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Diarrhea Flashcards

(45 cards)

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1
Q

What are the two preferred drugs for treatment of Campylobacter jejuni?

A
  • Quinolones (Ciprofloxacin)
    • Inhibits DNA gyrase and/or topoisomerase IV
  • Azithromycin, erythromycin
    • Binds 50S ribosomal subunit, blocking mRNA translocation
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2
Q

What are some potential alternatives for treatment of Campylobacter?

A
  • Gentamicin
  • Carbapenem
  • Tetracycline
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3
Q

Among the macrolides, what differences might provide an advantage for azithromycin vs. erythromycin?

A
  • Erythromycin
    • Pro-kinetic agent
    • Risk for arrhythmias, cardiac arrest
    • Drug interactions, CYP3A inhibitor
    • More frequent dosing
  • Azithromycin
    • Lower incidence of GI effects
    • Lower incidence of cardiac effects
    • Few drug interactions
    • Less frequent dosing
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4
Q

Salmonella (non-typhi) & Shigella

What are the basic properties of these bugs?

What are the implications for drug resistance?

A
  • Gram-negative rods
  • Facultative anaerobes
  • Members of the Enterobacteriaceae family
  • ß-lactamase (often transmissable) has become quite common in this family
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5
Q

What are the approved drugs for Shigella & Salmonella?

A
  • Ampicillin (both)
  • TMP/SMX (Shigella)
  • Ciprofloxacin (both)
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6
Q

What are the drugs used for Shigella & Salmonella?

A
  • Ciprofloxacin
  • Ceftriaxone
  • Azithromycin
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7
Q

Why does prophylactic antibiotic therapy increase the risk for contracting Salmonella & other enteric infections?

A

It suppresses the normal flora

  • GI normal flora is an important barrier to infection with enteric pathogens including Salmonella
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8
Q

What drugs are FDA-approved for C. difficile?

A
  • Vancomycin
  • Fidaxomicin
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9
Q

________ is a common accepted therapy for C. difficile, but is not formally FDA-approved for this use.

A

Metronidazole

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10
Q

Mutations in RNA polymerase ß (rpoB) could result in decreased sensitivity to ________.

A

Fidaxomicin

  • Macrocyclic that blocks formation of RNA polymerase open promoter complex
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11
Q

Describe Metronidazole resistance in C. difficile

A
  • Often transient
  • Lost in storage
  • After freeze/thaw
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12
Q

Which drug for C. difficile has the narrowest spectrum of antibiotic activity?

A

Fidaxomicin

  • Primarily Clostridium only
  • Some effects on Peptostreptococcus
  • No effects on other gram positives or negatives
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13
Q

What are the possible contributors to lower recurrence of C. difficile with fidaxomicin than vancomycin?

A
  • Less disruption of normal flora
  • cidal (time-dependent) vs. static effect of vancomycin on C. difficile
  • Fidaxomycin has an active metabolite OP-1118
  • Fidaxomycin has post-antibiotic effect (6-10 hr)
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14
Q

When using oral vancomycin for treating C. difficile, which drug side effects would you expect?

A

Nausea, abdominal pain

  • Oral vancomycin is very poorly absorbed
  • Maintains high colonic concentrations
  • Less likely to get systemic side effects (red man, ototoxicity, nephrotoxicity) w/ oral dosing
  • IV - phlebitis
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15
Q

For patients unable to take oral drugs, what can be given IV for treating C. difficile?

A

Metronidazole

*IV vancomycin has no effect on C. diff enterocolitis

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16
Q

C. difficile spores germinate in the ____________ upon exposure to bile acids.

_________ facilitate C. difficile movement

C. difficile multiplies in the _____

A

small bowel

flagellae

colon

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17
Q

The most common cause of infectious diarrhea in children is _______.

A

Viral

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18
Q

True/False

Gatorade is adequate for severely ill patients

A

FALSE

  • WHO recommends
    • 3.5 g NaCl
    • 2.9 g trisodium citrate or 2.5 g Na2CO3
    • 1.5 g KCl
    • 20 g glucose or 40 g sucrose
    • 1 L of water
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19
Q

Constipation is a very common problem with _____ use.

