

A

half tsp salt
half tsp baking soda
4 tbs sugar
1 L water

59
Q

Three commonly used symptomatic therapies for diarrhea

A

Loperamide (Immodium) – Anti-motility agent
Diphenoxylate (Lomotil) – Anti Motility agent
Bismuth subsalicylate (Pepto-bismol)

60
Q

5 commonly used steps in treatment of acute diarrhea

A 
Oral Rehydration
Symptomatic Therapy
Probiotics
Dietary Alterations
Empiric antibiotics
61
Q

Two commonly used probiotics

A

Align, Culturelle

62
Q

Commonly recommended dietary alterations for acute diarrhea patients

A 
Avoid Dairy (temporary lactase loss)
Low Residue Diet (white foods, cooked vegetables, low fat meats)
63
Q

Most commonly used empiric antibiotics for diarrhea

A

Fluoroquinolone (Cipro, levofloxacin)

Metronidazole

64
Q

Where should you look for stones in an abdominal x-ray

A

Ureter rides along in the psoas shadow

65
Q

Two types of abdominal x ray

A

KUB (kidney, ureter, bladder)

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ICM - Infectious Disease (11 decks)

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