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RRPA Clinical Med II > Infectious Diarrhea - Schoenwald (Exam 3) > Flashcards

Infectious Diarrhea - Schoenwald (Exam 3) Flashcards

1
Q

Infectious diarrhea is (acute/chronic) in onset and lasting ___ wks.

A

Infectious diarrhea is acute in onset and lasting <2 wks.

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2
Q

Noninflammatory diarrhea is describes as ______ and _________ and is associated with ________, ________, ______, and ________.

A

Noninflammatory diarrhea is described as water and nonbloody and is associated with cramping, bloating, nausea, and vomiting

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3
Q

T/F: In noninflammatory diarrhea, tissue invasion of colonic mucosa does not occur and there are no fecal leukocytes on smear.

A

True.

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4
Q

T/F: Inflammatory diarrhea does not involve fever or bloody diarrhea

A

False. Fever and bloody diarrhea.

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5
Q

Noninflammatory diarrhea disrupts normal absorption in the ___________, whereas inflammatory diarrhea involves primarily the ___________.

A

Small bowel; lower colon.

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6
Q

T/F: Inflammatory diarrhea is usually negative for fecal leukocytes because there is no invasion of the mucosa

A

False.

Will be positive for fecal leukocytes because there is invasion of the mucosa. This results in colonic tissue dammage.

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7
Q

Diarrhea >14 days most likely not due to infectious agent. What’s the exception to this?

A

C. diff

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8
Q

Do not use anti diarrheal meds or antimotility meds in (inflammatory/noninflammatory) diarrhea

A

Inflammatory

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9
Q

Which type of E. coli causes inflammatory vs noninflammatory diarrhea?

A
  • Inflammatory: Enterohemorrhagic E. coli 0157:H7
  • Non-inflammatory: Enterotoxigenic E. coli
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10
Q

Campylobacter, shigella, and salmonella are causes of (noninflammatory/inflammatory) diarrhea.

A

Inflammatory. They invade the mucosal tissue.

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11
Q

Norovirus, rotavirus, giardia, cryptosporidium, and listeria are all causes of (inflammatory/noninflammatory) diarrhea.

A

Noninflammatory

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12
Q

Enterotoxin producers, such as staph aureus, bacillus cereus, enterotoxigenic E coli, and vibrio cholerae are all causes of (inflammatory/noninflammatory) diarrhea.

A

Noninflammatory

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13
Q

Cytomegalovirus cause (inflammatory/noninflammatory) diarrhea

A

Inflammatory

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14
Q

Entamoeba histolytica causes (inflammatory/noninflammatory) diarrhea

A

Inflammatory

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15
Q

C. diff causes (inflammatory/noninflammatory) diarrhea.

A

Inflammatory.

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16
Q

What is the definition of C diff?

A
  • Presence of sx in the form of 3 or more unformed stool over 24 hrs for 2 consecutive days in conjunction with positive stools for pseudomembranes.
  • However, pts usually have profuse diarrhea (20-30 stools/day)
  • Prior abx use is not included in the new guidelines
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17
Q

What are some major risk factors for C diff?

A
  • Previous abx usage (Clindamycin is highest risk, but really any abx and mostly broad spectrum)
  • Advanced age
  • Previous hospitalization
  • Nursing home resident
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18
Q

C diff presents with watery diarrhea (15-30 stools/day), abd pain/cramps, and fever. It can lead to _________ and _________.

A

Megacolon (very large colon, can burst and kill you) and colectomy.

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19
Q

What will lab findings look like for C diff?

A
  • Leukocytosis often with bandemia (left shift)
  • Hypoalbuminemia
  • Positive stool C diff
  • Molecular test-PCR (highly sensitive & specific)
    • Can be positive in asymptomatic pts
  • Antigen detection (nonspecific)
  • Toxin A & B testing
    • High rate of false negatives
    • A lot of hospitals will do toxin testing 1st - if negative but pt symptomatic, then do PCR.
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20
Q

How do you treat initial episode of mild/moderate C diff?

A

Vancomycin PO or Fidaxamin PO

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21
Q

T/F: Alcohol hand preps are effective against C diff

A

False. Need soap and water. For surfaces, chlorine based disinfectants effective.

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22
Q

__________ is a gram negative rod carried in the GI tract of reptiles and birds and most cases occur from eating contaminated meat or eggs or from infected food handlers.

A

Salmonella

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23
Q

T/F: Bloody stools are uncommon with Salmonella enteriditis

A

True

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24
Q

T/F: Metastatic spread to vascular grafts, joints, kidneys, and liver common in bacteremic pts with salmonella enteriditis

A

True

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25
Q

Salmonella enteriditis treatment for…

  • Uncomplicated cases?
  • Complicated cases?
A
  • Uncomplicated: self-limiting
  • Complicated: Ciprofloxacin, or Bactrim (alternate)
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26
Q

Typhoid fever is caused by which bug?

A

Salmonella typhi

27
Q

T/F: Typhoid fever is endemic to the US and is transmitted by contaminated food, sewage, and infected food handlers.

