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Clin Med - GI > Acute Diarrhea- Piburn > Flashcards

Acute Diarrhea- Piburn Flashcards

(90 cards)

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1
Q

what are the types of diarrhea

A

decreased absorption of h20
increased intestinal secretion
increased osmotic load
abnormal motility

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2
Q

what is the most common cause of diarrhea

A

infection

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3
Q

what are high risk groups for diarrhea

A

travelers
ingesting certain foods
immunodeficiency
daycares
institutionalized
extremes of age

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4
Q

what are infectious agents that travelers are at risk for

A

campylobacter
norovirus
coronavirus
salmonella
shigella
Giardia (Beaver fever)

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5
Q

what is the most common agent seen in daycares

A

rotavirus

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6
Q

what is non-inflammatory acute diarrea

A

watery, not bloody
GI symptoms
larger volumes (+/- dehydration)
fecal leukocytes absent
small intestine

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7
Q

what is inflammatory acute diarrhea

A

blood diarrhea (dysentery)
systemic symptoms (fever) + LLQ cramping, urgency and tenesmus
small volumes
fecal leukocytes present
large intestine

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8
Q

what are non-infectious causes of acute diarrhea

A

malabsorption
Celiac, IBS, Crohn’s, UC, medications, bile acids, mesenteric ischemia

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9
Q

what are possible acute diarrhea work up tests

A

CBC, CMP
fecal leukocyte count
fecal hemoccult
stool culture - bacterial
+/- C. diff PCR
+/- viral testing, protozoal testing
+/- ova and parasite testing

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10
Q

if diarrhea persists, what are other workup tests that can be completed

A

flexible sigmoidoscopy- colonoscopy (biopsy)
Radiographs or CT scan
r/o IBD, ischemic colitis, or other non-infectious causes

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11
Q

what is the supportive treatment for acute diarrhea

A

maintain adequate oral intake
bowel rest
easy digestible foods
oral rehydration with electrolytes
anti-diarrheals

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12
Q

what is the BRAT diet

A

Banana, Rice, Apple sauce, toast

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13
Q

when is anti–diarrheal contraindicated

A

blood diarrhea, fever, systemic symptoms, persistent diarrhea
if concern for toxic megacolon

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14
Q

what criteria must be met for empiric antibiotic treatment for acute diarrhea

A

no concern for hospital acquired infection
presents of moderate to severe fever, tenesmus or bloody stools
no suspicion for E.coli - abx increase risk of HUS

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15
Q

what is the preferred abx for acute diarrhea

A

fluoroquinolone
-ciprofloxacin, ofloxacin, levofloxacin
bactrim or doxycycline

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16
Q

what is HUS

A

hemolytic uremic syndrome
blood break down, increased urea - results from blood clots, predominantly in the kidney

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17
Q

what is the criteria to admit for acute diarrhea

A

severe dehydration, especially if vomiting or unable to tolerate PO intake
severe or worsening bloody diarrhea
severe abdominal pain
severe infection or sepsis
severe or worsening diarrhea and age > 70 or immunocompromised
signs of HUS

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18
Q

what are complications of acute diarrhea

A

reactive arthritis
HUS
post infection IBS?
Precursor to Crohns, UC, celiac?

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19
Q

what are the most common viral agents for infectious diarrhea

A

norovirus and rotavirus

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20
Q

what is the leading agent causing food born illness

A

norovirus

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21
Q

what is the transmission of norovirus

A

fecal-oral route
contaminated foods and water
contaminated surfaces
person-to-person

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22
Q

what is the incubation of norovirus

A

1-3 days, average 48 hours

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23
Q

what are the symptoms of norovirus

A

nausea, vomiting, watery diarrhea, abdominal cramping
+/- fever
short duration (hours to 3 days)

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24
Q

what is the most common cause of severe gastroenteritiris in infants and kids worldwide

