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GI 2 > Mcgowen Acute Diarrhea and Small Bowel/Colon > Flashcards

Mcgowen Acute Diarrhea and Small Bowel/Colon Flashcards

1
Q

Definition of Diarrhea

A
  • Adult: >200 grams/day
  • Child >20 g/Kg/day
  • Clinically: 3 or more loose or watery stools/day or decreased consistency and increase in frequency of BM
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2
Q

What is lost with diarrhea

A

bicarb and K+

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3
Q

Medications that can cause diarrhea

A
  • antibiotics
  • Antidysrhythmics
  • antihypertensives
  • NSAIDS
  • certain antidepressants
  • Chemo
  • bronchodilaters
  • antacids
  • laxatives
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4
Q

What is the most common/likely non-infectious etiology of diarrhea for more than 14 days

A

medications

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5
Q

non medicinal Non-infectious diarrhea causes

A
  • Food sweeteners (sorbitol)
  • food allergies (Anaphylaxis)
  • Tube feeding
  • Acute diverticulitis
  • Graft vs. Host disease
  • ingestion of toxins (insecticides, amanita and mushrooms, arsenic, preformed environmental toxins in seafood, like ciguatera and scombroid
  • Chronic illness early in course (IBD and microscopic colitis, endocrine diseases, tumors: VIPoma, carcinoid, colorectal
  • Occlusive or nonocclusive ischemic colitis (over 50, acute lower abdominal pain preceding watery–>bloody diarrhea, . . acute inflammatory changes in sigmoid or left colon while sparing rectum
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6
Q

5 high risk groups for infectious diarrhea?

A
  • travelers
  • Immunodeficient
  • Daycare work/attendees and family (shigella, Giardia, Cryptosporidium, Rotavirus)
  • Institutionalized persons (nursing homes/assisted living/hospitals)
  • Certain foods
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7
Q
  • Frequent passage of small volumes of stool
  • Rectal urgency, tenesmus, feeling of incomplete evacuation
  • accompanies IBS or PROCTITIS
A

Psuedo-diarrhea

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8
Q
  • involuntary discharge of rectal contents

- most often caused by neuromuscular disorders or structural anorectal problems

A

Fecal incontinence

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9
Q
  • elderly/nursing home patients

- fecal impaction that is readily detectable by rectal exam

A

Overflow diarrhea

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10
Q

what do routine bacterial stool cultures include

A
  • Salmonella
  • Shigella
  • E. Coli (ask for Shiga toxin detection for 0157:H7 EHEC)
  • Most detect campylobacter but may need to requents
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11
Q

What cultures do you specifically need to ask for

A
  • C. diff PCR/toxin
  • Ova parasites (increase yield by obtaining 3 samples sequentially)
  • Stool antigen (parasites - giardia and cryptosporidium)
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12
Q

What Virus is not detected with routine and study and PCR is better

A

Norwalk

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13
Q

Picnic, banquet, or restaurant food: Chicken

A
  • Salmonella
  • Campylobacter
  • Shigella
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14
Q

Picnic, banquet, or restaurant food: Undercooked hamburger

A

-EHEC (0157:H7)

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15
Q

Picnic, banquet, or restaurant food: Fried rice or other reheated food

A

Bacillus cereus

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16
Q

Picnic, banquet, or restaurant food: potato salad, mayonnaise, or cream pastries

A

Staph. aureus

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17
Q

Picnic, banquet, or restaurant food: eggs

A

Salmonella

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18
Q

Picnic, banquet, or restaurant food: uncooked foods, LUNCH MEATS, or soft cheeses

A

Listeria

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19
Q

Picnic, banquet, or restaurant food: seafood, especially if raw

A

Vibrio species, Salmonella, acute hepatitis A

-Norwalk, Campylobacter

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20
Q

Staph Aureus: toxin?

symptoms?

type of diarrhea?

Onset?

Resolution?

Causes?

