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Clin Med - GI > Acute Diarrhea- Piburn > Flashcards

Acute Diarrhea- Piburn Flashcards

1
Q

what are the types of diarrhea

A

decreased absorption of h20
increased intestinal secretion
increased osmotic load
abnormal motility

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2
Q

what is the most common cause of diarrhea

A

infection

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3
Q

what are high risk groups for diarrhea

A

travelers
ingesting certain foods
immunodeficiency
daycares
institutionalized
extremes of age

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4
Q

what are infectious agents that travelers are at risk for

A

campylobacter
norovirus
coronavirus
salmonella
shigella
Giardia (Beaver fever)

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5
Q

what is the most common agent seen in daycares

A

rotavirus

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6
Q

what is non-inflammatory acute diarrea

A

watery, not bloody
GI symptoms
larger volumes (+/- dehydration)
fecal leukocytes absent
small intestine

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7
Q

what is inflammatory acute diarrhea

A

blood diarrhea (dysentery)
systemic symptoms (fever) + LLQ cramping, urgency and tenesmus
small volumes
fecal leukocytes present
large intestine

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8
Q

what are non-infectious causes of acute diarrhea

A

malabsorption
Celiac, IBS, Crohn’s, UC, medications, bile acids, mesenteric ischemia

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9
Q

what are possible acute diarrhea work up tests

A

CBC, CMP
fecal leukocyte count
fecal hemoccult
stool culture - bacterial
+/- C. diff PCR
+/- viral testing, protozoal testing
+/- ova and parasite testing

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10
Q

if diarrhea persists, what are other workup tests that can be completed

A

flexible sigmoidoscopy- colonoscopy (biopsy)
Radiographs or CT scan
r/o IBD, ischemic colitis, or other non-infectious causes

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11
Q

what is the supportive treatment for acute diarrhea

A

maintain adequate oral intake
bowel rest
easy digestible foods
oral rehydration with electrolytes
anti-diarrheals

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12
Q

what is the BRAT diet

A

Banana, Rice, Apple sauce, toast

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13
Q

when is anti–diarrheal contraindicated

A

blood diarrhea, fever, systemic symptoms, persistent diarrhea
if concern for toxic megacolon

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14
Q

what criteria must be met for empiric antibiotic treatment for acute diarrhea

A

no concern for hospital acquired infection
presents of moderate to severe fever, tenesmus or bloody stools
no suspicion for E.coli - abx increase risk of HUS

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15
Q

what is the preferred abx for acute diarrhea

A

fluoroquinolone
-ciprofloxacin, ofloxacin, levofloxacin
bactrim or doxycycline

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16
Q

what is HUS

A

hemolytic uremic syndrome
blood break down, increased urea - results from blood clots, predominantly in the kidney

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17
Q

what is the criteria to admit for acute diarrhea

A

severe dehydration, especially if vomiting or unable to tolerate PO intake
severe or worsening bloody diarrhea
severe abdominal pain
severe infection or sepsis
severe or worsening diarrhea and age > 70 or immunocompromised
signs of HUS

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18
Q

what are complications of acute diarrhea

A

reactive arthritis
HUS
post infection IBS?
Precursor to Crohns, UC, celiac?

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19
Q

what are the most common viral agents for infectious diarrhea

A

norovirus and rotavirus

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20
Q

what is the leading agent causing food born illness

A

norovirus

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21
Q

what is the transmission of norovirus

A

fecal-oral route
contaminated foods and water
contaminated surfaces
person-to-person

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22
Q

what is the incubation of norovirus

A

1-3 days, average 48 hours

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23
Q

what are the symptoms of norovirus

A

nausea, vomiting, watery diarrhea, abdominal cramping
+/- fever
short duration (hours to 3 days)

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24
Q

what is the most common cause of severe gastroenteritiris in infants and kids worldwide

A

rotavirus

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25
Q

what is the transmission of rotavirus

A

fecal-oral route
highly contagious
vaccine available

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26
Q

what is the incubation periods, duration of illness and viral course of rotavirus

A

incubation: 48 hours
duration of illness: 5-7 days
can shed virus for 10-20 days

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27
Q

what is rotavirus

A

double stranded RNA virus
causes gut epithelial necrosis

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28
Q

what are the symptoms of rotavirus

A

profuse watery diarrhea + vomiting in kiddos
more mild in adults
non-bloody diarrhea
fever in abou 50%

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29
Q

what is the treatment of rotavirus

A

symptomatic + vigorous hydration
anti-diarrheals not recommended in kids under 5

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30
Q

what are the species of shigella

A

shigella dysenteriae - blood version
shigella flexneri
shigella sonnei
shigella boydii

