GI Infectious Diarrhea and Hernias

Question 1

what three things could Rotavirus cause?

Answer 1

small bowel intussusception, bowel obstruction, severe dehydration

Question 2

who gets rotavirus?

Answer 2

children < 2yo who are not immunized MC

Question 3

labs for rotavirus?

Answer 3

look for rotavirus in stool sample (PCR)

Question 4

what are good rehydration liquids vs bad?

Answer 4

good ones have good electrolyte and osmolarity profile (ex: pedialyte vs gatorade or apply juice)

Question 5

what is the #1 cause of foodborne illness in the US?

Answer 5

Salmonella

Question 6

both of these types of diarrhea can present with “pea soup” diarrhea so how do you tell the difference

Answer 6

salmonella: poultry, eggs, milk products, REPTILES
typhoid: history of travel where sanitation is poor, constipation that turns into diarrhea

Question 7

why is Salmonella so hard to get rid of?

Answer 7

Forms a thick coating on equipment used for food processing

Question 8

what foodborne pathogen causes explosive watery diarrhea that progresses to mucous, bloody diarrhea?

Answer 8

Shigella

Question 9

where is shigella illness usually found? why?

Answer 9

in developing world. The US doesn’t have the bacteria that take Shigella and make the Shigella Toxin

Question 10

common sxs type of shigella in children

Answer 10

neuro manifestations (i.e febrile seizures)

Question 11

important lab value related to diagnosis of shigellosis?

Answer 11

leukemoid reaction (WBC >50K)

Question 12

Abx for those with shigella?

Answer 12

only for those who are VERY sick, indicated for children and adolescents with culture-proven shigella and who
have bacteremia, require hospitalization, at risk, etc.
FQs, bactrim

Question 13

where does one get giardia from ?

Answer 13

ingestion of contaminated water from remote streams/wells (“beaver’s fever” or “backpacker’s diarrhea”)

Question 14

how is Giardia transmitted?

Answer 14

fecal-oral transmission

Question 15

diarrheal symptoms of giardia ?

Answer 15

frothy, greasy, foul-smelling diarrhea NO BLOOD OR PUS

Question 16

dx and txt for giardia

Answer 16

dx: ova and parasites stool exam (see trophozoites and cysts)
tx: supportive- oral rehydration + ABX azoles (metronidazole aka flagyl)

Question 17

what does Cdiff come from ?

Answer 17

frequently part of normal flora, colonizes GI tract after normal gut flora have been altered by Abx therapy

Question 18

risk factors (3) for Cdiff?

Answer 18

recent ABX use (clindamycin classic in adults), elderly, gastric suppression therapy (PPI, H2 blockers)

Question 19

the presence of Cdiff in stool means what?

Answer 19

Does NOT mean you have the Cdiff infection (colitis). Cdiff is present in almost everyone at some level.

Question 20

3 complications of C. Diff

Answer 20

pseudomembrane colitis, bowel perforation, toxic megacolon

Question 21

how to diagnose C dif. What do you see on testing?

Answer 21

presence of severe diarrhea or ileus AND either positive stool test, OR endoscopic or histologic findings of pseudomembranous colitis
*c diff toxin in stool usually initial test

Question 22

what is pseudomembranous colitis look like?

Answer 22

thick, gunky, white layer inside the colon

looks like cottage cheese

Question 23

how to manage C diff infection?

Answer 23

1) . stop offending ABX if cause
2) . contact precautions and hand hygiene
3) . Oral vanc or fidaxomicin (dificid) 1st line (Flagyl less common due to increasing resistance)

Question 24

how to treat frequently recurring C diff (>3 recurrences)

Answer 24

fecal microbiota transplant (90% cure rate)

Question 25

fecal transplants for Cdiff can be given via ___ or ____ . who are the best donors?

Answer 25

enema or NG tube

donor: family members, family dog, etc.

Question 26

what pathogen is traveler’s diarrhea from?

Answer 26

• most commonly ENTEROTOXIGENIC E.Coli (not the enterohemorrhagic E coli from Jack in the Box)
• Cholera possibly in endemic area but v different presentation

Question 27

what are the four steps in managing infectious diarrhea?