A

rotavirus

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25
what is the transmission of rotavirus
fecal-oral route highly contagious vaccine available
26
what is the incubation periods, duration of illness and viral course of rotavirus
incubation: 48 hours duration of illness: 5-7 days can shed virus for 10-20 days
27
what is rotavirus
double stranded RNA virus causes gut epithelial necrosis
28
what are the symptoms of rotavirus
profuse watery diarrhea + vomiting in kiddos more mild in adults non-bloody diarrhea fever in abou 50%
29
what is the treatment of rotavirus
symptomatic + vigorous hydration anti-diarrheals not recommended in kids under 5
30
what are the species of shigella
shigella dysenteriae - blood version shigella flexneri shigella sonnei shigella boydii
31
what is shigella
acid-resistant bacteria - small dose can cause disease
32
what is the transmission of shigella
fecal-oral route contaminated food and water person-to person often young children at daycare/preschool
33
what is the incubation and duration of shigella
incubation: 24 hours to 3 days duration: usually 1 week (self limited)
34
what are the symptoms of shigella
abrupt onset of watery diarrhea - typically frequent, small volume, bloody stools (NO N/V) tenesmus, fever, abdominal cramping, lethargy infects colon so severe dehyration is less likely
35
what can shigella lead to
HUS - shiga toxin
36
what is the tx of shigella
abx recommended unless mild disease fluoroquinolones recommended for adults azithromycin for those under 18yo
37
what is the #1 cause of foodborn illness in US
salmonella
38
what is the transmission of salmonella
fecal contamination of food and water undercooked food eggs, milk and other dairy products contaminated vegetables contaminated processed foods person-to-person transmission from pets
39
what is salmonella
acid-sensitive - require larger dose for infection
40
what is the incubation and duration of salmonella
incubation: 1-3 days duration: usually 2-3 days, no more than 10 days
41
where does salmonella go into
GI tract through fecal-oral contamination invades small intestines, moves into regional lymph nodes (peyer's patches)
42
what are the symptoms of salmonella
may have gradual or abrupt onset first nausea, vomiting, fever later abdominal cramps and diarrhea progresses to bloody diarrhea in some, but uncommon symptoms more sever in immunosuppressed, infants, elderly
43
what is the treatment of salmonella
supportive for most + hydration abx not routinely indicated
44
when are abx for salmonella considered
immmunosuppressed, elderly, infants and other medical comorbidities fluoroquinolones for 3-7 days
45
what is Campylobacter
acid-sensitive - requires large dose to cause disease also leading cause of foodborn illnesses
46
what is responsible for 50% of infections of campylobacter
contaminated poultry
47
what is the incubation and duration of campylobacter
incubation: avg 3 days duration: 5-9 days
48
what are the symptoms of campylobacter
abrupt onset abdominal pain and diarrhea hematochezia in 15-50% often have relapse of symptoms within few days of apparent resolution
49
how is campylobacter diagnosed
microscopy rapidly motile spiral-shaped organism are characterisitics
50
what is campylobacter associated with
guillan-carre syndrome (onset 1 week - 2 months post infection_
51
what is Vibrio
gram negative bacteria see rapid volume loss, electrylyte abnormalities
52
what is the incubation and duration of vibrio
incubation: 1-2 days duration: 3-6 days
53
what is the transmission of Vibrio parahaemolyticus
salt water reservoirs, especially in summer and fall - can live on plankton raw and undercooked seafood (oysters(
54
what are the symptoms of Vibrio parahaemolyticus
Abrupt onset of watery diarrhea +/- blood abdominal cramps, fever, +/- N/v
55
what is the treatment of Vibrio parahaemolyticus
supportive + hydration consider abx if secer or immunocompromised -doxycycline, fluoroquinolones
56
what is vibrio cholerae
endemic in asia, africa, central and south america - primarily contaminated water, most US cases are travelers produces enterotoxin - profuse watery diarrhea (RICE WATER STOOLS)
57
What are the symtpoms fo vibrio cholerae
asymptomatic to severe diarrhea fluid loss up to 1L/Hour rice-water stools can cause severe dehydration oand electolte disturbances
58
what is the treatment of vibrio cholerae
rehydration with electrolytes IV fluids abx areindicated -tetracycline, doxy, azithromycin, fluoroquinolones
59
what is Escherichia coli