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31
Q

what is shigella

A

acid-resistant bacteria - small dose can cause disease

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32
Q

what is the transmission of shigella

A

fecal-oral route
contaminated food and water
person-to person
often young children at daycare/preschool

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33
Q

what is the incubation and duration of shigella

A

incubation: 24 hours to 3 days
duration: usually 1 week (self limited)

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34
Q

what are the symptoms of shigella

A

abrupt onset of watery diarrhea - typically frequent, small volume, bloody stools (NO N/V)
tenesmus, fever, abdominal cramping, lethargy
infects colon so severe dehyration is less likely

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35
Q

what can shigella lead to

A

HUS - shiga toxin

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36
Q

what is the tx of shigella

A

abx recommended unless mild disease
fluoroquinolones recommended for adults
azithromycin for those under 18yo

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37
Q

what is the #1 cause of foodborn illness in US

A

salmonella

38
Q

what is the transmission of salmonella

A

fecal contamination of food and water
undercooked food
eggs, milk and other dairy products
contaminated vegetables
contaminated processed foods
person-to-person
transmission from pets

39
Q

what is salmonella

A

acid-sensitive - require larger dose for infection

40
Q

what is the incubation and duration of salmonella

A

incubation: 1-3 days
duration: usually 2-3 days, no more than 10 days

41
Q

where does salmonella go into

A

GI tract through fecal-oral contamination
invades small intestines, moves into regional lymph nodes (peyer’s patches)

42
Q

what are the symptoms of salmonella

A

may have gradual or abrupt onset
first nausea, vomiting, fever
later abdominal cramps and diarrhea
progresses to bloody diarrhea in some, but uncommon
symptoms more sever in immunosuppressed, infants, elderly

43
Q

what is the treatment of salmonella

A

supportive for most + hydration
abx not routinely indicated

44
Q

when are abx for salmonella considered

A

immmunosuppressed, elderly, infants and other medical comorbidities
fluoroquinolones for 3-7 days

45
Q

what is Campylobacter

A

acid-sensitive - requires large dose to cause disease
also leading cause of foodborn illnesses

46
Q

what is responsible for 50% of infections of campylobacter

A

contaminated poultry

47
Q

what is the incubation and duration of campylobacter

A

incubation: avg 3 days
duration: 5-9 days

48
Q

what are the symptoms of campylobacter

A

abrupt onset abdominal pain and diarrhea
hematochezia in 15-50%
often have relapse of symptoms within few days of apparent resolution

49
Q

how is campylobacter diagnosed

A

microscopy
rapidly motile spiral-shaped organism are characterisitics

50
Q

what is campylobacter associated with

A

guillan-carre syndrome (onset 1 week - 2 months post infection_

51
Q

what is Vibrio

A

gram negative bacteria
see rapid volume loss, electrylyte abnormalities

52
Q

what is the incubation and duration of vibrio

A

incubation: 1-2 days
duration: 3-6 days

53
Q

what is the transmission of Vibrio parahaemolyticus

A

salt water reservoirs, especially in summer and fall - can live on plankton
raw and undercooked seafood (oysters(

54
Q

what are the symptoms of Vibrio parahaemolyticus

A

Abrupt onset of watery diarrhea +/- blood
abdominal cramps, fever, +/- N/v

55
Q

what is the treatment of Vibrio parahaemolyticus

A

supportive + hydration
consider abx if secer or immunocompromised
-doxycycline, fluoroquinolones

56
Q

what is vibrio cholerae

A

endemic in asia, africa, central and south america - primarily contaminated water, most US cases are travelers
produces enterotoxin - profuse watery diarrhea (RICE WATER STOOLS)

57
Q

What are the symtpoms fo vibrio cholerae

A

asymptomatic to severe diarrhea
fluid loss up to 1L/Hour
rice-water stools
can cause severe dehydration oand electolte disturbances

58
Q

what is the treatment of vibrio cholerae

A

rehydration with electrolytes
IV fluids
abx areindicated
-tetracycline, doxy, azithromycin, fluoroquinolones

59
Q

what is Escherichia coli

A

E. coli
2 types: enterotoxigenic and enterohemorrhagic

60
Q

what is the presentation of enterotoxigenic e. coli

A

infants and children under age 2 in developing countries
traverlers in US cases
few loose stools < 1day to sever watery diarrhea up to 1 week - m/c in resouse limited areas

