CPS: Diarrhea and C. Difficile Flashcards

1
Q

define diarhea

A

stool measuring over 300 grams per day sometimes decreased consistency

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2
Q

if you have diarrhea for longer than 3 weeks, then its considered to be:

A

chronic diarrhea

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3
Q

most common functional disorder for diarrhea

A

IBS

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4
Q

does C Dif produce bloody or non bloody diarrhea

A

usually non bloody

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5
Q

important aspects of physical exam for diarrhea

A

temperature, signs of dehydration, abdominal exam for signs of peritonitis and tenderness–> some bacteria can cause toxic megacolon, rectal exam

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6
Q

investigative tests for acute diarrhea

A

CBC with urea, bytes, creatinine stool test- parasites, cultures, CDiff 3 views of abdomen sigmoidoscopy if available

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7
Q

6 bacteria tested during stool test

A
  1. campylobacter 2. e coli 3. salmonella 4. shigella 5. yersinia 6. C diff.
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8
Q

alternative dx for bloody diarrhea if there’s no bacteria in culture

A

ischemic colitis

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9
Q

how to diagnose cdif

A

liquid stool only. done through PCR and toxin A and B testing (Elsa) stool cultures are not specific for CDI

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10
Q

hypervirulent Cdiff

A

a hardcore Cdif strain that has a deletion of tcdC- which usually down regulates toxin production. Causes greater toxin A and B production

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11
Q

preventing CDI

A
  1. wash with soap and water - avoid empiric BSA antibiotic use 3. probiotics is controversial 4. avoid/discontinue PPI 5. use disinfection with chlorine-based disinfectants
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12
Q

treatment for mild CDI

A

1st line: vancomycin PO QID alternatives: fidaxomicin, metronidazole

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13
Q

treatment for severe CDI but uncomplicated

A

both vancomycin QID and fidaxomicin BID

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14
Q

treatment for severe and complicated CDI

A

vancomycin NG, enema, metronidazole IV

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15
Q

treatment for 1st, 2nd and 3rd reoccurrence od Cdif

A

1st. vancomycin QID OR fidaxomicin BID 2nd. vancomycin 3xdaily for 7 days, BID for 7x, then OD x 7days, and then every second /third day for 2-8 weeks 3. fecal microbiota transplant.

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16
Q

why is vancomycin better than metronidazole better for treating CDif?

A

because vancomycin stays in the lumen of the intestine and kills the Cdif in the gut. metronidazole gets absorbed fast into the bile and then blood and gets excreted. good for UTI or systemic infection or for toxic mega colon.

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17
Q

4 ways to have fecal transplant

A
  1. capsules 2. NG tube 3. colonoscope and shoot it into colon. 4. enema
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18
Q

what must you do prior to fecal translant

A

must test for hepatitis C and other fecal-oral diseases.

19
Q

which antibiotics for toxic megacolon

A

IV metronadazole, oral vancomycin

20
Q

positive Cdif

A

vancomycin

21
Q

positive culture but negative Cdif, non bloody diarrhea

A

oral hydration

22
Q

stable signs, but bloody diarrhea

A

oral rehydration. you can’t give antibiotics all the time– you can contract Cdiff if you give antibiotics. Therefore, only give Vancomycin if there is Cdif, or metronidazole if toxic megacolon

23
Q

difference in amount of diarrhea in someone will small bowel vs large bowel disease

A

small bowel– LOTS of diarrhea large bowel – not as much

24
Q

if someone has chronic diarrhea with high frequency bms, disease of ____ bowel should be sustpected

A

LARGE bowel

25
Q

if someone has chronic diarrhea with bleeding symptoms, disease of ___ bowel should be suspected

A

LARGE bowel

26
Q

if someone has chronic diarrhea with periumbilical pain, disease of ___ bowel should be usspected

A

SMALL bowel. large bowel presents with lower quandrant pain

27
Q

if someone has chronic diarrhea with steatorrhea, disease of ____ bowel should be suspected

A

SMALL bowel. also would affect some nutrition because you’re not absorbing the fat, hence fat in the poop

28
Q

if someone has chronic diarrhea with weightless, disease of ___ bowel should be suspected

A

SMALL bowel. if nutrition and absorption is compromised, you’d lose weight

29
Q

if someone has chronic diarrhea with rectal symptoms and tenesmus, disease of ___ bowels mould be suspected

A

LARGE bowel.

