B2-051 - Big Case Stomach Pain

Question 1

diarrhea is defined by

Answer 1

3 or more loos/watery stools per day, change from normal bowel habits, usually >200/day

Question 2

What is dysentery

Answer 2

diarrhea with blood

Question 3

What is gastroenteritis

Answer 3

infection of the GI tract by bacteria, viruses, parasites

Question 4

what are improvements in diarrhea mortality due to?

Answer 4

Improved case management - oral rehydration and nutrition

also rotavirus vaccination

Question 5

what are the adverse outcomes from recurrent or persistent diarrhea

Answer 5

1. malnutrition
2. micronutrient deficiency
3. developmental delayas

Question 6

how is diarrhea spread

Answer 6

person to person

contaminated food or water

Question 7

what classifies acute diarrhe

Answer 7

less than two weeks

Question 8

what constitutes chronic diarrhea

Answer 8

more than two weeks

Question 9

what are the mechanisms of diarrhea

Answer 9

1. secretory
2. osmotic
3. malabsorptive
4. exudative/inflammatory

Question 10

in intestinal fluid absorption sodium coupled transport aids in absorption of what

Answer 10

1. glucose
2. galactose
3. amino acids
4. oligopeptides
5. water (passively)

Question 11

what are Na+/H+ exchangers important for absorbing?

Answer 11

electrolytes and other solutes

Question 12

chloride channels in small bowel along crypts do what?

Answer 12

part of secretion. Na+ and water follows Cl- into lumen

Question 13

in the colon what kinds of secretion channels are there

Answer 13

Cl-/HCO3- as well as Na+ and H+ exchangers

Question 14

what is paracellular transport?

Answer 14

Part of absorption, passive solute transport across enterocyte membrane

Question 15

What factors affect intestinal motility?

Answer 15

Innervation and neural control, hormonal and local factors

Question 16

What are 3 other things that affect diarrheal pathophysiology

Answer 16

hepatobilliary function, pancreatic function and dietary content

Question 17

secretory diarrhea causes increased water secretion how

Answer 17

activation of the Cl- channels

Question 18

what are causes of increased activation of Cl- channels

Answer 18

1. Toxins
2. Serotonin and enteric nervous system
3. inflammatory mediators

Question 19

what happens to sodium during secretory diarrhea

Answer 19

decreased Na+ and water reabsorption

Question 20

is secretory diarrhea aided by changing diet?

Answer 20

no, its isotonic loss of fluid and electrolytes.

Low stool osmotic gap which would persist even during fasting

Question 21

Osmotic diarrhea is characterized by what

Answer 21

increased osmotic pressure due to non absorbed solutes

water is pulled in to lumen

high stool osmotic gap, abates during fasting

Question 22

what is malabsorptive diarrhea caused by

Answer 22

faulure of nutrient absorption

steatorrhea

Question 23

inflammatory/ exudative diarrhea is caused by what

Answer 23

its multifactorial,
fecal leukocytes and it persists during fasting
dysentery is typical

Question 24

in acute diarrhea what are the types of infections causes

Answer 24

viral, bacterial, parasitic

Question 25

What are examples of viral infections that cause diarrhea

Answer 25

rotavirus, calicivirus, norovirus, enterovirus, astrovirus

Question 26

what are examples of bacterial infections that cause acute diarrhea

Answer 26

salmonella, campylobacter, E. Coli, shigella, yersinia, clostridium, difficile, vibrio

Question 27

what are examples of parasitic causes of acute diarrhea

Answer 27

entamoeba, giardia, cryptosporidium, isospora

Question 28

what causes of non infections acute diarrhea?

Answer 28

drugs, food allergies, extra intestinal infections, surgical conditions

Question 29

what is infussusception

Answer 29

when there is something blocking mechanically the colon during peristalsis and it "telescopes" in on itself

Question 30

what is the most common cause of diarrhea

Answer 30

infectious

Question 31

what is the most common cause of acute gastroenteritis in the US

Answer 31

norovirus

Question 32

what is norovirus

Answer 32

ssRNA virus of caliciviridae family

Question 33

what are symptoms of norovirus

Answer 33

nausea, vomiting, watery diarrhea, abdominal pain

Question 34

compare norovirus clearing activity in immunocompromised people and non immunocompromised people

Answer 34

immunocompetent - self limited | Immunocompromised - may lead to intermittent diarrhea with nutritional disturbances if not cleared

Question 35

what is rotovirus

Answer 35

dsRNA virus, encapsulated

Question 36

what is distinctive about rotavirus in newborns

Answer 36

newborns have protection from maternal antibodies for first 6 months of life

Question 37

what can happen with persistent rotovirus?

Answer 37

destruction of mature enterocytes with loss of absorptive surface

Question 38

what is salmonella

Answer 38

gran negative bacilli in enterobacteriacea family

Question 39

what is salmonellosis caused by

Answer 39

contaminated food, particularly poultry, eggs

Question 40

salmonellosis can cause severe illness in what groups

Answer 40

immunocompromised patients and sickle cell disease, cancer

Question 41

what is campylobacter

Answer 41

common cause of travelers diarrhea.,

Question 42

what is shigella

Answer 42

gram negative bacilli in enterobacteriacea family

Question 43

what is noteworthy about shigella

Answer 43

it can lead to formation of ulcers

Question 44

what does shigella present with

Answer 44

dysytery

Question 45

what is vibrio cholerae

Answer 45

cholera, non invasive but produces cholera toxin

Question 46

what does cholera do

Answer 46

opens chloride channels

Question 47

what is key to recovery in patients with cholera

Answer 47

rehydration orally

Question 48

what is E. coli

Answer 48

normal part of GI flora, most are non pathogenica

Question 49

pathogenic strains of E. coli

Answer 49

ETEC, EPEC, EHEC, EIEC, EAEC

Question 50

EHEC

Answer 50

has a resivoir in cows so easily spread through beef or manure

Question 51

EHEC presents as

Answer 51

diarrhea, dysentery, fever, abdominal pain

Question 52

do you treat EHEC with antibiotics?

Answer 52

NOOOOO, killing bacteria increases toxin and risk of HUS and its usually self limited

Question 53

What is pseudomembranous colitis

Answer 53

antibiotic associated, usually due to Clostridium difficile

Question 54

what does antibiotic associated clostridium difficile mean?

Answer 54

its a normal part of our gut fauna but when antibiotics are administered it can kill other types of bacteria which allows it to overgrow

Question 55

C difficile treatment

Answer 55

fecal transplant

Question 56

what are some parasites that can cause diarrhea

Answer 56

giardia, cryptosporidium, entamoeba

Question 57

where do you find cryptosporidium and what problems does it present with regards to preventing it

Answer 57

water borne, spores are resistant to chlorine so it can spread through pools

Question 58

what is the most host dependent factor that affects how a virus/bacterial infection can present

Answer 58

state of immune system

Question 59

what is HUS?

Answer 59

Hemolytic uremic syndrome

Question 60

what is HUS characterized by?

Answer 60

microangiopathic hemolytic anemia - destruction of RBCs thrombocytopenia - decrease in platelets renal injury prodromal diarrheal illness

Question 61

HUS is in 5-15% of cases of what

Answer 61

gastroenteritis due to Shiga-toxin producing EHEC

Question 62

Management of HUS includes what

Answer 62

renal support, hydration, RBC transfusions