A
  • Preformed enterotoxins
  • N/V
  • WATERY
  • rapid . .within 6 hours of ingestion
  • rapid . . 24-48 hours
  • Ham, poultry, Dairy, eggs, CREAM PASTRIES, POTATO SALAD, MAYO
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21
Q

Bacillus Cereus: Toxin?

Symptoms?

Onset?

Resolution

Cause?

type of diarrhea?

A
  • Preformed enterotoxins
  • Vomiting is main symptom
  • Rapid . .within 6 hours of ingestion
  • Rapid . . 24-48 hours
  • Fried rice
  • Watery diarrhea . . happens occasionally
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22
Q

Clostridium Perfringens: toxin?

Type of diarrhea?

symptoms?

Onset?

Resolution?

Cause?

A
  • Preformed Enterotoxins
  • Watery diarrhea
  • Crampy abd pain
  • Rapid . . within 8-16 hours of ingestion . . Need to ingest large quantity of organisms
  • Rapid . .within 24-48 hours
  • Beef, ham, poultry, legumes, gravy (heat resistant spores inadequately cooked
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23
Q

Shigells: Toxin?

Age?

foods?

type of diarrhea?

associated symptoms?

Stool cultures?

duration?

treatment?

complications?

A
  • enterotoxin Shiga Toxin
  • any age, but primarily children (daycare and families)
  • Potato or egg salad, lettuce, raw veggies
  • BLOODY, small volume
  • Abdominal cramps, FEVER for 3-4 days, FECAL LEUKOCYTES
  • distinguish from IBD . . . lactose neg.
  • 1-2 weeks duration
  • Bismuth, Amp., Fluoro., or Trimethorpim/sulfamethoxazole
  • Respiratory complaints and seizures in children and Post infectious reactive arthritis and HUS
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24
Q

Gram-negative , non-lactose fermenting, motile rod-shaped bacteria

A

Salmonella typhimurium

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25
Q

Salmonella typhimurium: Diarrhea?

Ass. Symptoms?

Resolution?

Foods?

Animal exposure?

Increased risk?

Stool culture?

Antibiotics?

Complications?

A

Watery –>BLOODY

Fever, Abd cramping, N/v, + fecal leukocytes

Self limited . . 5-10 days

Eggs, poultry

Reptiles (turtles), ducks, birds

HIV, leukemia, and SICKLE CELL pts

Lactose -, motile

NOT indicated . . can prolong course

reactive arthritis, endocarditis, septic arthritis, oseomyelitis

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26
Q

Salmonella Typhi: Risk factors?

Prevention?

Spread?

Ass. symptoms?

Diagnosis?

Treatment?

A
  • International travel, poor sanitation
  • good food prep, hand washing, vaccine
  • fecal-oral
  • Typhoid Fever: systemic SUSTAINED FEBRILE illness, 103 to 104, sometimes accompanied by weakness, headache, anorexia, RLQ pain, rash of flat rose-colored spots, and diarrhea
  • Stool and blood samples, fecal leukocyte +
  • Fluoroquinolones, ceftriaxone, and azithromycin
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27
Q

Campylobacter Jejuni: diarrhea?

Ass. symptoms?

Resolution?

complications?

Stool culture?

Foods?

Hosts?

Spread?

A

Watery –>BLOODY

  • Fever, crampy abd pain, fecal leukocytes +
  • Self limited 7 days, supportive treatment
  • Late onset, 1-8 weeks after diarrhea resolved, reactive arthritis, GUILLAN-BARRE syndrome
  • gram- curved rod, Campy blood agar, Spiral (S shaped), Oxidase +, motile with flagellum
  • raw undercooked meats (POULTRY), dairy (raw milk)
  • Wild birds including ducks
  • cross contamination during food prep, contaminated water
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28
Q

Vibrio Cholera: Diarrhea?

Ass. symto.?

Gram stain of stool?

Source?

duration?

Treatment?

Variants?

