Diarrhea Flashcards Preview

Clin Med 2 > Diarrhea > Flashcards

Flashcards in Diarrhea Deck (91):
1

Most cases of infectious diarrhea are

viral

2

Most cases of viral diarrhea are

norovirus

3

Most cases of severe diarrhea are

bacterial

4

Most cases of bacterial diarrhea are

campylobacter

5

Def of diarrhea

200g/day of loose water stool; 3x in 24hrs

6

Patho diarrhea

impaired water absorption or increased water secretion by the bowel

7

dysentery

infection of the intestinem resulting in severe diarrhea with blood or mucus

8

Acute v. Persistent v. Chronic

Acute- 14days or less
Persistent- more than 14 days and less than 30 days
Chronic- more than 30 days

9

Fxn small bowel

- fluid and enzyme secreting organ
- absorbs nutrients

10

Fxn large bowel

absorb fluid and salt and excrete potassium

11

Viral causes of diarrhea

norovirus
rotavirus
adenovirus
astrovirus

12

Bacterial Causes of diarrhea

salmonella
campylobacter
shigella
enterotoxigenic
E. coli
C. diff

13

Protozoan causes of diarrhea

cryptosporidium
giardia
cyclospora
Entamoeba

14

Clinical small bowel diarrhea

watery
large volume
abdominal cramping
bloating
gas
weight loss

15

Clinical large bowel diarrhea

frequent, regular
small volume
painful bowel movement
fever
blood or mucoid
inflammatory and RBC seen on microscopy

16

Diarrhea of large bowel due to

salmonella
shigella
campylobacter
CMV
adenovirus
C. diff

17

Diarrhea of small bowel due to

salmonella
e.coli
clostridium
s. aureus
rotavirus
norovirus

18

Petting zoo bacteria

salmonella

19

Daycare bacteria

shigella
cryptosporidium
giardia

20

Recent ABX use bacteria

C. diff

21

When to do stool culture

- more than 6 unformed stools in 24hrs
- severe abdominal pain
- hospitalization
- inflammatory diarrhea (bloody diarrhea, tempt over 101)
- high risk

22

High risk features that need stool culture

over 70
comorbidities
CV disease
DM
immunocompromised
IBD
Pregnancy
Sx more than 1 week
Public health concern

23

What is fecal lactoferrin

- detect inflammation in the intestines
- detect bacterial infections that cause inflammatory diarrhea
- sensitive and specific

24

Manage diarrhea

fluid replacement
nutrition replacement- sugar, salt, water
ABX- fluoroquinolones
Antimotility agents- loperamide, pepto-bismol
Probiotics

25

Clinical norovirus

- very contagious
- acute N/V
- watery diarrhea with abdominal cramps
- sx begin in 12-48hrs

26

Transmission of norovirus

- close personal contact with infected person
- fecal-oral route with contaminated food
- touching contaminated surfaces

27

When do norovirus sx end

24-72hrs

28

MC complication of norovirus

dehydration

29

Most common nosocomial infections

C. diff

30

Clinical C. diff

- patient on ABX therapy and sx develop or 5-10days later
- watery diarrhea more than 3 movements in 24hrs

31

ABX most implicated with C.diff

Fluoroquinolones
Cephalosporins
Penicillins

32

Risk for C.diff

ABX use
recent hospitalization
advanced age

33

Patho C.diff

- common in intestine
- grows out of control--> release toxins that damage lining of intestines

34

Tx c.diff

stop ABX
clean surfaces with soap and water
Vanco or Metronidazole

35

Where is camphylobacter located?

intestinal tracts of animals, mc in poultry

36

Incubation period of camphylobacter

3 days

37

Clinical camphylobacter

abrupt onset of abdominal pain
bloody/mucoid diarrhea
fever
chills
aches
mimics appendicitis

38

Tx camphylobacter

healthy ptn: IVF, antiemetic
Severe dz or immunocompromised: Levo, Cipro or azithromycin

39

Salmonella associated with ingestion of

poultry, milk products and eggs

40

When does salmonella occur

8-72hrs after ingestion of contaminated food/water

41

Clinical salmonella

N/V
vomiting
pea soup diarrhea with a little blood
abdominal cramping
fever

42

When does salmonella sx resolve?

