8 - Diarrhea And Food Borne Flashcards
(121 cards)
1
Q
Acute vs chronic diarrhea?
A
Acute: <3 weeks
Chronic: > 3 weeks
The pt knows what is abnormal
2
Q
Noninfectious diarrhea?
A
Malabsorption Milk protein/lactose intol IBS IBD Laxative abuse
3
Q
Infectious diarrhea
A
Virus
Bacteria
Fungi
Parasites
4
Q
Non-invasive toxin mediated diarrhea tends to present?
A
Afebrile
Abdominal cramping with watery diarrhea
5
Q
Diarrhea where bacteria invade the mucosa?
A
Febrile
RBC/WBC in stool
6
Q
Acute gastroenteritis (AGE)
A
1-5 days of watery diarrhea with prominent N/V
Can be any number of infections, toxins, drugs, diseases
7
Q
Food poisoning
A
Disease caused by toxin present in food
8
Q
Food poisoning classifications?
A
Ultrashort - 1-2 hrs
- chemical
Short - 1-6 hrs
- toxin in food
Long - 8-16hrs
- organism in food
- toxin produced after consumption
9
Q
Who is susceptible to AGE?
A
Everybody
Especially travelers to “developing” countries
Honestly whoever came up with that term has never been to the countries, they arent developing, they are stagnant at best
10
Q
Questions for diarrhea
A
- History
- stool volume
- stool characteristic
- stool consistency
- flatus
- food history
- travel history
- systemic symptoms
- day care
- failure to thrive
- malnutrition
- water exposure
- camping
- animal exposure
- onset and duration
Borborygmi
11
Q
Borborygmi?
A
Rumbling or gurgling noise made by the movement of fluid and gas in the intestines
12
Q
Dairy is associated with?
A
Campylobacter and salmonella
13
Q
Eggs are associated with?
A
Salmonella
14
Q
Meats are associated with?
A
C. Perfringes
Aeromonas
Campylobacter
Salmonella
15
Q
Ground beef are associated with?
A
Enterohemorrhagic E. Coli
16
Q
Poultry are associated with?
A
Campylobcter species
17
Q
Seafood are associated with?
A
Astrovirus
Aeromonas
Plesimonas
Vibro
18
Q
Oysters are associated with?
A
Calicivirus
Plesiomonas
Vibro species
19
Q
Vegetables are associated with?
A
Aeromonas species
C. Perfringins
20
Q
Underdeveloped tropics are associated with?
A
C. Perfringes
21
Q
Africa, S/C america, and India are associated with?
A
Entamoeba species
Vibro cholera
22
Q
Mexico is associated with?
A
Aeromonas
Entamoeba
Plesimonas
Yersinia species
23
Q
Asia is associated with?
A
Vibrio cholera
24
Q
Australia, canada, europe are associated with?
A
Yersinia species
25
Japan is associated with?
V. Parahaemolyticus
26
New guinea is associated with?
Clostridium species
27
C. Difficile is associated with?
Hospitalization
| Abx
28
Plesimonas species is associated with?
Liver disease
| Malignancy
29
Salmonella species is associated with?
```
Intestional dysmobility
Malnutrition
Achlorhydria
Hemolytic anemia
SCD
Immunosuppression
Malaria
```
30
Rotavirus is associated with?
Hospitalization
31
Giardia species is associated with?
Agammaglobulinemia
Chronic pancreatitis
Achlorhydria
Cystic fibrosis
32
Nonspecific diarrhea/food borne disease s/s?
- Lethargy
- depressed consciousness
- dry mucous membranes
- sunken eyes
- poor skin turgor
- delayed cap refil
- drop in BP
- nonfocal abdominal pain
- cramping
- borborygmi
- perianal erythema
- fever
- wt loss
33
Tests to consider for diarrhea/food borne?
```
O and P
Stool pH
CBC- diff
Gram stain
Bacterial culture
Blood culture
LFTs
Fecal leukocytes
Hemoccult
Serum electrolytes
X-rays
Simoidoscopy
Upper endoscopy (EGD)
Intestinal biopsy
String
```
34
Non specific treatments?
Oral/IV rehydration
BRAT diet
Anti motility agents
Antimicrobial therapy
35
Most diarrhea organisms are?
Self limiting
36
When to suspect a virus with diarrhea?
```
Vomiting is prominent
14hr + incubation
Short (<3 days)
No bacterial warning signs
No epidemiologic clues
```
37
Adenovirus?
