Diarrhea

Question 1

What time frame is considered acute diarrhea

Answer 1

14 days

Question 2

What time frame is considered chronic diarrhea

Answer 2

4+ weeks

Question 3

What is severe acute diarrhea

Answer 3

4+ stools/day with systemic symptoms

Question 4

What is the second leading cause of death in children <5

Answer 4

acute diarrhea because of dehydration

Question 5

What are some high risk groups for acute diarrhea

Answer 5

travelers
immunodeficient
daycares
Extremes of age (<5, >65)

Question 6

Characteristics of non-inflammatory diarrhea

Answer 6

watery, non bloody
GI symptoms only
larger volumes
no fecal leukocytes
small intestine

Question 7

What are characteristics of inflammatory diarrhea

Answer 7

bloody diarrhea
systemic symptoms + tenesmus
small volume
fecal leukocytes
large intestine

Question 8

what are reasons for non-infectious diarrhea

Answer 8

malabsorption
celiac, crohns, UC
medications
bile acids
mesenteric ischemia

Question 9

What are the indications for workup of acute diarrhea

Answer 9

signs of inflammation
profuse watery diarrhea
immunocompromised
>70y/o or SNF
recent abx use
systemic illness
>7-14 days of sx
no improvement over 48 hours

Question 10

Which patients should you order ova/parasite testing in a stool sample

Answer 10

diarrhea in people who have traveled, have symptoms >1 week, or drank untreated water

Question 11

If testing for parasites with acute diarrhea, which infections are we looking for

Answer 11

giardia
crytosporidium
E. Hystolytica

Question 12

If diarrhea persists after treatment, how do you work a patient up

Answer 12

flexible sigmoidoscopy +/- colonoscopy with a bx

Question 13

When are anti-diarrheals contraindicated

Answer 13

bloody diarrhea
fever
systemic symptoms
persistent diarrhea

Question 14

What are the preferred empiric abx treatment for diarrhea

Answer 14

fluoroquinolone (Cipro or levo)
1-3 day course

*travelers diarrhea: ryfamixin or azithromycin

Question 15

What are complications of acute diarrhea

Answer 15

reactive arthritis
hemolytic uremic syndrome
post infectious IBS
precursor to crohns or celiac

Question 16

What are the primary causes of viral infectious diarrhea

Answer 16

primarily norovirus / rotavirus

Question 17

What is the leading cause of food borne illness

Answer 17

norovirus

Question 18

What is the typically duration of norovirus

Answer 18

hours to 3 days

Question 19

What is the m/c cause of severe gastroenteritis in infants and kids

Answer 19

rotavirus
*vaccine now present

Question 20

When is rotavirus more common

Answer 20

in winter

Question 21

Who generally gets Shigella

Answer 21

young children at daycare/preschool

Question 22

What is the presentation of shigella

Answer 22

small, frequent, bloody stools

*infects the colon so severe diarrhea is less likely

*+fecal leukocytes

Question 23

What may shigella lead to

Answer 23

hemolytic uremic syndrome (Dysenteriae)
*shiga toxin

Question 24

How do you treat shigella

Answer 24

fluoroquinalones
*azithromycin if younger than 18

Question 25

What is the #1 cause of food borne illness in the US

Answer 25

Salmonella

Question 26

Where does salmonella come from

Answer 26

eggs milk other dairy products

Question 27

Where is the GI tract typically effect

Answer 27

small intestine *LOVES Peyers patches

Question 28

What are the symptoms associated with salmonella

Answer 28

N/V, fever that turns into abd. cramps and diarrhea

Question 29

How do you treat salmonella

Answer 29

fluoroquinalones 3-7 days

Question 30

What is the most common source for campylobacter

Answer 30

contaminated poultry

Question 31

What are the symptoms of campylobacter

Answer 31

abrupt onset of abdominal pain and diarrhea *often have a relapse of symptoms within a few days of apparent resolution

Question 32

What are the characteristic organisms for campylobacter

Answer 32

rapidly-motile spiral shaped organisms

Question 33

How do you treat campylobacter

Answer 33

3-5 days of azithromycin

Question 34

What is C. Jejuni associated with

Answer 34

Gullian- Barre

Question 35

What is seen with vibrio (cholera)

Answer 35

rapid volume loss and electrolyte abnormalities

Question 36

What is vibrio parahaemolyticus typically found

Answer 36

salt water reservoirs, especially in summer and fall *raw and undercooked seafood