A

RICE WATER , profulse up to 1 L/hour

vomiting and dehydration: hypotension, renal failure, death

Curved/comma shaped, anaerobic gram- bacilli with flagellum, Darting, motile

waterborn, salt water, raw oysters, underdeveloped nations

1 week

Rehydration/electrolyte replacement . . prevent with sanitation and vaccination

O1 and O139

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29
Q

Vibrio Parahemolyticus: Variants?

Toxin?

Ass. Sym?

Diarrhea?

duration?

Food?

A

NON-O1 and NON-O139

Cytotoxin production

N/V/Abd cramps, Fecal leukocyte +

Watery–>BLOODY diarrhea (colonic)

2-5 days

Sea food associated

30
Q

Vibrio Vulnificus: stain and shape?

Found where?

Foods?

Ass. Symp.?

you get this how?

A
  • Gram - bacillus
  • Warm, shallow COASTAL SALT WATER

Raw shellfish

Vomiting, diarrhea, abdominal within 16 hrs of ingestion

Open wound in water: bullous skin lesions, life threatening in immunocompromised especially CIRRHOSIS pts

31
Q

Aeromonas Hydrophila: describe?

Source?

get this how? location?

2 types?

Treatments?

A

Gram -, non spore forming, rod shaped, facultative anaerobeic bacteria, motile with flaggelum

Fresh water or brackish water (more salt than fresh but less than salt)

Wounded in water; foot and ankle most common; necrotizing fasciitis aka flesh eating bacteria
Eating rish or shellfish
Scuba divers that swallow small amounts of fresh water

cholera-like: Non bloody watery rice water stools
Boody mucoid stools

Ampicillin

32
Q

Travelers Diarrhea (TD): locations?

Onset?

Symptoms?

What is UNCOMMON?

resolution?

Risk factors?

A

-Asia, South and Central America, Mexico

3 days - 2 weeks after travel

N/V, WATERY diarrhea, bloating, Abd cramps, fatigue/malaise, loss of appetite and LOW grade fever

Bloody diarrhea and fever

Self limited; 1-5 days

H2blocker/PPI use . . . lowers pH

33
Q

Travelers Diarrhea (TD): most common, Enterotoxin production, water salads meats cheese, affect small intestine?

Asia

Misc. other causes

Visitors to Russia (St. Petersburg); Campers, backpackers and swimmers in wilderness

Visitors to Nepal

Cruise ships

A
  • ETEC
  • Campylobacter Jejuni

Salmonells, shigella, Aeromonas, EAEC, Norovirus, Coronavirus

Giardia associated diarrhea

Cyclospora

Norovirus

34
Q

E. coli; ETEC: Diarrhea?

Fecal leukocyte?

onset?

Diagnose?

source?

Treatment?

A

Watery

neg

sudden . . lasts 3-6 days

Clinically

contaminated food or water

Antibx may reduce infection by 1-2 days

  • Trimethoprim/sulfamethoxazole, Coxycycline, ciprofloxacin,
  • Bismuth may help
35
Q

EHEC: diarrhea?

Ass. Symp?

Stool culture

Acquired

complications

Treatment

A
  • watery–>BLOODY (can lead to ischemic colitis)
  • Abd tenderness, NO FEVER, + peripheral leukocytes, + fecal leukocytes or lactoferrin

Shiga-like toxin

under cooked hamburger; raw veggies; animal contact

HUS (more often than shigella)
more likely to happen in children treated with antibiotics

Supportive, rehydration

36
Q

Yersinia Enterocoitica: Higher risk in?

Transmission?

Diarrhea?

Ass. Sym?

location of pain?

Indistinguishable from?

duration?

complications?

Treat?

A

-IRON OVERLOAD SYNDROMEs, diabetes and preexisting GI disorders

Contaminated food/water; dairy, contaminated domestic animal feces (maybe a puppy?)

Bloody (and non bloody) . . + fecal leukocytes

Abd pain + PHARYNGITIS

Terminal ileum: right sided abd pain . . mimic APPENDICITIS or Crohns

Salmonella or shigella

10-20 days

Rash, reactive arthritis, hemochromatosis

supportive care

37
Q

Listeria monocytogenes: Who gets it?

