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Gastrointestinal II Exam 1 > Infectious Diarrhea DSA > Flashcards

Infectious Diarrhea DSA Flashcards

1
Q

Who is at high risk for infectious diarrhea?

A

travelers

immunodeficient

daycare people

institutionalized people

consumers of certain foods (wtf?)

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2
Q

What is the most important thing to look for on PE for infectious diarrhea?

A

signs of dehydration

mild: thirst, decreased fluid output
moderate: orthostatic BP, tenting, sunken eyes/fontanelle
severe: lethargy, hypotension, shock

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3
Q

Acute infectious diarrhea is transmitted how?

A

fecal oral

(mild and self limited)

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4
Q

when to work up infectious diarrhea?

A

profuse diarrhea with 6+ stools per day WITH dehydration

hypotension/tachycardia

fever

>48hrs without improvement

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5
Q

What is the cornerstone of diagnosis for infectious diarrhea?

A

microbiologic analysis of the stool

routine studies: salmonella, shigella, E. coli, campylobacter

takes 24-48hrs

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6
Q

What are some specific stool analyses?

A

special cultures for EHEC, Vibrio, and Yersina

PCR for C. diff

ova/parasites

protozoa antigens for giardia, crypto, E.histolytica

PCR antigen for rotovirus, norwalk

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7
Q

When to suspect food poisoning?

A

summer-time, several sick members from picnic/banquet/restaurant

routine testing not done

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8
Q

Common causes of food poisoning?

A

chicken (salmonella, campylobacter)

beef (EHEC)

fried rice (B. cereus)

potato salad (s. aureus)

lunch meats (listeria)

seafood (vibrio, norovirus)

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9
Q

What is the micro of S. Aureus?

Sx

risk factors?

A

g+ cocci, preformed enterotoxins

watery diarrhea, N/V, onset within 6 hrs, better in 24-48

eggs, cream pastries, potato salad, mayo

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10
Q

Micro of B. Cereus

Sx

risks

A

g+ rods, preformed enterotoxins

rapid onset vomiting, 6hrs of ingestion, watery diarrhea, better in 24-48 hrs

fried rice

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11
Q

Micro for C. perfringens?

sx

risks

A

g+ heat resistant spore forming rods with entertoxins

watery diarrhea, no vomiting

onset 6-18hrs, acid labile, better 24-48 hrs

beef, ham, poultry, legumes, gravy

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12
Q

Micro of shigella

sx

treat

risks

complications

A

g- rods, toxin mediated

bloody diarrhea, pus, fever, fecal leukocytes

difficult to differentiate from IBD

1-2wks long

bismuth, abx

lettuce raw veg.

reactive arthritis

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13
Q

Micro of salmonella

sx

dx

tx

risks

complications

A

gram -, infects peyers patches, non-typhoid in US

bloody diarrhea

stool culture

self limitied 5-10 days

eggs, poultry, reptiles, Sickle Cell

septic arthritis, abcess, osteomyelitis

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14
Q

micro for salmonella typhi

sx

dx

tx

A

gram-, anaerobic

typhoid fever, salmon/rose colored rash, pea soup poo, bradycardia

stool and blood cultures

fluoroquinolines

risks: travel, poor sanitation

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15
Q

micro of C. jejuni

sx

dx

tx

risks

complications

A

gram-, cruved, spiral rod

bloody diarrhea

fecal leukocytes

campy blood agar,

self limitied, 7 day illness

poultry

guillan barre

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16
Q

V. cholorae micro

sx

dx

risks

treatment

A

gram-, anarobic, curved with flagella, toxin

rice water diarrhea, dehydration

stool micropscopy, gram stain

waterborn illness, seafood

rehydrate, vaccinate

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17
Q

V. parahmolyticus micro

sx

dx

tx

risks

A

gram-, cytotoxin, bacilli

N/V, blood diarrhea

self-limited

seafood

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18
Q

Micro of V. vulnificus

Sx

risks

A

gram - bacilius

bullous skin lesions, cirrhosis, vomiting, diarrhea

coastal sea water, shellfish

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19
Q

A. hhydrophila micro

sx

tx

risks

A

gram-, non-spore forming rod, flagella

two types cholera like-watery and bloody

ampicllin

fresh water fish/shelflfish, wound in water, nec fasc., gastroenteritis if swallowing water while diving/swimming

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20
Q

Travellers diarrhea

A

recent travel

watery diarrhea

self limitied

often ETEC

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21
Q

Micro of ETEC

Sx

Dx

Tx

Risks

A

gram - rod,

watery diarrhea

fecal leukocyte neg, clinical diagnosis

abx treatment

food/water esp in kids and elderly

22
Q

EHEC micro

sx

dx

tx

risks

complications

A

gram-, rod, shiga toxin

blood diarrhea, no fever

elevated leukocytes, shiga toxin

supportive, rehydration

undercooked burger

hus, more common in kids

23
Q

EAEC is bloody or not bloody?