20
Q

afebrile

fluid overload

scleral icterus

petechial rash on LE

bilateral LE edema to ankle

E. coli O157:H7

Study These Flashcards
A

Hemolytic Uremic Syndrome

21
Q

Hemolytic Uremic Syndomre after antibiotics

Study These Flashcards
A

Enterohemorrhagic E. coli (O157/H7)

22
Q

Traveler’s diarrhea & post-infectious IBS

Study These Flashcards
A

Enterotoxigenic E. coli

23
Q

Guillain Barre Syndrome

Crohn’s Mimic

Pseudoappendicitis

Study These Flashcards
A

Campylobacter

24
Q

Pet turtles

Osteomyelitis in sickle cell/asplenic patients

25
Day care/institutions HUS, but less common Seizures Reactive arthritis
**Shigella** | (S. dysenteriae for HUS)
26
Shellfish contamination
**Vibrio cholerae**
27
Most common cause of C. difficile worldwide Cruise ships
**Norovirus**
28
Most common pediatric cause of C. difficile
**Rotavirus**
29
When should you order a stool culture?
* Severly ill * Outbreaks * Require hospitalization * Immunocompromised patients (HIV) * Patients w/ co-morbidities (IBD) * Some employees, such as food handlers or daycare providers, may require negative stool cultures to return to work
30
What empiric antibiotics are used to treat Traveler's Diarrhea?
* Moderate-severe * Fluoroquinolone or TMP-SMX
31
What are the indications for empiric antibiotics?
* \>8 stools/day * Volume depletion * Symptoms \>1 wk * Hospitalize patients * Immunocompromised hosts
32
When should anti-motility agents be used? What are some examples?
* ONLY if fever is absent & stools not bloody * Bacterial translocation * C. diff --\> toxic megacolon * Loperamide or diphenoxylate
33
What is **osmotic** diarrhea?
* Neither the small intestine nor the colon can maintain an osmotic gradient * Unabsorbed ions remain in the lumen * Retain water * Maintain intraluminal osmolality (290 mOsm/kg)
34
What can cause **osmotic** diarrhea?
* Ingestion of poorly absorbed ions or sugars or sugar alcohols * Mannitol, sorbitol * Magnesium, sulfate, phosphate * Disaccharidase deficiency will prevent absorption (lactose intolerance)
35
How does osmotic diarrhea present _clinically_ compared to secretory diarrhea?
* **Osmotic diarrhea disappears with fasting or cessation of the offending substance** * Electrolye absorption is not impaired in osmotic diarrhea
36
What are the causes of **secretory** diarrhea? What is the most common cause?
* Either net secretion of anions (Cl or H2CO3) or inhibition of net Na absorption * The most common cause is **infection** * Enterotoxins * Interact w/ receptors & modulate intestinal transport * Block specific absorptive pathways, in addition to stimulating secretion * Inhibit Na/H exchange in the small intestine & colon * Peptides produced by endocrine tumors
37
What is the osmotic gap?
**Osmotic gap = serum Osm - Est stool Osm** 2 x (Na + K) ~ 290 mmol/L small osmotic gap \<50 gap \>100 indicates osmotic diarrhea
38
What is the clinical presentation of "classic Celiac Disease"?
Diarrhea, bloating, abdominal pain & weight loss
39
"Atypical" Celiac Sprue
* Iron Deficiency * Osteoporosis * Dermatitis Herpetiformis * IBS * DM type 1 * Elevated LFTs
40
Where is folate absorbed? Where are the fat-soluble vitamins absorbed? Where is vitamin B12 absorbed?
* Folate & DAKE * Duodenum & jejunum * Vitamin B12 * Ileum
41
What is the non-GI presentation of Celiac Disease?
* Unexplained iron-deficiency anemia * Folic acid or VitB12 deficiency * Reduced serum albumin * Unexplained elevated LFTs * Other autoimmune disorders * _Type 1 DM_ * _Thyroid disfunction_ * Addison disease * Primary Biliary Cirrhosis * Sjogren's disease * Autoimmune hepatitis * Down syndrome & Turner syndrome * Selective IgA deficiency
42
All newly diagnosed Celiac Disease patients should have a \_\_\_\_\_\_\_\_\_\_.
bone density
43
What are the malignant complications of Celiac Disease?
* Enteropathy Associated T-cell Lymphoma * High-grade T-cell NHL * 5 yr survival ~10% * 20X more in CD * Risk normal on GFD
44
What is the most clinically useful serology for CD? What is seen on small intestinal biopsy?
* **IgA Tissue Transglutaminase (tTG)** * "scalloping" or "notching" of the folds * Small intestinal villous atrophy, intraepithelial lymphocytosis & crypt hyperplasia
45
What does a gluten free diet consists of?
Avoid all foods containing wheat, rye & barley gluten Avoid malt

Symptoms (17 decks)

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