Sympt.

duration

confirm by?

source?

complication

A

anyone: predilection for PREGNANT WOMEN

Fever, NON bloody diarrhea, headache, N/V

2-3 days

BLOOD CULTURE

unpasteurized dairy, DELI MEATS, rarely cantaloupe

Menengoencephalitis

38
Q

Clostridium Difficile: Describe?

Ass. Symt?

PCR?

other associations?

Treatment?

complications?

A

Anaerobic, Gram +, spore forming baciliius

Watery diarrhea, Abd pain and fever, Pseudomembranes

Toxins A and B

-recent hospitalization; antibiotics (PPIs, Clindamycin, cephalosporins, fluroquinolones) . . WASH hands with soap and water

PO/IV metronidazole, ORAL vancomycin

Toxic megacolon

39
Q

Nosocomial infections

A
  • C. diff

- Norovirus (nursing homes)

40
Q

“wagon Wheel appearance on electon microscopy

A

Rotavirus

41
Q

Rotavirus: age?

symp?

onset and duration?

detection?

spread?

Death by?

Treatment?

A

Most common cause of acute diarrhea in INFANTS (under 2) . . in winter months

Vomiting and watery diarrhea –> severe dehydration

in 72 hr . . . last 2-3 days up to 5

viral culture or PCR

fecal oral

dehydration

Supportive care . . . vaccine available

42
Q

Norovirus: age?

sympt?

onset and duration?

transmission and common link?

treatment?

A

Older children and adults

Vomiting and Watery diarrhea

in 24-48 hrs and lasts 3 days

fecal oral . . . CRUISE SHIPS

Supportive care

43
Q

Adenovirus (serotypes 40 and 41): age?

Sympt?

course?

treatment

A
  • Children
  • Fever (103-104) chills, myalgias, sore throat, Watery diarrhea, CONJUNCTIVITIS, PHARYNGITIS,

Prolonged . . . 10 days

supportive care

44
Q

CMV: what pts?

sympt?

duration?

diagnose how?

A

Immunosuppressed . . AIDS and organ transplant. CD4<200

Fever, Abd pain, bloody diarrhea

several weeks

endoscopy with biopsy of ulcerated lesions using CMV special stains

45
Q

Most common cause of dysentery in the world

A

Entamoeba Histolytica

46
Q

“Flask shaped ulcer”

A

Entamoeba Histolytica

47
Q

Entamoeba histolytica: complications?

duration?

stool?

found in what situations?

treatment?

A

-can penetrate bowel and into portal circulation: liver abscesses or lung or brain. Toxic megacolon or pneumatosis coli

days to weeks

Stool for ova and parasites or Stool antigen (PCR or DNA)

Crowded living conditions (fecal oral); mental health institutions, poor sanitation, endemic areas, Asia, Africa, Central and south american

Metronidazole and Paromomycin

48
Q

Pear-shaped, 4 flagella, 2 nuclei protozoan

A

Giardia lamblia

49
Q

Giardia Lamblia: transmission?

Diarrhea?

Ass. Sympt?

Duration?

Stool?

Acquired how?

Treatment?

A

fecal-oral

Watery (malodorous),

Steatorrhea, flatulence, abd pain, belching, weight loss, nasuea, malaise, cramps, anorexia, bloating

14-28 days

ova parasites (3 samples sequentially); STOOL ANTIGEN DETECTION

Water (lakes, streams) from hiking camping; Zoonosis, beaver, cattle, dogs, rodents, big horn sheep, person-person. conatminated water in russia . . IgA deficiency more susceptible

Metronidazole

50
Q

What are the 2 main clinical syndromes from cryptosporidium?

A

Self limited diarrhea in immunoCOMPETENT . .. 7-14 days no treatment other than rehydration

Life-threatening intractable in immunoSUPPRESSED pts . . . AIDS . .CD4 <200 . . biliary dx RUQ pain and fever

51
Q

outbreaks for cryptosporidium

A

Swimming pools . . can be resistant to chlorine

52
Q

Nematode/roundworm that enters body through exposed skin such as bare feet on contaminated soil?

who is more susceptible?