Prolonged diarrhea (compared to rotavirus)
Multiple viral illness (“the cold”)
38
Calicivirus
Common cause of pediatric diarrhea
Possible association with intussuception
39
Norovirus
Norwalk / norwalk-like
Cruise ships
40
Rotavirus
AGE in kids
URT infections
Vaccine available (not widely used)
41
Cytomegalovirus
Immunocompromised pts
Possible dysentary
Bennefits from antivirals
42
Yersinia entercolitica
Sever cramping
Misdiagnosed as appendicitis
Associated with polyarticular arthritis
43
Staphylococcus aureus
Toxin in food
No organism in body
“I want to die” gastroenteritis
44
Bacillus cereus
Contaminated rice
Systematic movement through GI tract
45
Clostridium perfringens
Known for causing gas gangrene
Mild gastrointestinal symptoms
46
General info for campylobacter jejuni
Community acquired inflammatory enteritis
Fecal/oral
Food borne (chickens 50-70%)
Sick pets
Unpasteurized milk
47
Campylobacter jejuni s/s?
```
Acutely ill
Diffusely Tender abdomen
Abdominal pain
Fever (104)
HA
Myalgias
```
10+ watery BM/day
48
Differentiator for campylobacter jejuni?
Abdominal pain
Salmonella/shigella has minimal/no pain
49
Campylobacter jejuni diagnosis?
Stool exam
- microscopic
- culture (slow)
50
Treatment for campylobacter jejuni?
Azithromycin
51
Salmonellosis groups?
2,300 salmonella serovars exist
But they are all grouped into one species
Most of which are pathogenic
52
Another name for salmonella?
Nontyphoidal salmonellae
53
Sources of salmonella?
Pets:
- reptiles
- birds
Food borne illness (95%)
- eggs
- poultry
- vegetables
- cheese
- unpeeled fruit
54
Common crawly things that spread salmonella?
```
Turtles
Lizards
Iguana
Snakes
Salamanders
Frogs and amphibians
```
55
S/S of salmonellosis?
- Non blood loose stool or watery diarrhea
- N/V
- Vomiting
- mild abd cramping
- rare symptoms
— choleralike diarrhea
— tenesmus
56
How long after eating food do you get salmonellosis?
12-36hrs
57
How is salmonellosis diagnosed?
- macConkey agar
58
Tx for salmonellosis?
Ciprofloxacin
59
Typhoid fever?
Salmonella infection that is a systemic bacterial infection
60
Enteric fever?
Typhoid fever
61
What organisms cause typhoid fever?
Salmonella typhi (typhoid fever)
Salmonella paratyphi (paratyphoid fever)
62
MC typhoid fever strain?
Salmonella typhi
Also the more severe
63
70% of typhoid pts have a hx of?
Travel
64
How is typhoid fever spread?
Food borne transmission w feces and urine
65
Hallmark of typhoid fever?
Invasion/multiplication
Mononuclear phagocytic cells
66
Where are the mononuclear phagocytic cells of typhoid fever found?
Liver
Lymph
Spleen
Peyer patches of the ileum
67
Typhoid fever prevention?
Besides not eating from street venders (or outside your bubble if you are Ms Booker)
Vaccine
68
Systemic infection of typhoid fever?
Bacteremia
69
Phases of typhoid fever?
- Incubation
- first week
- days 7-12
- third week (mortality week)
- 4th week
3-60 days
- Average 7-14 days
70
Incubation phase of typhoid fever?
Usually asymptomatic but can also have transient diarrhea or constipation
71
First week of typhoid fever infection?
HA
Malaise
Remittent Fever (103-104*F)
72
Days 7-12 s/s
2-4mm diameter pink papules
- rose spots
- fade with pressure
- upper abdomen and lower chest
```
Relative bradycardia
Dicoratic pulse (double beat)
```
73
Third week s/s
```
Increased toxicity
Wt loss
Pyrexia
Delirious state
Pronounced abdominal distention
Pea soup diarrhea
Weak thready pulse
Tachypnea
```
This is when they may die
74
What is the delirious state of typhoid fever aka?
Typhoid state
75
Fourth week s/s?
If they survive (50% mortality)
Symptoms resolve slowly
- fever
- mental state changes
- abdominal distention
Still have intestinal complications
Relapses
76
Typhoid mary?
Typhoid fever has a carrier state that some pts get and they can spread it around like a dirty little salamander
77
What lab findings come with typhoid fever?
```
Anemia
H ESR
Thrombocytopenia
H LFT
Lymphopenia
+ culture
```
78
Tx for typhoid fever?
Regular:
Ciprofloxin
From Asia:
Ceftriaxone or azithromycin
79
90% of shigellosis are?
Shigella sonnei
Shigella flexneri
80
What is bacillary dysentery?