Answer 27

1) . fluid repletion: MAINSTAY, oral repletion
2) . diet: bland, low-residue (BRAT)
3) . anti-motility agents (bismuth, opioid agonists, anticholinergics) **DON’T GIVE TO INVASIVE DIARRHEA pts
4) . anti-emetics: serotonin or dopamine blockers

Question 28

difference between non-invasive and invasive diarrheas: PP, bowel location, common sxs, what is seen in the stool

Answer 28

non-invasive: enterotoxins increase GI secretion of electrolytes, which leads to secretory diarrhea (no cell destruction or mucosal invasion), location = small bowel (large volume stool), no WBCs, blood or mucus, VOMITING
invasive: cytotoxins cause mucosal invasion and cell damage, location = large bowel (many small-volume stools, HIGH fever), + WBC, blood, or mucus

Question 29

6 types of non-invasive diarrhea

Answer 29

1) . norovirus
2) . rotavirus
3) . S. aureus gastroenteritis
4) . Enterotoxigenic E. coli
5) . vibrio cholerae
6) . C. Diff

Question 30

5 types of invasive diarrhea

Answer 30

1) . campylobacter
2) . enterohemorrhagic E. coli
3) . typhoid fever
4) . non-typhoidal salmonella
5) . shigellosis

Question 31

MC cause of adult gastroenteritis in US and viral gastroenteritis worldwide

Answer 31

norovirus

Question 32

what is norovirus most often associated with

Answer 32

OUTBREAKS (cruise ships, hospitals, restaurants)

Question 33

3 physical exam findings of typhoid fever

Answer 33

1) . fever with relative bradycardia
2) . rose spots (pink/salmon rash that spreads trunk to extremities)
3) . hepatosplenomegaly

Question 34

how to treat typhoid fever?

Answer 34

first= oral rehydration and electrolyte replacement

FQ ABX 1st line

Question 35

how to treat salmonella?

Answer 35

same tx (oral rehydration + electrolyte replacement) and FQ abx when needed

Question 36

who gets cholera and where does it commonly occur?

Answer 36

vibrio cholerae: contaminated food and water, outbreaks of poor sanitation/overcrowding (usually abroad)

Question 37

what diarrheal illness: copious watery diarrhea (“rice water stools”) with flecks of mucus, may have fishy odor

Answer 37

cholera

Question 38

which diarrheal illness is most likely after eating contaminated dairy products, mayo, eggs, salads?

Answer 38

staph aureus gastroenteritis?

Question 39

what ABX do you give someone with cholera if severe infection?

Answer 39

TETRACYCLINE (unique)

Question 40

which diarrheal illness is most likely to precede Guillain-Barre syndrome?

Answer 40

C. jejuni

Question 41

source of C. jejuni infection

Answer 41

contaminated food (raw or undercooked poultry most common, raw milk, dairy cattle) OR puppies in children

Question 42

how do you dx and tx C. jejuni infection

Answer 42

dx: stool culture (gram-negative “S”, comma or seagull shaped organisms)
tx: supportive stuff like usual + macrolide ABX prn

Question 43

enterohemorrhagic E coli source of infection. what two age groups is this most commonly seen in?

Answer 43

undercooked ground beef, unpasteurized milk/apple cider, DAY CAREs, contamined water
children + elderly

Question 44

characteristics between direct vs indirect inguinal hernia

Answer 44

1). indirect: overall MC type of hernia in all people (originates lateral to inferior epigastric artery, may force intestines through internal inguinal ring into canal and follow testicle into scrotum)
PP: often congential due to persistent patent processes vaginalis
2). direct: originates medial to the inferior epigastric vessels (hesselbach’s triangle) and protrudes through floor of inguinal canal

Question 45

sxs for AS hernia, incarcerated and strangulated hernia

Answer 45

AS: swelling/fullness at site, enlarged with increased intrabdominal pressure

incarcerated: painful, enlarged, IRREDUCIBLE hernia
strangulated: ischemic incarcerated hernia with systemic toxicity

Question 46

tx for hernia

Answer 46

inguinal often require surgical repair

strangulated hernias are surgical emergencies

Question 47

where does a femoral hernia occur? who does it most commonly occur in?

Answer 47

protrusion of contents through femoral canal (below inguinal ligament)

• MC in women
• OFTEN BECOME INCARCERATED OR STRANGULATED

Question 48

management of umbilical hernias in kids vs adults

Answer 48

usually observe in kids because most resolve by 2 years old
*maybe surgical repair if still persistent by 5 years old
adults = usually repair to prevent complications

Question 49

what does enterohemorrhagic E coli infection cause in kids?

Answer 49

hemolytic uremic syndrome (acute renal failure)