Acute Diarrhea DSA Powerpoint Flashcards
1
Q
what does schistosoma mansoni cause
A
bloody stools
bladder cancer
liver cysts
2
Q
most common cause of acute infectious diarrhea (2 bacteria)
A
salmonella
campylobacter
3
Q
commoin in tropical and subtropical areas of the world
acute non bloody watery diarrhea
in immunosupp pts diarrhea can be severe
caused by coccidian parasite
malabsoprtion and weight loss bc can last 4 weeks
A
cystoisospora belli (formerly isospora belli)
4
Q
shigella
A
children potato or egg salad, lettuce, raw veggies blood disarrhea fecal leukocytes positive lactrose negative reactive arthritis and HUS
5
Q
mutation for FAP
A
APC or MUTYH
6
Q
child diarrhea defined as
A
> 20/g/kg/day stool
7
Q
cryptosporidium 2 main clinical symptoms
-type of diarrhea
outbreaks involving what
A
self limited diarrhea in immunocompetent pts
-no treatment
life threatetning intractable in immunosupp pts
-AIDS cd4 count below 200, antivirals to increase CD4 count
- watery diarrhea large volume (over 20L a day)
- outbreaks involving swimming pools
8
Q
motile S shaped gram neg rod
A
campylobacter
9
Q
HUS
A
shigella most common
EHEC next most common
happens in children more that are treated with antibiotics
10
Q
yersiniosis may lead to
A
autoimmune type thyroiditis, pericarditis, GN
11
Q
shigella treatment
A
bismuth, amp, fluoroquin, trimeth/sulfa
12
Q
chronic diarrhea cuases
A
SSRI cholinesterase inhib NSAIDs PPI ACEI metformin allopurinol
13
Q
what is recommended to person with IBS
A
low FODMAP diet
14
Q
yersinia enterocolitica
- higher risk in
- type of diarrhea
- complications
- treatment
A
iron overload syndromes bloody and non bloody mimics appendicitis hemochromatosis supportive care
15
Q
for celiac and pt with IgA defeiicency check what
A
anti-DGP
16
Q
treatment of constipation/fecal impaction
diagnose too
A
diagnose with DRE
tx: enema, digital disruption
17
Q
short bowel syndrome increased chance of
A
oxylate kidney stones
give clacium supplemntation
increawsed cholest gallstones
18
Q
treatment for salmonella typhimurium
A
antiobiotics are usually not indicated
19
Q
genetic defect Familial juvenile polyposis
A
18 and 10
MADH4 and BMPR1A
20
Q
get from produce from endemic areas
- lettuce, fresh basil, imported raspberries
- travel to endemic area
- watery diarrhea
- indefinite in immunosupp and 21 days in immunocomp
A
cyclospora cayetanesiss
21
Q
treatment for EHEC
A
supportive
antibiotics only in severe cases
22
Q
traveler’s diarrhea risk factor
A
H2 blocker/PPI
23
Q
secretory diarrhea
- sodium
- osmotic gap
A
high, normal
24
Q
SBS: colon removed need at least ___ cm of prox jejunum for oral nutriotino
A
200 cm
25
2nd most common cause of gastroenteritis in children
watery diarrhea and vomiting
conjunctivitis
pharyngitis
adenovirus
26
etiology of bacterial overgrowth
PPI
gastric surgery of small bowel
SI motility disorder
gastrocolic or coloenteric fistula
27
which organisms do you use immunoassays for
c diff
rotavirus
giardia
e histolytica
28
painless rectal bleed
diverticulosis bleed
29
whipple disease finding
PAS (+) macrohages with gram + bacilli
30
screening for lynch
colonscopy every 1-2 yrs starting at 25 or 5 yrs younger than age of youngest affect family member at diagnosis
-pelvic exam, transvag US, endometrial samp for women at 30-35
upper endoscopy every 2-3 yrs at 30-35
prophylatic hysterectomy with oophorectomy age 40 or once done childbearing
31
salmonella typhimurium
```
gram negative, non lactose fermenting, motile, rod shaped
blood diarrhea
fecal leukocytes +
eggs and poultry
reptile exposure
complications are septic arthitis, osteomyelitis
increased risk sicle cell pts
