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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
Salmonella enteriditis treatment for... * Uncomplicated cases? * Complicated cases?
* **_Uncomplicated:_** self-limiting * **_Complicated:_** Ciprofloxacin, or Bactrim (alternate)
26
Typhoid fever is caused by which bug?
Salmonella typhi
27
T/F: Typhoid fever is endemic to the US and is transmitted by contaminated food, sewage, and infected food handlers.
False. NOT endemic to US - travel hx vital for diagnosis! High risk areas: India, Pakistan, Carribean, Mexico.
28
Common sx of typhoid fever?
* Diarrhea OR constipation * Rose-colored rash on torso and back * Fever * Abd pain * Weakness * Can be fatal
29
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.
Azithromycin (mild) and Carbapenems (severe)
30
\_\_\_\_\_\_\_\_\_\_\_ is a gram negative rod responsible for dysentary.
Shigella
31
How is Shigella spread?
* 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
Describe the diarrhea associated with shigella. This is a fun one!
Bloody, watery, pus and mucus (secretory). Pt also has fever, stomach cramps, n/v, dehydration
33
How do you tx shigella?
* Rehydration * Ciprofloxacin * Bactrim or Azithromycin (alternates) * Recent strains show high rates of resistence
34
\_\_\_\_\_\_\_\_\_\_\_ is a gram negative rod that you can get from sausage, hard meats, or undercooked chicken
Campylobacter
35
T/F: Campylobacter sx are often highly severe
False. Often low grade sx.
36
Drug of choice for campylobacter?
* Ciprofloxacin * Azithromycin (alternate)
37
What are 3 complications of campylobacter?
* Bacteremia in \<1% * Guillain Barre * Reactive arthritis
38
80% of traveler's diarrhea is caused by \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Enterotoxigenic-shiga toxin from pathogenic E coli infections
39
What is the main cause of hemolytic uremic syndrome in the US?
E coli 0157:H7
40
Which bug is linked to undercooked ground beef, drinking of unpasteurized juices and milk, working with cattle (1% of cattle in US carry)
E coli 0157:H7
41
Which test differentiates HUS from TTP?
ADAMTS 13 (positive in TTP)
42
HUS triad?
* Acute renal insufficiency * Hemolytic anemia * Thrombocytopenia
43
What will labs look like with E coli 0157:H7 infection?
* Culture often negative * Anemia and thrombocytopenia * Decreased haptoglobin and increased LDH * Negative coomb's * Elevated creatinine * Hematuria and proteinuria
44
Tx for E coli 0157:H7?
Supportive. Abx use controversial.
45
Staph food poisoning usually onsets within ___ to ___ hrs.
4-8 hrs
46
Tx for staph food poisoning?
Usually self-limiting. Abx not indicated.
47
How is listeria typically spread?
Foodborne.
48
\_\_\_\_\_\_\_\_\_\_ is a gram positive bacillus. Previous corticosteroid use is a predisposing risk factor.
Listeria
49
Tx of choice for listeria?
Ampicillin. Crosses blood brain barrier to tx meningitis.
50
What is the main cause of traveler's diarrhea?
Enterotoxigenic E coli
51
Tx options for enterotoxigenic E coli?
* Ciprofloxacin * Bactrim * Azithromycin
52
\_\_\_\_\_\_\_\_\_\_ is waterborne and can also be in shellfish. It results in massive secretion from small bowel.
Virbrio cholera
53
\_\_\_\_\_\_\_\_\_\_ causes rapid dehydration - profuse watery diarrhea - lose 1-3 L per day, up to 20 L per day.
Vibrio cholera
54
"Rice water stools" = \_\_\_\_\_\_\_\_\_\_\_\_\_\_
Vibrio cholera
55
Tx for Vibrio cholera?
* HYDRATION, HYDRATION, HYDRATION * Doxycycline or Ciprofloxacin * Can limit duration of dz, but dehydration is main issue
56
Inflammation of the stomach and intestinal tract with sudden onset and rapid resolution: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Viral gastroenteritis
57
Most common cause for nonbacterial acute gastroenteritis?
Norovirus (aka "Cruiseship virus")
58
T/F: Norovirus is contagious even after sx resolve, may shed in stool up to several weeks
True
59
How is norovirus spread?
Person to person contact, contaminated food and water, airborne
60
With norovirus, kiddos usually have more (_vomiting/diarrhea_), whereas adults usually have more (_vomiting/diarrhea_).
Vomiting (kiddos) Diarrhea (adults)
61
Tx for norovirus?
Self-limiting. Supportive tx.
62
Gold standard test for norovirus?
Stool culture; however, turnaround is 48-72 hrs, so sx will likely be gone anyway.
63
Have you done the H&P nutrition assignment yet?
Slacker

RRPA Clinical Med II (45 decks)

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