Question 37

Who do you treat with vibrio parahaemolyticus and what is used

Answer 37

severe illness / immunocompromised doxy/fluoroquinalones

Question 38

Where is cholera found

Answer 38

asia, africa, central/South America *most US cases are from travelers

Question 39

What are the symptoms for cholera

Answer 39

profuse watery diarrhea, usually abrupt onset from enterotoxin *rice water stools

Question 40

How do you treat cholera

Answer 40

tetracycline, doxy, azithro, cipro *can use empirically for endemics

Question 41

How do enterotoxigenic E. coli adhere to the GI tract

Answer 41

fimbriae

Question 42

What are the symptoms of enterotoxigenic E. coli

Answer 42

loose stools or severe diarrhea up to 1 week *m/c in resource limited area

Question 43

How is enterotoxigenic E. coli clinically diagnosed

Answer 43

neg fecal leukocytes neg routine stool culture

Question 44

What is the mainstay tx of entertoxigenic E. coli

Answer 44

rehydration

Question 45

How is enterohemorrhagic E. Coli

Answer 45

undercooked meat, especially ground beef

Question 46

What type of toxin does enterohemorrhagic E. coli create

Answer 46

shiga toxin which leads to bloody diarrhea, TTP, HUS, and hemolytic anemia *most often progress to bloody diarrhea

Question 47

What can you NOT give those with enterohemorrhagic E. coli

Answer 47

antidiarrheals antibiotics (increase risk for HUS

Question 48

What is a common cause of food poisoning

Answer 48

Staph Aureus

Question 49

Where is S. Aureus generally found in relation to food

Answer 49

high in sugar, those with cream, and all particularly at room temp

Question 50

How long does food poisoning typically last

Answer 50

24 hours or less

Question 51

What is clostridium perfringes

Answer 51

spore forming bacterium found in soil and animal intestinal flora

Question 52

How id C. Perfringes transmitted

Answer 52

via improperly refrigerated cooked meats

Question 53

What is the most common antibiotic associated diarrhea

Answer 53

antibiotic diarrhea *not C. Diff

Question 54

Which abx can lead to C. Diff

Answer 54

clindamycin ampicillin amoxicillin cephalosporin fluoroquinolone

Question 55

What are the symptoms of pseudomembranous colitis

Answer 55

severe watery diarrhea, abdominal cramping, fever, leukocytosis

Question 56

If someone with pseudomembranous colitis has watery diarrhea, what toxin do they have

Answer 56

toxin A

Question 57

What toxin causes colon cellular destruction with pseudomembranous colitis

Answer 57

toxin B

Question 58

What is occurring to the bowel underneath the pseudomembranes

Answer 58

mucosa will be necrotic

Question 59

What can pseudomembranous colitis lead to

Answer 59

toxic megacolon

Question 60

How is C.Diff transmitted

Answer 60

fecal-oral via spores

Question 61

What symptoms will someone with C. Diff have

Answer 61

greenish, foul smelling, watery-diarrhea *up to 5-15 BMs per day

Question 62

What will be seen in labs with severe fulminant C. Diff

Answer 62

WBC >30k Albumin <2.5 Elevated lactate increase serum creatinine

Question 63

What can fulminant C diff progress to

Answer 63

respiratory failure metabolic acidosis toxic megacolon colon perf death

Question 64

How do you screen for C. Diff

Answer 64

glutamate dehydrogenase (C. diff antigen)

Question 65

What is the hallmark for severe C. Diff

Answer 65

pseudomembranous colitis

Question 66

How do you treat C. Diff

Answer 66

PO Vanco

Question 67

Who is cryptosporidium typically seen in

Answer 67

generally immunocompromised (AIDS)

Question 68

Where does cryptosporidium come from

Answer 68

contaminated food/water *commonly recreational water

Question 69

What are the symptoms for cryptosporidium

Answer 69

watery diarrhea abdominal cramps malaise **In AIDS patients: frequent foul smelling stool, malabsorption, weightloss

Question 70

How do you detect cryptosporidium

Answer 70

Acid fast stain *must test min of 3 specimens to improve the yield

Question 71

How do you treat cryptosporidium

Answer 71

supportive tx, anti-diarrheal- hydration

Question 72

How can you prevent cryptosporidium

Answer 72

boil water x 1 min water filtration avoidance of high risk lakes/streams

Question 73

Where is Giardia most commonly seen

Answer 73

with camping and contaminated water

Question 74

What are the symptoms of Giardia

Answer 74

watery diarrhea flatulence abd. cramping epigastric pain nausea

Question 75

How do you diagnose Giardia

Answer 75

+stool ova and parasites *to increase yield of results, obtain samples at different times