non typhoidal--> gastroenteritis
```
32
short bowel syndrome from what disease
crohns ,mesenteric infarction, radiation enertiis, volvuus, tumor resetion and trauma
33
diarrhea defined clinically
3 or more loose or watery stools/day
or
decreaes in consistency and increase in frequency of BM of individual
34
undercooked foods, lunch meat, soft cheeses
listeria
35
alcohol gels are ineffective aginast
norovirus and c dif
36
lynch syndrome inherit
auto dom
37
TD in nepal
cyclospora
38
gene mutaiton lynch
MLH1, MSH2
39
microscopic colitis presentation
```
idiotpathic or from meds
women in 50s,60s
chronic or intermittent watery diarrhea
normal mucosa on endoscopy
-histo: chronic inflammation, thickened band subep collagen
```
40
need to asks for specific labs for
c diff pcr/toxin
ova parasites
giardia and cryptosporidium stool antigen
41
fever, abdominal pain, bloody diarrhea in immunosuppresed pts under 200 CD4
CMV
42
seafood especially if raw
vibrio species mainly
43
watery diarrhea that occurs in immunocompromised host that can be found on a modified acid fast staining of the stool
cystoisorpora belli
44
MEN2A
PTH hyperplasia
Medullary throid carcinoma
pheochromocytoma
45
antimotility agents should not be used with
C diff or EHEC infection
46
pathogen typically affects large bowel presents with
frequent
small volume stools
pain in lower abd or rectum
47
adult diarrhea defined as
greater than 200g/day of stool weight
48
how do you detect norwalk
PCR
49
short bowel syndrome
removal of significant segment of SI
TI resection
bile salt and vit b12 malabsorption
B12 injectables, bile salt binding resins low fat diet, fat soluble vitamin replacement
50
autoimmune gastritis
desrution of fundic glands
achlorhydria
pronounced hypergastrinemia
hyperplasia gastric enterochromaffin like cells
development of small multicentric carcinoid tumors
51
cowden diseae
lipoma, harmartomas, and benign hair follicle tumors
| hair follicle tumor on the skin and face
52
strongyloides stercoralis
how get, where, what type parasite, what pts more susceptible, how diagnose, treat
```
bare feet on contaminated soil
roundworm
rural areas
HTLV-1 pts are more susceptible
rhabditiform larvae in stool, eosinophils in stool
```
treat: ivermectin
53
EIEC
fever, abd pain, watery bloody diarrhea with leukocytes
| dysnetery
54
diverticulitis tx
antibiotics and npo/clear liquid diet
55
protozoa that can penetrate bowel and into portal circulation and cause liver lung or brain abscess
e histolytica
56
osteoma of mandilble, skull, and long bones
-95% develop colorectal polyps (adenomatous)
supernumerary teeth
thydoid adrenal tumors
desmoid tumors
auto dom
gardner's syndrome
57
fish tapeworm, can get long (30 ft), raw/undercooked fish
diphyllobothrium latum
58
vibrio cholera
get from what
treatment
waterborne illness
raw oysters
rehydration/electrooyte replacement
59
echinococcus granulosus
what is parasite
get from what
complications
image on CT
tapeworm
unsanitary livestock slaughter especially sheep
dogs main carrier
form cysts in liver or lungs
looks like free flowing hydatid sand on CT
60
what can develop in peutz heghers syndrome
GI malignancy or breast cancer
| also gonadol or pancreati cancer
61
what kind of toxins does staph have and what type of diarrhea
preformed enterotoxins
watery diarrhea
rapid onset wtithin 6 hours
62
causes of osmotic diarrhea
mg antacids, sorbitol, lactose intolerance, laxatives
63
MEN1
pituitary adenoma
PTH hyperplasia
pancreatic tumors
64
95% of cases of colon adenocarcinoma believed to come from
| higher risk
adenomas and serrated polyps
| higher risk if over 1 cm or 1 cm
65
most common cause of chronic diarrhea