A

False. NOT endemic to US - travel hx vital for diagnosis! High risk areas: India, Pakistan, Carribean, Mexico.

28
Q

Common sx of typhoid fever?

A
  • Diarrhea OR constipation
  • Rose-colored rash on torso and back
  • Fever
  • Abd pain
  • Weakness
  • Can be fatal
29
Q

Resistance to abx is an issue with typhoid fever. The current recommendation is _______________ for mild cases and ________________ for more severe cases especially with hx of travel to SE Asia.

A

Azithromycin (mild) and Carbapenems (severe)

30
Q

___________ is a gram negative rod responsible for dysentary.

A

Shigella

31
Q

How is Shigella spread?

A
  • Fecal oral spread
  • Often spreads in daycare setting (not washings hands b/w washing diapers)
  • Also flies and inanimate objects
  • Incubation 12 hrs - 4 days.
32
Q

Describe the diarrhea associated with shigella. This is a fun one!

A

Bloody, watery, pus and mucus (secretory). Pt also has fever, stomach cramps, n/v, dehydration

33
Q

How do you tx shigella?

A
  • Rehydration
  • Ciprofloxacin
  • Bactrim or Azithromycin (alternates)
    • Recent strains show high rates of resistence
34
Q

___________ is a gram negative rod that you can get from sausage, hard meats, or undercooked chicken

A

Campylobacter

35
Q

T/F: Campylobacter sx are often highly severe

A

False. Often low grade sx.

36
Q

Drug of choice for campylobacter?

A
  • Ciprofloxacin
  • Azithromycin (alternate)
37
Q

What are 3 complications of campylobacter?

A
  • Bacteremia in <1%
  • Guillain Barre
  • Reactive arthritis
38
Q

80% of traveler’s diarrhea is caused by ________________

A

Enterotoxigenic-shiga toxin from pathogenic E coli infections

39
Q

What is the main cause of hemolytic uremic syndrome in the US?

A

E coli 0157:H7

40
Q

Which bug is linked to undercooked ground beef, drinking of unpasteurized juices and milk, working with cattle (1% of cattle in US carry)

A

E coli 0157:H7

41
Q

Which test differentiates HUS from TTP?

A

ADAMTS 13 (positive in TTP)

42
Q

HUS triad?

A
  • Acute renal insufficiency
  • Hemolytic anemia
  • Thrombocytopenia
43
Q

What will labs look like with E coli 0157:H7 infection?

A
  • Culture often negative
  • Anemia and thrombocytopenia
  • Decreased haptoglobin and increased LDH
  • Negative coomb’s
  • Elevated creatinine
  • Hematuria and proteinuria
44
Q

Tx for E coli 0157:H7?

A

Supportive. Abx use controversial.

45
Q

Staph food poisoning usually onsets within ___ to ___ hrs.

A

4-8 hrs

46
Q

Tx for staph food poisoning?

A

Usually self-limiting. Abx not indicated.

47
Q

How is listeria typically spread?

A

Foodborne.

48
Q

__________ is a gram positive bacillus. Previous corticosteroid use is a predisposing risk factor.

A

Listeria

49
Q

Tx of choice for listeria?

A

Ampicillin. Crosses blood brain barrier to tx meningitis.

50
Q

What is the main cause of traveler’s diarrhea?

A

Enterotoxigenic E coli

51
Q

Tx options for enterotoxigenic E coli?

A
  • Ciprofloxacin
  • Bactrim
  • Azithromycin
52
Q

__________ is waterborne and can also be in shellfish. It results in massive secretion from small bowel.

A

Virbrio cholera

53
Q

__________ causes rapid dehydration - profuse watery diarrhea - lose 1-3 L per day, up to 20 L per day.

A

Vibrio cholera

54
Q

“Rice water stools” = ______________

A

Vibrio cholera

55
Q

Tx for Vibrio cholera?

A
  • HYDRATION, HYDRATION, HYDRATION
  • Doxycycline or Ciprofloxacin
    • Can limit duration of dz, but dehydration is main issue
56
Q

Inflammation of the stomach and intestinal tract with sudden onset and rapid resolution: ________________

A

Viral gastroenteritis

57
Q

Most common cause for nonbacterial acute gastroenteritis?

A

Norovirus (aka “Cruiseship virus”)

58
Q

T/F: Norovirus is contagious even after sx resolve, may shed in stool up to several weeks

A

True

59
Q

How is norovirus spread?

A

Person to person contact, contaminated food and water, airborne

60
Q

With norovirus, kiddos usually have more (vomiting/diarrhea), whereas adults usually have more (vomiting/diarrhea).

A

Vomiting (kiddos)

Diarrhea (adults)

61
Q

Tx for norovirus?

A

Self-limiting. Supportive tx.

62
Q

Gold standard test for norovirus?

A

Stool culture; however, turnaround is 48-72 hrs, so sx will likely be gone anyway.

63
Q

Have you done the H&P nutrition assignment yet?

A

Slacker

RRPA Clinical Med II (45 decks)

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