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CMT-dos > Acute Diarrhea > Flashcards

Acute Diarrhea Flashcards

1
Q

Diarrhea vs acute Diarrhea vs chronic Diarrhea

A

Diarrhea: > 3 loose stools per day

Acute Diarrhea: < 2 weeks duration

Chronic Diarrhea: > 3 weeks duration

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2
Q

Gastroenteritis

A

diarrhea w/ nausea & vomiting

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3
Q

Dysentery

A

diarrhea w/ blood, mucus, pus

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4
Q

Osmotic diarrhea / secretory diarrhea

A

Osmotic Diarrhea (sorbitol): solutes in lumen draw/keep water in lumen

Secretory Diarrhea (Cholera): intestinal secretion of solutes and water into lumen

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5
Q

when to use diagnostics for diarrhea

A

Diagnostics: reserved for severe dehydration or illness, persistent fever, bloody stool, immunosuppression, cases of suspected nosocomial infection or outbreak

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6
Q

antibiotics should be considered for which pathogens

A

shigella, campylobacter, Clostridioides difficile, traveler’s diarrhea, protozoal infections

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7
Q

noninfectious / infectious diarrhea / infective colitis

A

Noninfectious diarrhea: lack of constitutional symptoms

Infectious diarrhea: large volume (often watery) stool, constitutional symptoms, nausea/vomiting/abdominal cramps (gastroenteritis)

Infectious colitis: fever, tenesmus, and dysentery

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8
Q

Non-inflammatory Diarrhea

general
Sx and pathogens

A

Usu viral (some bacterial, parasitic)
Intestinal secretion, mucosa intact (cells are not damaged)
No fever, no blood in stool
No fecal leukocytes

Norovirus, rotavirus, Cholera, enterotoxigenic E coli, Staph aureus, Giardia…

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9
Q

inflammatory diarrhea

General
Sx and pathogens

A

Usu invasive, toxin-producing bacteria
Mucosa damaged (hence blood and WBCs)
Fever, bloody stool
Fecal leukocytes

Shigella, Campylobacter, C diff, some Salmonella, Shiga-toxin E coli

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10
Q

High Yield Associations of Diarrhea

Daycare

A

Rotavirus common
Multiple pathogens possible

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11
Q

High Yield Associations of diarrhea

Travel

A

Enterotoxigenic E coli (ETEC)
Norovirus outbreaks on cruise ships (and locally)

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12
Q

High Yield Associations of diarrhea

Animals

A

Animals
Turtles, reptiles = Salmonella

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13
Q

High Yield Associations of diarrhea

Food and water

A

Foods
Eggs & Dairy = Salmonella

Water (Camping)
Streams = Giardia

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14
Q

Toxin-mediated “Food Poisoning”

A

Bacterial toxin
abrupt onset (1-8 hours after ingestion)
vomiting prominent (diarrhea minimal)
resolution usually < 24 hours

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15
Q

E. Coli (ETEC) Classic “Traveler’s Diarrhea”

A

Contaminated food / water

Symptoms:
anorexia, cramps, watery diarrhea, low grade fever
may be nausea & vomiting—not prominent
no pus or bloody stools

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16
Q

Rotavirus

general

this baby needs IV hydration, ER time
A

Common cause of acute diarrhea hospitalizations in children

Winter prevalence

Viral shedding: 21 days

Acute onset, may be fever

vaccine available

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17
Q

Noravirus

General

A

Common cause of
diarrheal epidemics

Acute onset:
nausea & vomiting
watery diarrhea
abdominal cramps
lasts 1-3 days

18
Q

If blood is present you culture, possible offenders?

A

Campylobacter
Salmonella
Shigella
E. coli / E. coli O157:H7

19
Q

Campylobacter

general and Sx

A

Common Bacterial Pathogen
contaminated food (poultry)
contact with fecal material/animal-to-person

Symptoms:
diarrhea +/- blood
abdominal cramps / pain
fever
usually self-limited—may not require antibiotics

20
Q

Salmonella

General and Sx

A

Common in children < 4 years old
contaminated food (poultry)
infected animals (turtles)

Symptoms:
fever
diarrhea +/- blood
abdominal cramping/pain
usually self-limited—usually does not require antibiotics

21
Q

Shigella

general and Sx

A

“Shiga toxin”— toxic to enterocytes

Symptoms:
fever
abdominal cramps/pain
tenesmus–mucoid stools +/- blood
abx shorten duration of illness, limit fecal shedding

