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PHM 603- ID Part 1 > Infectious Diarrhea and C. diff > Flashcards

Infectious Diarrhea and C. diff Flashcards

1
Q

Patho of acute/watery diarrhea

A

Altered intestinal motility leads to less reabsorption of water and premature emptying of the colon

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2
Q

Causative pathogens of acute/watery diarrhea

A

E. coli, rotavirus, V. cholerae

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3
Q

Patho of dysentery

A

Altered ion transport where the normal ionic contents and osmolality is equal to the plasma

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4
Q

Causative pathogens of dysentery

A

Shigella, salmonella, campylobacter, clostridium

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5
Q

Causative pathogens of traveler’s diarrhea

A

E. coli, shigella, giardia, salmonella, viral causes

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6
Q

Causative pathogens of acute viral gastroenteritis

A

Rotavirus, norovirus, parvovirus, adenovirus

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7
Q

Causative pathogens of food poisoning

A

Staph, campylobacter, shigella, salmonella, clostridium

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8
Q

Prevention of acute viral gastroenteritis

A

Wash hands, fruits, and vegetables; cook meat to recommended temperatures

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9
Q

Treatment of food poisoning

A

Supportive care; can use antimotility agents in some patients

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10
Q

Signs of acute/watery diarrhea

A

<10 episodes a day
Risk of severe dehydration
FOBT +

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11
Q

Treatment of acute/watery diarrhea

A

Diarrhea stops with fasting

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12
Q

Signs of persistent/dysentery diarrhea

A

> 10 episodes/day
FOBT+
Mild dehydration
Possible fevers

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13
Q

Signs of traveler’s diarrhea

A

Travel followed by sudden onset watery diarrhea

Malaise, anorexia, abdominal cramps -> sudden, onset watery diarrhea

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14
Q

Signs of enterotoxic E. coli

A

Diarrhea and abdominal cramping

No blood or pus in stool

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15
Q

What is produced in enterotoxic E. coli?

A

Heat-labile and heat-stable toxins

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16
Q

Treatment for traveler’s diarrhea: initial management

A

Symptomatic control and source control

Loperamide PRN x2 days

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17
Q

Treatment for traveler’s diarrhea: high risk individuals

A

Bactrim x1-3 days

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18
Q

Enterotoxic E. coli treatment

A

Ciprofloxacin x1-3 days

Rifaximin or azithro x1-3 days

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19
Q

What is CI’ed in enterotoxic E. coli treatment?

A

Antimotility agents

20
Q

Mild water loss definition

A 
<5% body weight loss
Alert but restless
Increased thirst
Moist to slightly dry mucous membranes
Normal/slightly decreased uurine output
21
Q

Moderate water loss definition

A 
6-9% water loss
Lethargic and restless
Low BP, high HR
Dry mucous membranes
Delayed cap refill
Dark urine
22
Q

Severe water loss definition

A 
>10% body weight loss
Drowsy, limp, loss of consciousness
Bradycardia
Cyanotic
Skin "tenting"
No urine production
23
Q

Treatment for mild-moderate water loss

A

PO replacement with glucose ORT, milk, rice ORT, Pedialyte

24
Q

Treatment for severe water loss

A

IV fluids like NS or lactated ringers

25
Q

Patho of C. diff infections

A
  1. Exposure
  2. Travels to large intestine
  3. Maturation
  4. Toxin production
  5. Mucosal injury, intestinal fluid secretion, inflammation, cell death, pseudomembrane formation
26
Q

Risk factors for C. diff infection: patient-specific

A

Age >65, GI surgery, tube feeding, immunocompromised

27
Q

Risk factors for C. diff infections: facility-related

A

Length of stay, ICU admission, exposure

28
Q

Risk factors for C. diff infection: medication-related, highest risk ABX

A

Clindamycin, 3rd and 4th gen cephalosporins, fluoroquinolones, carbapenems

29
Q

Risk factors for C. diff infection: medication-related, lower risk ABX

A

Erythromycin, ampicillin, amoxicillin, pip/tazo

30
Q

Risk factors for C. diff infection: medication-related, lowest risk ABX

A

Aminoglycosides, vanco, metronidazole

31
Q

Non-severe C. diff disease: markers (lab values)

A

Leukocytosis (WBC ≤15,000 cells/ml) AND SCr <1.5 mg/dl

32
Q

Severe C. diff disease: markers

A

Leukocytosis OR SCr <1.5 mg/dl

33
Q

Fulminant C. diff disease: signs

A

hypotension or shock, ileus, megacolon

34
Q

AB-associated diarrhea without colitis manifestations

A

Mild to moderate (~6 loose BM/day)
Crampy lower abdominal discomfort
Slight lower abdominal tenderness

35
Q

AB-associated colitis without pseudomembranes

A 
10+ loss BM/day
Fecal leukocytes
Occult blood
Nausea, anorexia, fever, malaise, dehydration, leukocytosis
Abdominal distention, tenderness
36
Q

Pseudomembranous colitis

A 
>10 BM/day
Fecal leukocytes
Occult blood
Nausea, anorexia, fever, malaise, dehydration, electrolyte imbalance, leukocytosis
Marked abdominal tenderness, distention
37
Q

C. diff clinical diagnostics

A

> 3 unformed stools in 24 hours PLUS positive stool test for C. diff or toxins OR pseudomembranous colitis diagnosed by colonoscopy

38
Q

Initial, non-severe treatment of C. diff

A

Vanco 125mg PO QID x10 days
Fidaxomicin 200mg PO BID x10 days
Metronidazole 500mg PO TID x10 days

39
Q

Initial, severe treatment of C. diff

A

Vanco 125mg PO QID x10 days

Fidaxomicin 200mg PO BID x10 days

40
Q

Initial, severe, complicated treatment of C. diff

A

Vanco 500mg PO or NG QID (metronidazole 500mg IV added on if ileus is present)

41
Q

Alternate treatments for C. diff

A

Rifaximin 400mg TID x20 days as a vanco chaser for recurrence
Actoxumab and bezlotoxumab
Fecal microbiota transplantation

42
Q

First time recurrence of C. diff infection treatment

A

Use same treatments as initial treatment

43
Q

Second time recurrence of C. diff infection

A

Vanco taper or pulsed every other day

44
Q

C. diff infection prevention

A

Hand hygiene
Contact precautions- gowns, gloves, patient isolation
Environmental cleaning

45
Q

What should you avoid taking in a C. diff infection?

A

Antiperistaltic agents like loperamide and narcs, any concurrent ABX therapy if possible

46
Q

Leading cause of infectious diarrheal entities

A

Viral

PHM 603- ID Part 1 (22 decks)

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