OnlineMedEd: Gastroenterology - "Acute Diarrhea" Flashcards

1
Q

What is the difference between acute and chronic diarrhea?

A
  • Acute: less than 2 weeks

* Chronic: greater than 4 weeks

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2
Q

Why is it helpful to differentiate between acute and chronic diarrhea?

A

Acute diarrhea is likely to be infectious; chronic diarrhea is not.

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3
Q

Inflammatory diarrhea can be diagnosed by ______________.

A

fever, hematochezia, and WBCs in the feces

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4
Q

Non-inflammatory (enterotoxic) diarrhea is characterized by ______________.

A

watery diarrhea with lack of fever and lack of fecal WBCs

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5
Q

WBCs are not the most specific test for inflammatory diarrhea. The most is ____________.

A

lactoferrin

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6
Q

List the etiologies of non-inflammatory diarrhea and their risk factors.

A
  • ETEC (third-world traveler’s diarrhea)
  • C. difficile (recent antibiotic use)
  • V. cholerae (third-world outbreaks)
  • Giardia lamblia (camping/hiking)
  • B. cereus (reheated rice)
  • S. aureus (proteinaceous food like egg salad)
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7
Q

List the etiologies of inflammatory diarrhea and their risk factors/associations.

A
  • Shigella (HUS)
  • Campylobacter (most common cause)
  • EHEC (E. coli O157;H7) (raw meat)
  • Amoeba histolytica (AIDS)
  • Salmonella (eggs, poultry)
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8
Q

What is a good way to determine if a case of diarrhea is viral gastroenteritis?

A
  • If the person is lacking signs of inflammatory diarrhea (fever greater than 104, bloody stool, severe abdominal pain) and the exposures that would make you worry about non-inflammatory diarrhea, then viral gastroenteritis is more likely.
  • Also, if the person is vomiting, then it is more likely to be viral gastroenteritis.
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9
Q

List two treatment options for viral gastroenteritis.

A
  • ORT

* Loperamide

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10
Q

If the person has signs and symptoms that suggest a more severe illness than viral gastroenteritis, then you should _______________.

A

evaluate first for C. diff (testing for toxin) and then do a stool culture and O&P

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11
Q

Testing for toxin is the old technique of evaluating for C. diff. Now, it’s more common to use _____________.

A

NAAT

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12
Q

Go through the treatment protocol for C. diff.

A

• 1st occurrence: try oral metronidazole, then vancomycin if that fails
•2nd occurrence: try oral metronidazole, then vancomycin if that fails
3rd occurrence: fidaxomycin
•Fecal transplant

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13
Q

Discuss the more severe presentation of C. diff.

A
  • Fever, leukocytosis, and abdominal distention (suggesting toxic megacolon) can occur in severe C. diff infections.
  • Treat with oral vancomycin and IV metronidazole.
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