fever= 48-72hrs
gastroenteritis= 4-10days

43

TX salmonella

IVF replacement
electrolyte replacement
Severe diz/immuno: Cipro or Levo

44

Short term carriage

normal shedding of virus after infection; no sx but bacteria shedding

45

Long term carriage

shedding of bacteria for more than 1 year after infection; no sx but bacteria shedding

46

Special property of shigella

less susceptible to stomach acid and multiples in small bowel

47

Transmission of shigella

direct person to person and contaminated food and water
fecal oral in developed countries

48

Natural reservoir for shigella

human

49

Where is shigella common

day care centers

50

Clinical shigella

high fever
small volume diarrhea that is initially watery and then bloody and mucoid
abdominal cramping
tenesmus

51

Tx shigella

IVF
Electrolyte depletion
Severe dz/immunocompromised: Fluoroquinolone (no Cipro), Azithromycin, Bactrim

52

How long does shigella last

7 days

53

Microbiology of botulism

gram + rod shaped anaerobe

54

Special about botulism spores

heat resistant

55

How does botulism spread

vascular system

56

Botulism causes what type of syndrome

neuroparalytic

57

What is the most potent bacterial toxin

botulism

58

Botulism spread via

home canning of fruits, veggies, fish

59

Clinical botulism

sx begin 12-36hrs
N/V
Diarrhea
abdominal pain and cramping
dry mouth and sore throat
bilateral cranial nerve involvement/palsy

60

Dx botulism

serum toxin

61

TX botulism

antitoxins
abx possible- Pen G, Metronidazole

62

What does cholera cause?

profound fluid and electrolyte loss in stool and rapid progression to hypovolemic shock

63

Where does cholera affect?

- resource limited areas with inadequate clean water access
- Africa, Asia, Caribbean (MC Haiti)

64

Transmission of cholera

ingestion of contaminated food and water

65

Clinical cholera

- incubation 1-2days
- abdominal pain
- rice water stool, fishy smell
- borborygmi
- vomiting

66

Dx cholera

stool culture and rapid dipstick

67

Tx cholera

Aggressive volume depletion
ABX for moderate/severe depletion- macrolides, Fluoroquinolones, tetracyclines

68

Prevention of cholera

- clean water with sanitation
- oral cholera vaccines

69

MC cause of intestinal entomoeba

E. histolytica

70

Increased risk of intestinal entomoeba

institutional patients and MSM

71

Infection of intestinal entomoeba due to

ingestion of amebic cysts via contaminated food and water

72

Clinical intestinal entomoeba

Onset 1-3days
Asymptomatic
Mild diarrhea to severe dysentery
Abdominal pain
Weight loss
Fever

73

Complication of intestinal entomoeba

fulminant colitis with bowel necrosis leading to perforation and peritonitis

74

Tx intestinal entomoeba

Metronidazole
Tinidazole
Ornidazole

75

What is the most common parasitic cause of acute foodborne diarrhea in US

Cryptosporidium

76

Transmission of Cryptosporidium

infected person or animal
fecally contaminated food/water

77

Tx Cryptosporidium

Antiparasitic meds- Nitazoxanide

78

What is a common cause of waterborne and foodborne diarrhea in daycare center outbreaks

Giardia

79

Tx giardia

Metronidazole
Tinidazole
Nitazoxanide

80

Def travelers diarrhea

diarrhea develops during or within 10 days of returning from travel

81

MC organism in travelers diarrhea

E. coli

82

MC organism in travelers diarrhea in SE Asia

Campylobacter

83

MC organism in travelers diarrhea in Jamaica

Rotavirus

84

Countries with highest risk of travelers diarrhea

India, Nepal, W./C. Africa

85

Prevent travelers diarrhea

Bottle only water
Food thoroughly cooked
Pasteurized dairy products

86

Tx travelers diarrhea

Cipro and Levo

87

Clinical travelers diarrhea

- patient comes back from trip 5 days ago
- malaise
-anorexia
-abdominal cramps
- watery diarrhea

88

When to use oral or IV fluids

Oral is best for diarrhea
IVF in severe dehydration- normal saline or ringers lactate (best due to electrolytes) (200mL/kg body weight)
Want fluids with water, salt and sugar

89

Who shouldn't take antimotility meds

protozoan and parasitic patients

90

How does loperamide work

slow down gut motility, decrease number of stool and diarrhea less watery

91

When to use bile acid sequesters

- patients with persistent diarrhea despite antidiarrheal use
- cholestyramine, colestipole, colesevelum