53. Bacterial Diarrhea Flashcards Preview

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Flashcards in 53. Bacterial Diarrhea Deck (18):
1

What is diarrhea?

change in consistency/frequency of stools

secretion>absorption

2

impt questions for patient w/diarrhea ?

duration, character, associated sxs

travel history

Abx use

Ill contacts - suspected source

PMH - IBD? Celiacs?

3

a physical exam for a pt w/diarrhea should focus on what?

dehydration

ie orthostatics, dehydration degree w/lack of turgor, dry mucous membranes, no tears w/crying

4

A 27 y/o woman w/sudden onset severe nausea followed by vomiting and watery diarrhea. Multiple bouts of vomiting and diarrhea x 18 hours. Husband has similar sxs starting 2 hours after her illness. Recover w/in 24 hours.

Most likely bacteria?
a. C. jejuni
B. E.coli
c. Salmonella enterica
d S.aureus
e. V.cholerae

S.aureus

5

features of acute gastroenteritis?

sudden onset

short duration

common source

prominent vomiting

6

etiologies of acute gastroenteritis?

preformed toxins:
- S. aureus
- C. perfringens
- Bacillus cereus

viruses

7

Management of Acute Gastroenteritis?

- eval level of hydration and IV rehydration PRN
- anti-emetics and antimotility agents for sxs relief

8

Acute watery diarrhea features?

cramps, vomiting variable

fever not prominent

no mucous or blood in stools

9

etiologies of acute watery diarrhea?

- viruses
- ETEC, EAEC, EPEC
- V.cholerae
- Campylobacter, salmonella, shigella, EIEC
- parasites

10

Tx of acute watery diarrhea?

ORS, lactoferrin test/leukocyte test of stools

11

acute inflammatory diarrhea features?

- cramps, abd pain prominen
- fever present
- stool w/mucous +/- blood

dysentery: frequent low volume bowel movements w/blood +/- mucous and tenesmus

12

etiologies of acute inflammatory diarrhea?

- C.diff
- Campylobacter, Salmonella, Shigella, EHEC, EIEC, Yersinia
- parasites

dysentery: shigella and ameboae

13

what pts w/diarrhea get a culture?

- immunocompromised
- outbreak
- dysentery
- cholera suspected
- duration >24 hours w/positive leukocytes or lactoferrin stool sample

14

tx for confirmed shigella?

empiric: ciprofloxacin or azithromycin

check susceptibilities, resistance common....if resistant to ^^^ then use TMP-SMX, if still resistant, use IV ceftriaxone

15

tx for confirmed C.diff?

metronidazole, oral vancomycin if severe

fidaxomicin (expensive)

16

tx for suspected v.cholerae?

ORS or IV fluids

resistance common but for severe disease use doxycycline, azithromycin or ciprofloxacin

17

tx of acute inflammatory diarrhea prior to confirmation?

ciprofloxacin, TMP-SMX, or rifamixin but,,,

BEWARE! if suspect SALMONELLA, don't use abx because prolongs duration, prolongs carrier state, and assoc w/symptomatic relapse. If blood in stool may suspect EHEC, don't use abx re: increased risk of HUS

DON'T treat campylobacter if >3 days

18

tx for traveler's diarrhea?

loperamide and if doesn't respond use ciprofloxacin or rifamixin