EPEC is blood or not bloody?

EIEC is blood or not bloody?

A

not bloody

both (infantile)

bloody

24
Q

Y. enterocolitica micro

sx

dx

tx

risks

complications

A

gram - coccobacilli

bloody diarrhea, right sided abd pain,

fecal leukocytes +

supportive care

deranged iron metabolism

reactive arthritis, erythema nodosum

25
Q

L. monocytogenes micro

sx

dx

tx

risks

complications

A

gram + rod

non bloody diarrhea

blood culture, no listeria in stool sample

ampicillin

pregnant woman issues with placenta, deli meats

meningoencephalitis and listeria placentitis

26
Q

Rotavirus micro

sx

dx

tx

risks

A

DSRNA,

vomiting and watery diarrhea

viral culture or PCR, wagon wheel appearance

supportive care, vaccine

infants and children, esp in winter

27
Q

adenovirus micro

dx

dx

tx

risks

A

dsDNA

fever, watery diarrhea and vomiting, eye issues

viral culture

supportive care

children

28
Q

Norovirus micro

sx

dx

tx

risk

A

small, naked RNA virus

vomiting, watery diarrhea

viral cultures usually unrevealing, fecal leuk. -

supportive care

older children and adults, nursing homes, schools, cruises

29
Q

CMV mircro

sx

dx

risks

A

dsDNA, linear

fever, bloody diarrhea

endoscopy with biopsy shows ulcerated lesions

AIDS pts CD<200

30
Q

E. histolytica micro

sx

dx

tx

risks

complications

A

trophozite, most common cause of dysentery

bloody dairrhea, liver abscess

flask shaped ulcer, ova and parasite stool or stool antigen

crowded living, endemic areas, poor sanitation

metronidazole

toxic megacolon or pneumatosis coli

31
Q

G. lamblia micro

sx

dx

tx

risks

A

4 flagella, 2 nuclei protozoan

watery persistent diarrhea

ova parasites, fecal leuk.-, stool antigen detection

supportive care or metronidazole

water, hiking campling, IgA def. more susceptible

32
Q

C. parvum micro

sx

dx

tx

risks

A

4 motile sporozoites

watery diarrhea

stool ag detection or direct microscopy, modified acid fast staining, DFA

resistant to chlorine treatment

swimming pools

33
Q

S. stercoralis micro

sx

dx

tx

risks

A

nemotode, enters through bare feet

of asymptomatic, abd, vomiting, rash

rhabditiform larvae in stool, eosinophils

anti-helmintic

34
Q

C. cayetanensis micro

sx

dx

tx

risks

A

produce, water even treated with Cl or I

watery diarrhea can last up to 3wks

fecal leuk-, oocytes in stool

TMP-SMX,

35
Q

C. belli micro

sx

dx

tx

risks

A

tropical and subtropical areas

acute, non bloody, watery diarrhea

may have eosinophilia, repeated stool examinations and concentration procedures are recomended

may be seen in duodenal biopsy

stained with modified acid fast

tx with bactrim DS

36
Q

What is a complication of ascaris lumbricoides

A

bowel obstruction

37
Q

What is a complication of D. latum fish tapeworm

?

A

vitamin B12 def.

38
Q

What is the 2nd most common cause of esophageal varices in africa?

A

Schistosoma mansoni

causes bloody stools, bladder cancer, liver cysts

39
Q
A
40
Q

T. solium comes from what animal and can cause what severe problem?

A

pork, seizures

41
Q

E. granulosus main carrier is what?

forms what where?

A

comes from dogs

forms cysts in liver or lungs “hydatid sand” on CT

42
Q

What causes severe perianal itching?

A

E. vermicularis

43
Q

What is general treatment and hydration rules for diarrhea due to ifnection?

A

hydration PO or IV to maintain electrolyte balance

antimolitility agents can be used IF patient has no fever and nonbloody stools (not in EHEC or c. diff)

44
Q

Best prevention of infectious diarrhea?

A

washing hands with soaps and waters

alcohol based rubs are ineffective against norovirus and C. diff

45
Q

PPx for travellers?

A

antibiotic prophylaxis for travelers is generally not recommended

occasionally, will give cipro, azith, or rifaximin

46
Q

What is reactive arthritis?

A

arthritis

urethritis

conjunctivitis

(can come with salmonella, campylobacter, shigella, yersinia)

47
Q

Pathogens that cayse watery stools typically affect which part of the bowel?

A

small bowel

can cause weight loss, dehydration and malabsorption

48
Q

Pathogens that cause blood and or wbc in the stool are typically located where?

A

in the large bowel

49
Q

Which types of immunosuppressed patients are at greater risk of developing diarrhea?

A

lymphoma, bone marrow transplant, hiv, IgA def., hemochromatosis, AIDS with CD4<200

50
Q

What are opportiunistic infections in AIDS patients?

A

mycobacterium species, CMV, adenovirus, HSV, protozoa

Gastrointestinal II Exam 1 (16 decks)

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