30
Q

if someone has chronic diarrhea with has decreased diarrhea if they fast, disease of the ___ bowels should be suspected

A

SMALL bowel. if fasting doesn’t help with diarrhea symptoms, consider large bowel disease

31
Q

if if someone has chronic diarrhea with nutritional deficiencies, disease of the ___ bowels should be suspected.

A

small bowel. this is the site of absorbing. if there is disease and small bowel integrity is compromised, there would be nutritional defieicneis like B12 def, folate def etc.

32
Q

in chronic diarrhea, what tests to run in ALL Cases (small and large bowel diseases)

A
  1. CBC + Cdiff, urea, lytes, creatinine 2. stool for O and P (leukocytes)–ova and parasites 3. 72 hour stool collection– if comes back at 500 grams of stool, there’s no diarrhea. because diarrhea is defined as 300 grams per day. If you have steattorhea without profuse diarrhea, then it might be PANCREAS related
33
Q

in chronic diarrhea what tests to run in SMALL BOWEL suspect

A

small bowel biopsies CT/MR enterography 72 hour stool for fat- if steatorrhea, consider pancreatic investigations. - blood work: ferritin, B12, RBC folate, albumin, calcium, INR

34
Q

in chronic diarrhea what tests to run in LARGE BOWEL suspect

A
  1. colonoscopy 2. if non-bloody, do random biopsies (right colon, for microscopic or collagenous colitis)
35
Q

2 types of watery chronic diarrhea

A
  1. secretory: secretory toxins and excess bile acids enter the colon. LARGE VOLUME EVEN WHEN FASTING 2. osmotic: maldigestion/malabsorption. Tons of poorly absorbed ions (ex/ from lactulose or PEG) draws water out from body into lumen of colon.
36
Q

what type of diet can increase osmotic diarrhea

A

FODMAPS. Can cause IBS-D. gotta have a low-FODMAP diet.

37
Q

causes of fatty diarrhea

A

maldigestion or malabsorption causes

maldigestion: pancreatic insufficency– not enough lipase. OR chronic pancreatitis – decrease lipase
malabsorption: mucosa integrity decrease – crohns, ulcerative colitis. OR a hepatobiliary problem – can’t absorb because no bile or cholestasis

38
Q

causes of dysmotility

A

 Functional – most common, IBS/D

 Diabetes – autonomic nervous system dysfunction

 Hyperthyroidism

 Carcinoid tumor

if there’s rapid motility: then theres malabsorption

if there’s too slow motility: bacterial overgrowth or fat malabsorption.

39
Q

colitis vs enteritis

A

colitis: inflammation and ulceration disrupt mucosal integrety of large bowel. Would see bleeding mucus and pus
enteritis: deranged mucosa usually in small bowel. Impaired carb and electrolyte absorption.

40
Q

common causes of inflammatory chronic diarrhea

A
41
Q

epidemiology and etiology of chronic diarrhea in developed and developing countries

A

developed: major (IBS), IBD, malabsorption (lactose intolerance)

developing countries: BUGS

42
Q

A person previously on ciprofloxacin for a UTI comes in with abdominal cramping and diarrhea (non-bloody). they feel urgency and no one else in their family has it. They tested positive for Cdif culture.

CT was done and thumbprinting was seen– waht does this indicate?

biospy of colon was done and this was seen:– what does this indicate? Dx?

A

Mucopurulent exudate forming a layer (pseudomembrane) on the surface of the mucosa.

this is pseudomembranous colitis

thurmbprinting indicates an inflammation–ischemic, UC, pseudomembranous, micropscopic colitis etc.

43
Q

how woudl you treat C dif

A

vancomycin, if it’s second time consider also using metronidazole