E. coli 2 types: enterotoxigenic and enterohemorrhagic
60
what is the presentation of enterotoxigenic e. coli
infants and children under age 2 in developing countries traverlers in US cases few loose stools < 1day to sever watery diarrhea up to 1 week - m/c in resouse limited areas
61
what is the tx of enterotoxigenic e.coli
rehydration can consider abx -azithro or rifaximin
62
what is enterohemorrhagic e.coli
2/3 of cases are in children incubation: 3-5 days duration: few days to 2 weeks
63
what is the transmission of enterohemorrhagic e.coli
undercooked meat (esp. ground beef) contaminated vegetables and fruits contaminated water via animals person-to-person
64
what does enterohemorrhageic e.coli produce
enterotoxin - shiga toxin bloody diarrhea, TTP, HUS< hemolytic anemia
65
what are the symptoms of enterohemorrhagic e.coli
watery diarrea for 2-5 days progresses to bloody diarrhea in 90%
66
what is the treatment of enterohemorrhagic e.coli
supportive with hydration no anti-diarrheals no abx - increased risk of HSU
67
what foods are prefered by s. aureus
foods high ins urgar, or those with cream, particularly at room temp
68
what is the duration of illness of s. aureus
24 hours or less - hallmark is rapid recovery
69
what is clostridium perfringens
commonly found in soil and animal intestinal flora spore forming bacterium almost always transmitted via improperly refrigerated cooked mesats
70
what is the symtpoms of clostridium perfringens
watery diarrhea and crampy abdomonal pain
71
what is pseudomembranous colitis
classically, pt given abx - abx kills normla flora - c.diff may already be there but able to proliferate and superinfect the colon - endotoxin release -watery diarrhea colon cellular destruction pt will have severe watery diarrhea, abdominal cramping, fever, leukocytosis
72
what can pseudomembranous colitis progress into
necrosis and toxic megacolon colonic performation, sepsis, death
73
what are high risk groups for c.diff
elderly debilitated immunocompromised pt on multiple abx abx > 10 days enteral nutrition PPI use undergoing chemotherapy IBD
74
how is c.diff transmitted
fecal-oral via spores primarily person-to-person
75
what is the presentation of mild and moderate c.diff
greenish, foul smelling watery diarrhea up to 5-15 BMs per day WBC > 15,000
76
what is the presentation of sever or fulminant c. diff
greenish, foul-smelling watery diarrhea profuse, up to 30 BM per day WBC > 30,000 albumin < 2.5 g/dL elevated lactate increased serum creatinine (usu. greater than 1.5x baseline)
77
what can fulminant c. diff progress to
respiratory failure metabolic acidosis toxic megacolon colon perforation death
78
what is the workup of c. diff
screen with glutamate dehydrogenase (c. diff antigen) enzyme assay to ID toxins PCR and ID gene regulating toxin production
79
what is the treatment of c.diff
PO vancomycin 10-14 days 2nd line: metronidazole
80
what usually causes cryptosporidium
cryptosporidium hominis cryptosporidium parvum much more common in immunocompromised (esp AIDS)
81
what is the transmutation of cryptosporidium
contaminated food and water - commonly recreational water person-to-person animal-to-human
82
what is the incubation and duration of cryptosporidium
incubation: 1-14 days duration: typically 5-10 days in immunocompetent weeks to months in immunocompromised
83
what are the symptoms of cryptosporidium
watery diarrhea, abdominal cramps, malaise AIDS pts: frequent foul smelling stools, malabsorption, weight loss prone to relapse of symtpoms after apparents resolution
84
how is cryptosporidium diagnosed
negative fecal leukocytes detection in stool via acid fast stain
85
what is the treatment of cryptosporidium
supportive + hydration + anti-diarrheals no 'best' drug in literature recommended: Nitazoxanide
86
what is giardia lamblia
m/c protozoal infection in the US travelers diarrhea or contaminated water -camping and contaminated water
87
what is the incubation and duration of giardia lamblia
incubation: 1-3 weeks most recover in 3-4 weeks
88
what are symtpoms of giardia lamblia
watery diarrhea, occasiaonlly prfuse flatulence, abdominal cramping, epigastric pain, nausea some have steatorrhea and weight loss due to malabsorption
89
how is giardia lamblia diagnosed
+ stool ova and parasite +/- immunoassay to identify giardia antigens
90
what is the tx of giardia lamblia
depends on age tinidazole single dose nitrazoxanide metronidazole

Clin Med - GI (11 decks)

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