22
Q

E. Coli O157: H7 (Shiga toxin)

general and Sx

A

Contaminated food / water

Symptoms:
bloody diarrhea– not typical Traveler’s Diarrhea
severe abdominal cramps
high fever (> 101.3)
do not use abx, abx increase risk of complications (HUS)

23
Q

Clostridium difficile (C diff)

general

A

Associated with antibiotic use
Major diarrhea cause in pts hospitalized >3 days (consider in all hospitalized patients with unexplained leukocytosis)

Greenish, foul, watery diarrhea 5–15 x daily, rarely bloody;
PE: normal or mild LLQ tenderness.

24
Q

C diff

PE findings

A

PE: normal or mild LLQ tenderness.
Severe/fulminant: profuse diarrhea (≥ 30 stools/day); PE: fever; hemodynamic instability; abdominal distention, pain, tenderness

25
Q

C Diff

Labs

A

Labs suggestive of severe = WBC >30,000, albumin < 2.5 (due to protein-losing enteropathy), elevated serum lactate, rising Cr

Stool toxin/antigen assay

26
Q

C diff

CT

A

Noncontrast abdominal CT scans if severe/fulminant to look for colonic dilation and wall thickening

27
Q
A
28
Q
A

C diff increases risk for toxic mega colon

29
Q

C diff

Tx

A

Complex antibiotic decision tree

Prevention: minimize antibiotic use, don’t suppress gastric acid

30
Q

parasites

A

Contaminated food, water, person
Gradual onset, can be chronic
Watery, persistent, non-bloody diarrhea
Vomiting not prominent
Malabsorption
Foul smelling stool
Weight loss

Giardia, Entamoeba histolytica, Cryptopsporidium

31
Q

Symptoms that call for workup / culture

A

Usually not, but some exceptions:
weight loss / dehydration
bloody diarrhea
severe abdominal pain
recent abx use
immune suppressed/ associated illness/ elderly
high fever (> 101.3)

Shigella, campylobacter, C diff, severe traveler’s diarrhea, protozoal infections – NO ANTIOBIOTICS for E. Coli O157: H7

32
Q

Workup options

A

Stool culture, Giardia antigen testing, O&P
Fecal leukocytes/Fecal lactoferrin
C diff testing
CBC with diff
Electrolytes
Renal function testing

33
Q

Tx options for diarrhea

A

Oral rehydration therapy/early refeeding for dehydration
IV fluids as needed
Avoid antimotility agents if bloody diarrhea
Probiotics? may shorten duration of sx

probiotics should be 11 billion CFU

34
Q

Anti-motility
Meds

A

For symptomatic relief if:
no significant fever
non-bloody stools

Agents:
Loperamide (OTC)
Pepto-Bismol (OTC)
Kaopectate (OTC)
Lomotil (Rx) = narcotic + atropine

35
Q

Diarrhea

when to admit

A

ADMIT if:
Severe dehydration / unstable VS
Bloody diarrhea with anemia
Severe abdominal pain & recent abx use
Significant comorbidities

36
Q
A
37
Q

N/V

general

A

Acute symptoms = usually infectious, inflammatory, or iatrogenic

Most infections self-limiting and require minimal intervention; iatrogenic causes resolved by removing offending agent

38
Q

N/V

Chronic Sx

A

Chronic symptoms - variety of conditions
GI: obstruction, functional disorders, organic diseases
CNS: increased intracranial pressure (typically additional neurologic signs)
Pregnancy - most common endocrine cause of nausea, consider in any woman of childbearing age
Metabolic abnormalities, psychiatric diagnoses
Evaluation: focus on detecting emergencies or complications that require hospitalization

39
Q

N/V

when cause is not certain

A

When cause not certain, empiric therapy with antiemetic is appropriate
Initial diagnostic testing should be limited to basic labs and plain radiography. Further testing, such as EGD or CT of abdomen, should be determined by clinical suspicion based on complete Hx and PE

40
Q

Colic

A

Sharp, localized abdominal pain that increases, peaks, and subsides

Associated with numerous diseases of hollow viscera

Mechanism of pain: smooth muscle contraction proximal to partial or complete obstruction (gallstone, kidney stone, small bowel obstruction)

Location may help diagnose cause
Absence of colic useful for ruling out acute cholecystitis (only < 25% of patients with acute cholecystitis present without RUQ colic)

CMT-dos (95 decks)

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