The disease caused by shigellosis
81
2 mechanisms of bacillary dysentary from shigellosis?
Invasion of the colonic epithelium
Production of enterotoxin
82
Production of enterotoxin for shigellosis?
Not essential for colitis but enhances virulence
83
How is shigellosis spread?
Fecal oral
From
Water and food
84
Shigella is invasive, that means?
Fever
85
S/S of shigellosis?
```
Acute blood diarrhea
Tenesmus
Mucus poo
Fever (1-3 days later)
Lower abdominal tenderness
Normal/increased bowel sounds
```
86
Shigellosis timeline?
Often self-limited
3d - 1 week
- occasionally last up to 1 month
87
Diagnosis for shigellosis?
+stool culture
Fecal leukocytes and erythrocytes
Leukocytosis (rare)
88
Tx for shigellosis?
Usually self limited
Ciprofloxacin (cipro)
89
Dont give ___ to shigellosis
Narcotic-related antidiarrheals
90
Types of excherichia coli?
There are 6 but 4 matter now
1. ETEC - Enterotoxigenic E Coli
2. EPEC - enteropathogenic E coli
3. EIEC - enteroinvasive E coli
4. EHEC - Enterohemoryhagic E coli
91
Travelers diarrhea is aka
ETEC
92
Childhood diarrhea is aka?
EPEC
93
Shigella-like dysentery is aka?
EIEC
94
Hemolytic uremic syndrome (HUS) is aka?
EHEC
95
Travelers diarrhea general S/S?
Abdominal cramping
EXPLOSIVE BM
Tenesmus
N/V
96
Tx for travelers diarrhea?
Loperamide
+
Ciprofloxacin
97
O157:H7
EHEC
Produces shiga toxin
98
S/s of O157:H7?
Early - Watery diarrhea
Later - grossly bloody
HUS
99
HUS?
Hemolysis
Thrombocytopenia
URemia (dialysis)
Death
100
Pathoghnomic of O157:H7 or EHEC?
Watery diarrhea that has a sudden switch to grossly bloody
101
Diagnosis of EHEC?
Stool culture
- MacConkey
Must request this test specially
102
Tx for EHEC?
Typically self limiting
NO ANTIBIOTICS
NO antidiarrheals
Treat the HUS
103
Why no ABX with EHEC?
Renal complications
| - the HUS kills the kidneys
104
Cholera is NBD right?
If only
It can kill you w/in hours from massive dehydration
105
S/S of cholera?
```
Painless watery diarrhea
Voluminous diarrhea
Vomiting
Abd cramps (maybe)
NO FEVER
hypovolemic shock
```
106
Cholera poop?
Rice water stools
Fishy odor
107
Tx for cholera?
Fluid replacement is primary
Abx can shorten the course
108
Abx for cholera?
- doxycycline
| - azithromycin
109
Prevention of cholera?
oral vaccine
Vaxchora for 18-64 y/o for O1 serogroup
110
This disease is uncommon and not that bad for most people but it is bad for preggos
Listeria monocytogenes
111
Listeria monocytogenes and preggo?
25% result in fetal loss
112
What is listeria spread through?
Food
- dairy (unpasterurized)
- soft cheese
- ice cream
- raw fruit
- vegetables/produce
- hot dogs
- cold cuts
- deli meats
113
Typical presentation of listeria?
Diarrhea
114
Uncommon presentation of listeria?
```
Meningitis
Meningoencephalitis
Abscess formation
Endocardidits
Arthritis/osteomyelitis
Pneumonia
```
115
S/s of listera
```
Non invasive diarrhea (1-3 days)
Poss bacteremia
- fever
- myalgias
- arthritis
- back pain
- HA
```
116
Types of Neonatal listeria?
Early-onset sepsis (w/in 6 days)
(Transplacental transmission)
Late onset - 7-28 days after birth
(Vaginal transmission)
117
Effects of transplacental transmission of listeria?
Premature birth
Abortion
Stillbirth
Intrauterine infection
Abscess and/or granulomas
118
S/S of neonatal listeria?
CNS: brain parenchyma
- mental status changes
- seizure
- cranial nerve deficits
- strokelike syndrome
- hemiplegia
- movement disorders
- encephalitis
- meningitis
- ventriculitis
119
What labs for listeria?
```
Blood culture
CSF culture
Wet mounts - motile
Serologic (not reliable)
Stool cultures (not good)
```
120
Tx for listeria for at risk populations?
Empiric abx
- ampicillin
- gentamicin
- trimethoprim-sulfamethoxazole
121
Have you see the sequel, Diarrhea?
It leaked so they had to release it early
