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H&D > Wk 6 TBL 4 GI Infections > Flashcards

Wk 6 TBL 4 GI Infections Flashcards

1
Q

Esophagitis

A
  1. inflammatory process caused by infection
  2. most often in immunocompromised
  3. extent of damage related to severity of symptoms
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2
Q

Causes of esophagitis

A
  1. Candida (fungal) - often in immunocompromised, HIV
  2. Herpesviruses
    a. CMV
    b. Herpes simplex virus
  3. acid reflux
  4. medication-induced (doxycycline)
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3
Q

2 key clinical manifestations of esophagitis

A
  1. odynophagia (pain on swallowing)
  2. dysphagia (difficulty swallowing)
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4
Q

Dx of esophagitis

A

empiric trial of fluconazole -> improvement -> assumed Candida esophagitis
2. endoscopy and biopsy

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5
Q

Gastritis

A
  1. can be erosive or nonerosive
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6
Q

Define peptic ulcer disease

A

break in the gastric and adjacent duodenal mucosa

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7
Q

What causes peptic ulcer disease

A

Helicobacter pylori

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8
Q

Clinical presentation of gastritis

A
  1. dyspepsia (epigastric pain, burning)
  2. n/v
  3. can be asymptomatic
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9
Q

Pathogens associated w/ gastritis

A
  1. H. pylori
  2. CMV
  3. Histoplasma capsulatum (fungi)
  4. Mucor (fungi)
  5. Anisakis (larvae after raw fish)
  6. Mycobacteria (TB and nonTB)
  7. Giardia
  8. STronglyoides
  9. EtOH
  10. meds (NSAIDS)
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10
Q

Dx gastritis

A

endoscopy w/ gastric biopsy
H. pylori confirmed w/ urease test or urea breath test or stool antigen test

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11
Q

Tx of H. pylori gastritis

A

Quad therapy:
1. tetracycline
2. bismuth
3. metronidazole (or tinidazole)
4. PPI (omeprazole)
OR:
1. amoxicillin
2. clarithromycin
3. metronidazole (or tinidazole)
4. PPI

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12
Q

Other names for diarrhea
Define acute and chronic

A

= gastoenteritis, enterocolotis
-Either acute (<2 wks) or chronic (>4 wks)

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13
Q

What are 2 categories of acute diarrhea?

A
  1. noninflammatory (watery, nonbloody)
  2. inflammatory (bloody w/ pus) = dysentery
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14
Q

4 Characteristics of watery diarrhea

A
  1. No RBCs or WBCs in stool
  2. typically afebrile
  3. usually large-volume
  4. infection typically sm intestine
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15
Q

4 char of dysentery

A
  1. RBC and WBC in stool
  2. often febrile
  3. usually small volume
  4. infection typically colon
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16
Q

9 organisms that cause watery diarrhea

A
  1. ETEC
  2. Vibrio cholerae
  3. Staph aureus
  4. Bacillus cereus
  5. Listeria monocytogenes
  6. Norovirus
  7. Rotavirus
  8. Giardia lamblia
  9. Cryptosporidium hominis
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17
Q

7 organisms that cause dysentery

A
  1. STEC (Shiga toxin-producing E. coli)
  2. Shigella
  3. Salmonella
  4. Campylobacter jejuni
  5. Clostridioides difficile
  6. Yersinia enterocolitica
  7. Entamoeba histolytica
18
Q

What is the most common cause of acute diarrhea in the US?

A

Norovirus

19
Q

What is the second leading cause of diarrheal outbreaks?

A

Salmonella

20
Q

What is the most common cause of fatal diarrhea?

A

C. diff

21
Q

What MOA usually causes acute diarrhea?

A
  1. preformed exotoxins in food
  2. infectious agents in intestinal tract (via enterotoxin and cytotoxin production or mucosal invasion)
22
Q

What pathogens produce preformed exotoxins?

A
  1. Staph aureus
  2. Bacillus cereus
  3. Clostridium perfringens
23
Q

What pathogens cause non-inflammatory acute diarrhea by enterotoxin production?

A
  1. ETEC
  2. Vibrio cholerae
24
Q

What 5 pathogens cause acute inflammatory diarrhea?

A
  1. Salmonella
  2. Shigella
  3. Campylobacter (mucosal invasion)
  4. Shiga toxin-producing E. coli (0157:H7)
  5. C. diff (via cytotoxin production)
25
Q

What are risk factors for diarrheal illness?

A
  1. PPIs
  2. Recent travel to certain areas
  3. Abx tx
  4. Immunosuppressed have more frequent and severe diarrhea
26
Q

What pathogen is suspected if sx begins w/in 6 hrs after ingestion of contaminated food?

A
  1. Staph aureus
  2. Bacillus cereus (reheated rice)
27
Q

What can STEC in children progress to?

A

HUS = hemolytic uremic syndrome
-occurs when Shiga-like toxin enters bloodstream

28
Q

What are the symptoms of HUS?

A
  1. hemolytic anemia
  2. thrombocytopenia
  3. renal failure
  4. schistocytes in blood smear
29
Q

What med increases the risk of HUS?

A

ciprofloxacin

30
Q

What causes severe, life-threatening watery diarrhea?

A

Vibrio cholerae

31
Q

What are the 2 most common causes of bloody diarrhea in the US?

A
  1. Salmonella
  2. Campylobacter
32
Q

What causes amebic dysentery?

A

E. histolytica

33
Q

When do we seek dx for diarrhea?

A
  1. severe watery diarrhea
  2. dysentery
  3. patient is febrile
  4. patient is elderly or immunocompromised
34
Q

What culture is used to detect STEC?

A

MacConkey-sorbitol agar
-STEC does not ferment sorbitol

35
Q

What is a definitive dx technique for STEC/EHEC?

A

PCR
immnoassay for Shiga-like toxin

36
Q

What can cause pseudomembranous colitis?

A

C. diff
-yellowish pseudomembranes seen on colonoscopy

37
Q

Meds for mod-severe traveler’s diarrhea

A
  1. azithromycin
38
Q

Med for colitis caused by C. diff

A

oral Vancomycin

39
Q

Is there a vaccine for rotavirus?

A

Yes, 2 oral, live vaccines
1. live, attenuated Rotarix w/ most common strain
2. live reassortant Rotateq w/ 5 strains

-rare, but intussusception reported with both

40
Q

What are some causes of appendicitis?

A
  1. fecaliths
  2. infections (parasites)
  3. tumor

-> increased luminal and intramural pressure
-bacterial overgrowth occurs w/ inflammation
-if necrosis is present, perforation can -> peritonitis

41
Q

Dx of appendicitis

A

abdominal CT w/ contrast

H&D (23 decks)

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