Ass. Sym?

Whats in Stool?

Treatment?

A

Strongyloides stercoralis

those with HTLV-1 infection

Abd pain, bloating, diarrhea, cough, SOB, perianal urticaria, migratory rash

Rhabdiform larvae and eosinophils

Ivermectin

53
Q

Cyclospora: source?

duration in immunocompetent?
suppressed?

Resistance?

Stool?

Treatment

A

-PRODUCE imported from endemic areas (lettuce, fresh basil, imported respberries); Travel to endemic areas

up to 21 days
indefinite

Chlorine and iodine unlikely to kill oocysts

oocysts

TMP/SMX

54
Q

Stain for Cystoisospora belli?

What pts?

Treatment?

A

modified acid fast stain

Immunosuppressed

Bactrim (TMP/SMX)

55
Q

hook worm . .bowel obstruction

A

Ascaris lumbricoides

56
Q

fish tapeworm

A

Diphyllobothrium

57
Q

esophageal varices . .freshwater snails . . . bladder cancer and liver cysts

A

Schistosoma mansoni

58
Q

Pork tape worm; causes cysticercosis . . seizure and muscle or eye disease

A

Taenia solium

59
Q

sheep and dog tapeworm

  • cysts in liver or lungs
  • looks like free flowing “hydatid sand” on CT
A

Echinococcus granulosus

60
Q

General Nutritional advice for infectious colitis?

A
  • BRAT diet (bananas, Rice, Applesauce, Toast)
  • Easily digestible foods (boiled potatos, crackers, yogurt, soup)
  • Rice water
  • avoid lactose containing products as they can make diarhea worse
  • Avoid high fiber roots, fats, caffeine, and alcohol
61
Q

General advice to make you feel better

A
  • drink 8-10 glasses of clear fluids/day
  • drink at least 1 cup of liquid every time you have a loose BM
  • Eat small meals throughout the day instead of 3 big meals
  • Eat some salty foods such as pretzels, soups, and sports drinks
  • Eat some high K+ foods such as bananas, potatoes without the skin
62
Q

Alcohol gels are ineffective against what

A

norovirus and C. diff

63
Q

What viral vaccines are there

A
  • rotavirus
  • S. typhi
  • V. cholerae
  • Hep A
64
Q 
Reactive Arthritis (Reiter's syndrome)
-Arthritis, urethritis, conjunctivitis
A
  • Salmonella
  • campylobacter
  • shigella
  • Yersinia
65
Q

yersiniosis may lead to what?

A
  • autoimmune thyroiditis
  • pericarditis
  • glomerulonephritis
66
Q

Guillian-Barre syndrome

A

Campylobacter jejuni

67
Q

HUS–>high mortality rate

A
  • EHEC

- shigella

68
Q

Pathogens that usually affect the small bowel present with what?

What is in stool?

Location of pain?

other associ?

specific organisms

A

-Large volume, watery stools, abd cramps weight loss

WBC absent . . NON inflammatory

Mid abdomen or diffuse

dehydration/malabsorption

-Salmonella, vibrio cholerae, ETEC, EPEC, Yersinia, Rotavirus, Norovirus, CMV, Adenovirus, Giardia, Cyrptosporidium, Cyclospora, Clostridium perfringens, staph. aureus, Bacillis cereus

69
Q

pathogens that usually affect Large bowel present with what?

Associted with?

Locatiion?

what organisms?

A

-Frequent small volume stools

Fever, Blood or WBC in stool (inflammatory), fecal leukocytes common

lower abd or rectum . . (tenesmus)

-Campylobacter, Salmonella, Shigella, yersinia, EIEC, EHEC, C. diff, vibrio parahaemolyticus, E. histolytica, CMV, Adenovirus, Herpes simplex

70
Q

Persons with Hemochromatosis susceptible to what?

should avoid what?

A

-Vibrio and Yersinia infections

Avoid Raw Fish

GI 2 (13 decks)

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