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Diarrhea Flashcards

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1
Q

Most cases of infectious diarrhea are

A

viral

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2
Q

Most cases of viral diarrhea are

A

norovirus

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3
Q

Most cases of severe diarrhea are

A

bacterial

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4
Q

Most cases of bacterial diarrhea are

A

campylobacter

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5
Q

Def of diarrhea

A

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

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6
Q

Patho diarrhea

A

impaired water absorption or increased water secretion by the bowel

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7
Q

dysentery

A

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

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8
Q

Acute v. Persistent v. Chronic

A

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

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9
Q

Fxn small bowel

A
  • fluid and enzyme secreting organ

- absorbs nutrients

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10
Q

Fxn large bowel

A

absorb fluid and salt and excrete potassium

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11
Q

Viral causes of diarrhea

A

norovirus
rotavirus
adenovirus
astrovirus

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12
Q

Bacterial Causes of diarrhea

A 
salmonella
campylobacter
shigella
enterotoxigenic
E. coli
C. diff
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13
Q

Protozoan causes of diarrhea

A

cryptosporidium
giardia
cyclospora
Entamoeba

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14
Q

Clinical small bowel diarrhea

A 
watery
large volume
abdominal cramping
bloating
gas
weight loss
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15
Q

Clinical large bowel diarrhea

A 
frequent, regular
small volume
painful bowel movement
fever
blood or mucoid
inflammatory and RBC seen on microscopy
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16
Q

Diarrhea of large bowel due to

A 
salmonella
shigella
campylobacter
CMV
adenovirus
C. diff
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17
Q

Diarrhea of small bowel due to

A 
salmonella
e.coli
clostridium
s. aureus
rotavirus
norovirus
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18
Q

Petting zoo bacteria

A

salmonella

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19
Q

Daycare bacteria

A

shigella
cryptosporidium
giardia

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20
Q

Recent ABX use bacteria

A

C. diff

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21
Q

When to do stool culture

A
  • more than 6 unformed stools in 24hrs
  • severe abdominal pain
  • hospitalization
  • inflammatory diarrhea (bloody diarrhea, tempt over 101)
  • high risk
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22
Q

High risk features that need stool culture

A 
over 70
comorbidities
CV disease
DM
immunocompromised
IBD
Pregnancy
Sx more than 1 week
Public health concern
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23
Q

What is fecal lactoferrin

A
  • detect inflammation in the intestines
  • detect bacterial infections that cause inflammatory diarrhea
  • sensitive and specific
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24
Q

Manage diarrhea

A

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

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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

Clin Med 2 (25 decks)

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