stool osmotic gap
meds
IBS
lactose intolerance
SOG = normal
66
special cultures for
EHEC
virbrio
yersinia
others
67
cyclospora cayetanensis
treament of water or food with chlorine or iodine is ____ to kill cyclospora oocysts
how detect cysts
treatment
unlikely
stool sample
trimethoprim/sulfamethoxazole
68
anaerobic toxin forming gram + bacillus
C diff
69
widal test positive with O and H antigens
salmonella typhi
70
multiple myeloma is associated with what
impaction and hypercalcemia
71
what does FIT detect
human globin
72
TD in asia
campylobacter jejuni
73
pathogen typically affects small bowel presents with
```
large volume
watery stool
abdominal cramps
weight loss
pain is mid abdomen or diffuse
```
74
whipple disesae present
fever, arthralgias, LAD
weight loss
malabsroption, chronic diarrhea
encephalitis
75
```
causes of constpiation
diet
thryoid
drug
supplement
```
inadequate fiber and fluid intake
hypothryroidism
CCB use
calcium supplementation
76
routine stool culture includes
salmonella
shigella
e coli (ask for shiga toxin)
most detect campylobacter
77
diagnosis lynch:
| besthesda criteria
CRC under 50
CRC or lynch syndrome associated tumor at any age
CRC with with one or more 1st degree relations with CRC or lynch syndrome related cancer with one of the cancers before
CRC with two or more second degree relative with CRC or lynch syndrome related cancer at any age
tumors with infiltrating lymphocytes, mucious.signet ring diff or medullary growth pattern in pts younger than 60
78
C diff description
anaerobic, gram positive, spore forming bacillus
79
vibrio vulnificus
how you get it
associated with
life threat in
```
warm shallow coastal salt water
raw shellfish (oysters)
open wound in water
bullous skin lesions
life threatening in cirrhosis pts
```
80
other risk factors for C diff
chemo
PPI
IBD
enteral tube feeding
81
protozoa that can cause toxic megacolon or pneumatosis coli
how to diagnose this infection
and treatment
e histolytica
stool antigen to diagnose
metronidazole treatment
82
watery diarrhea
| pear shaped 4 flagella 2 nuclei protozoan
giardia
83
treatment for salmonella typhi
fluorquin
ceftriaxone
azithromycin
84
profuse watery diarrhea that doesn't improve with fasing, episodes of getting hot and her face turns red
what tumor and whats elevated
carcinoid tumor secreting serotonitn
| 5-HIAA
85
most common form of TD
ETEC
86
cytoisospora belli negative stool exam then what
-treatment
duodenal specimen by biopsy
also modified acid-fast stain
treat: trimeth/sulfameth
87
sign that goes with colon ancer which is lesions all over the skin
sign of lesar-trelat
88
clostridium perfringens
toxin
diarrhea
onset
cause
preformed enterotoxin
watery diarrhea
rapid onset 8-16 hrs
beef, ham, poultry, legumes, gravy
89
lynch syndrome associated with
HNPCC
| associated with endometrial, bladder, ovarian, rneal, and SI cancer
90
MEN 2B
mucosal neuromas
marfanoid body habitus
medullary thryoid carcinoma
pheochromocytoma
91
hook worm, fecal oral transmission, can get long, can cause bowel obstruction
ascaris lumbricoides
92
cerebellar lesions
trichilemmomomas
hamartromatous polyps and lipomas
PTEN syndrome
cowden disease
93
suspect HNPCC in
personal early onset CRC
| FH CRC, or assocaited cancers
94
osmotic diarrhea
- stool sodium
- osmotic gap
low, increased
95
```
worldwide problem (africa), 2nd most common cause of esophageal varices behind alcohol in africa
get from contaminated freshwater snails
```
schistosoma mansoni
96
pt has rash on knees and elbows which is ___ associated with malabsorption disease which can lead to ___ so check with ___
dermatitis herpatitis with celiac
