Lecture 7 - GI infections 1 Flashcards
Diarrhea definition
more than 3 stools per day
Type of diarrhea
acute = < 2 weeks
Persistent = > 14 day
Chronic = > 30 days
Clinical Presentation Diarrhea
Signs of volume depletion = weight loss, dec urine output, change skin turgor
Abnormal vitals = HR,Fever
Altered mental status
Abdominal tenderness
Leading cause of diarrhea?
viruses
rotovirus in children
norovirus
Most common cause of bacterial diarrhea?
Vibrio = world wide
Watery Diarrhea classification
ie Watery
< 10 per day
reduce absorption
Absent or few PMNS
*** Flids, Electrolytes, Self-limiting **
Dysenteric Diarrhea classification
ie. Bloody/Mucousy
> 10 per day
toxins, mucosal invasion
Many PMNS
* Antimicrobials (not EHEC), fluids and electrolytes**
N/ vomitign is caused by….
toxins
Food Poisoning info
Often caused by Staph
Due to contaminated food/handler
Rapid onset within 4-6hrs
Vibrio cholera Diarrhea
causes “rice water” stools
can also cause skin lesions
Due to ingestion of contaminated water/food
E.Coli diarrhea
most common cause of travelers
causes “cholera-like”
usually self limiting 24-48hrs
Shigella Diarrhea
caused by poor sanitation and hygiene
High risk infants, elderly, immunocompromised
causes Dysenteric Diarrhea and can last a week
Salmonella Diarrhea
S. Typhi = typhoid fever
S. enteriditis = chicken
N/V/ watery diarrhea, abdominal cramping, chills, headache, myalgia
Self limiting
increased mortality with bacteremia
Rehydration therapy for mild-moderate diarrhea
ORT
100-150ml/kg/day
BRAT diet
Avoid high fiber, sodium, sugar
probiotics and zinc supplementation
Rehydration therapy for therapy diarrhea
IV fluid replacement
Lactated ringers & normal saline
Vibrio cholerae antibiotic treatments
Adults = Doxycycline 1 dose
Children/ TMP/SMX, erythromycin
Salmonella antibiotic treatments
Cipro: 500mg BID X 3-7days
Azithromycin 1g po, then 500mg QD X 6 days
** no anti motility**
prevention of food borne illness
Wash hands
Handle foods properly = cook thoroughly, clean areas, fridge leftovers
dont prepare foods if you’re sick
Common causes of Travelers Diarrhea?
ETEC
Symptoms occurs within 48hrs
> 3 loose watery stools in 24hrs with cramping. lasts 3-7 days
prevention is key, peel it, boil it, cook it or forget it
Traveler’s Diarrhea Prophylaxis = Bismuth subsalicylate
Bismuth subsalicylate (QID)
Reduces risk by 50%, dont use in Aspirin allergy, pregnancy or DI..dont use anticoagulant pts
SE = blackish stool and tongue
Traveler’s Diarrhea Prophylaxis = Probiotics
Lactobacillus GG & Sacchromyces boulardii most data
Travelers Diarrhea Prophylaxis = Abx
Rifaximin = 200mg QD/BID but not used much, minimally absorbed
In general, ABX not recommended for Prophylaxis
if blood in stool or fever can you use loperamide/antimotility?
nah, only if they dont have those symptoms
Travelers Diarrhea Treatment Fluids & food
Clear liquids and salty foods
ORT or mineral water containing Na/Glu
Travelers Diarrhea Treatment Symptomatic relief
anti motility if no fever/blood stool
loperamide 4mg, then 2mg PO after each loose stool = 16mg max ****
Bismuth subsalicylate, max 8 doses/24hrs
Travelers Diarrhea Treatment Abx
Cipro 3 day course or Azithro 3 day course if FQR & OK preg