61
Q

what is the tx of enterotoxigenic e.coli

A

rehydration
can consider abx
-azithro or rifaximin

62
Q

what is enterohemorrhagic e.coli

A

2/3 of cases are in children
incubation: 3-5 days
duration: few days to 2 weeks

63
Q

what is the transmission of enterohemorrhagic e.coli

A

undercooked meat (esp. ground beef)
contaminated vegetables and fruits
contaminated water
via animals
person-to-person

64
Q

what does enterohemorrhageic e.coli produce

A

enterotoxin - shiga toxin
bloody diarrhea, TTP, HUS< hemolytic anemia

65
Q

what are the symptoms of enterohemorrhagic e.coli

A

watery diarrea for 2-5 days
progresses to bloody diarrhea in 90%

66
Q

what is the treatment of enterohemorrhagic e.coli

A

supportive with hydration
no anti-diarrheals
no abx - increased risk of HSU

67
Q

what foods are prefered by s. aureus

A

foods high ins urgar, or those with cream, particularly at room temp

68
Q

what is the duration of illness of s. aureus

A

24 hours or less - hallmark is rapid recovery

69
Q

what is clostridium perfringens

A

commonly found in soil and animal intestinal flora
spore forming bacterium
almost always transmitted via improperly refrigerated cooked mesats

70
Q

what is the symtpoms of clostridium perfringens

A

watery diarrhea and crampy abdomonal pain

71
Q

what is pseudomembranous colitis

A

classically, pt given abx - abx kills normla flora - c.diff may already be there but able to proliferate and superinfect the colon
- endotoxin release
-watery diarrhea
colon cellular destruction
pt will have severe watery diarrhea, abdominal cramping, fever, leukocytosis

72
Q

what can pseudomembranous colitis progress into

A

necrosis and toxic megacolon
colonic performation, sepsis, death

73
Q

what are high risk groups for c.diff

A

elderly
debilitated
immunocompromised
pt on multiple abx
abx > 10 days
enteral nutrition
PPI use
undergoing chemotherapy
IBD

74
Q

how is c.diff transmitted

A

fecal-oral via spores
primarily person-to-person

75
Q

what is the presentation of mild and moderate c.diff

A

greenish, foul smelling watery diarrhea
up to 5-15 BMs per day
WBC > 15,000

76
Q

what is the presentation of sever or fulminant c. diff

A

greenish, foul-smelling watery diarrhea
profuse, up to 30 BM per day
WBC > 30,000
albumin < 2.5 g/dL
elevated lactate
increased serum creatinine (usu. greater than 1.5x baseline)

77
Q

what can fulminant c. diff progress to

A

respiratory failure
metabolic acidosis
toxic megacolon
colon perforation
death

78
Q

what is the workup of c. diff

A

screen with glutamate dehydrogenase (c. diff antigen)
enzyme assay to ID toxins
PCR and ID gene regulating toxin production

79
Q

what is the treatment of c.diff

A

PO vancomycin 10-14 days
2nd line: metronidazole

80
Q

what usually causes cryptosporidium

A

cryptosporidium hominis
cryptosporidium parvum
much more common in immunocompromised (esp AIDS)

81
Q

what is the transmutation of cryptosporidium

A

contaminated food and water - commonly recreational water
person-to-person
animal-to-human

82
Q

what is the incubation and duration of cryptosporidium

A

incubation: 1-14 days
duration: typically 5-10 days in immunocompetent
weeks to months in immunocompromised

83
Q

what are the symptoms of cryptosporidium

A

watery diarrhea, abdominal cramps, malaise
AIDS pts: frequent foul smelling stools, malabsorption, weight loss
prone to relapse of symtpoms after apparents resolution

84
Q

how is cryptosporidium diagnosed

A

negative fecal leukocytes
detection in stool via acid fast stain

85
Q

what is the treatment of cryptosporidium

A

supportive + hydration + anti-diarrheals
no ‘best’ drug in literature
recommended: Nitazoxanide

86
Q

what is giardia lamblia

A

m/c protozoal infection in the US
travelers diarrhea or contaminated water
-camping and contaminated water

87
Q

what is the incubation and duration of giardia lamblia

A

incubation: 1-3 weeks
most recover in 3-4 weeks

88
Q

what are symtpoms of giardia lamblia

A

watery diarrhea, occasiaonlly prfuse
flatulence, abdominal cramping, epigastric pain, nausea
some have steatorrhea and weight loss due to malabsorption

89
Q

how is giardia lamblia diagnosed

A

+ stool ova and parasite
+/- immunoassay to identify giardia antigens

90
Q

what is the tx of giardia lamblia

A

depends on age
tinidazole single dose
nitrazoxanide
metronidazole

Clin Med - GI (11 decks)

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