can lead to vitamin D deficiency
check with DEXA scan
97
```
aeromonas hydrophila
description
environment
eating what
other transmission
2 types
treatment
```
gram negative, non spore forming rod, facultatively anaerobic bacteria, motile with flagellum
fish or shellfish
wounded in fresh water or open wounds, foot and ankle most common
necrotizing faciitis aka flesh eating bacteria
- choleral like
- bloody mucoid stools
- ampicillin
98
risk factor diverticular disease of colon
older
| CT disease
99
```
c diff toxin
type of diarrhea
other risk factor
treatment
complication
```
toxin A and B (PCR to detect)
pseudomembranes
recent hospitalization, PPI use, antibiotic use
-clindamycin, cephalosporins, fluorquin risk factors
treatment: metronidazole or oral vancomycin
complication: toxic megaclon, need surgery
100
EAEC
persistent diarrhea in children
101
what do you get malabsoprtion of in whipples
ADEK
102
vibrio parahemolyticus
```
cytotoxin production
bloody diarrhea
from seafood consumption
positive fecal leukocyte
non-O1 and non O139 variants
```
103
organism that is assciated with sinus bradycardia, neutropenia, and enlarged spleen
-invades peyers patches
salmonella typhi
| -carrier state in GB
104
lactose intolerance test
hydrogen breath
105
test for bacterial overgrowth
breath test: glucose, lactulose, or C-xylose
106
most common cause of dysentery in the world
e histolytica
107
what do you lose in diarrhea
bicarb
| potassium
108
treatment for campylobacter
supportive bc self limited
109
ROME III criteria for IBS dx
ab discomfort or pain 3/days month for past 3 months with symptom onset over 6 months before diagnosis and at leas 2/3:
- relieved with defecation
- onset associated with change in frequency of stool
- onset associated with a change in form (appearance) of stool
110
blood in urine, haptoglobin decreased, hemolysing (elevated indirect bilirubin), schistocytes
HUS
111
confirmation of listeria
blood culture
112
treatment for microscopic colitis
stop offending meds, loperamide, budesonide, bile-salt binding agents or 5-ASA
113
treatment C diff
metronidazole
| vancomycin
114
motile comma shaped gram negative bacillus
cholera
115
watery diarrhea in infants under 2
| wagon wheel appearance on electron microscopy
rotavirus
116
B cererus toxin is ___
main symptom
onset
presenttation
```
preformed enterotoxin
vomiting
rapid within 6 hrs
fried race consumption
watery diarrhea
```
117
TD with Russia visit, especially st. petersburg
giardia
| also campers
118
SBS: colon and 100 cm prox jejunum preserved
oral nutrition with low fat and high complex carb diet
119
reactive arthritis following infection by
salmonella
campylobacter
shigella
yersinia
120
adenomatous colon polpys
brain tumor
CRC 100% over 40
auto dom
turcot's syndrome
121
taenia solium
pork tape worm
most asymptomatic
rare serious cases of seizures and muscle or eye disease
122
pernicious anemia from
| increase risk of
autoimmune gastritis
| increased risk of gastric adenocarcinoma
123
causes of secretory diarrhea
hormones (tumors)
laxative abuse
villous adenoma
bile salt malabsorption
124
no colon and less than 100-200 cm of prox jejunum
TPN
125
what does a medullary thyroid carcinoma secrete
calcitonin
126
toxic shock syndrome bateria most common and second most
```
staph aureus 1
strep pyogenes (group A) 2
```
127
pt had all small bowel resected except 50 cm of proximal jejunum what should be diet
TPN
| low fat if still had colon and 100 cm of jejunum
128
EPEC
infantile watery or bloody diarrhea
129
familial juvenil polyposis
hamartomatous polyposis syndrome
auto dom
>10 juvenile hamartomous polyps mainly in colon
increased risk adenocarinoma
