Exam 2 - Diarrhea Flashcards
(134 cards)
1
Q
host defenses - physical barriers to GI tract
A
gastric acidity, bile, mucosal layer, intestinal motility, normal enteric flora
2
Q
host defenses - innate immune system GI tract
A
antimicrobial peptides, acids
3
Q
host defenses - adaptive immune system GI tract
A
mucosal IgA antibodies, T cells, Peyer’s patches
4
Q
where is an exotoxin secreted
A
into the environment
5
Q
what is an enterotoxin
A
a toxin that acts on intestine, often secretory
6
Q
what is a cytotoxin
A
a toxin that acts on cells, causing cell damage - often inflammatory
7
Q
characteristics of inflammatory diarrhea
A
invasive, bloody stools, systemic symptoms, fever
8
Q
characteristics of secretory diarrhea
A
non-invasive, non-bloody, larger volumes, may have N/V, no systemic symptoms or fever
9
Q
diarrhea definition
A
3 loose stools in 24 hours or greater than 200 grams/day
10
Q
acute diarrhea timeline
A
less than 2 weeks
11
Q
persistent diarrhea timeline
A
2-4 weeks
12
Q
chronic diarrhea timeline
A
greater than 4 weeks
13
Q
secretory diarrhea mechanism
A
enterotoxin/adherence
14
Q
inflammatory diarrhea mechanism
A
cytotoxin/invasion
15
Q
stool findings in secretory diarrhea
A
no fecal leukocytes
16
Q
stool findings in inflammatory diarrhea
A
fecal leukocytes
17
Q
secretory diarrhea pathogens
A
viruses, travelers diarrhea pathogens, b. cereus, giardia, vibrio cholerae, some e. coli, most parasites
18
Q
inflammatory diarrhea pathogens
A
c diff, shigella, salmonella, campylobacter, yersinia, some e. coli, entamoeba histolytica
19
Q
when to test for stool pathogens
A
persistent symptoms after 7 days
20
Q
what GI infections can be detected with PCR
A
viral infections (norovirus, enterovirus, adenovirus), salmonella, shigella, campylobacter, EC0157
21
Q
what GI infections can be detected with EIA
A
giardia, cryptosporidium, rotavirus, e. histolytica
22
Q
when to perform O&P
A
only if immunocompromised or foreign travel is documented
23
Q
what GI infections can be detected using toxin assay
A
c diff, shiga-toxin producing e coli (0157)
24
Q
what GI infections are detected using histology
A
Hepatitis A IgM, entamoeba histolytica
25
antibiotic associated diarrhea pathogen
c diff
26
daycare-associated diarrhea pathogens
giardia, rotavirus, norovirus
27
waterborne secretory diarrheas
cryptosporidium, vibrio cholera
28
waterborne inflammatory diarrheas
plesiomonas, vibrio vulnificus
29
foodborne secretory diarrheas
hep A, B. cereus (rice)
30
foodborne inflammatory diarrheas
E. coli 0157, campylobacter, yersinia, listeria
31
E coli 0157 food
ground beef
32
campylobacter food
poultry, milk
33
yersinia food
pork
34
listeria food
deli meats
35
travel associated diarrhea
norowalk virus, giardia, ETEC
36
immunocompromise-associated diarhea
cyclospora, cryptosporidium
37
animal associated diarrhea
giardia, salmonella
38
immunocompromised associated diarrhea
cyclospora, cryptosporidium
39
diarrhea pathogen associated with fried rice
bacillus cereus
40
diarrhea pathogen associated with salad dressing/custards
staph aureus
41
diarrhea pathogen associated with poultry, beef, gravy
clostridium perfringes
42
diarrhea pathogen associated with poultry, eggs, milk, beef, turtles
salmonella
43
diarrhea pathogen associated with salads, raw vegetables, contaminated water, undercooked meats
shigella
44
diarrhea pathogen associated with poultry, unpasteurized milk
campylobacter
45
diarrhea pathogen associated with undercooked beef
E. coli 0157:H7
46
diarrhea pathogens with incubation period < 12 hours
bacillus cereus, staph aureus, clostridium perfringens
47
diarrhea pathogens with medium incubation period (hours-days)
salmonella, shigella, E coli 0157
48
diarrhea pathogen with long incubation period (days)
campylobacter
49
b cereus clinical characteristics
preformed toxin causes emesis, and later heat tolerant spores cause diarrhea
50
staph aureus clinical characteristics
ingestion of preformed enterotoxin causes emesis>diarrhea of 1-2 days duration
51
clostridium perfringens clinical characteristics
spores germinate and then release toxin leading to water diarrhea of 1 day duration
52
salmonella clinical characteristics
invasive inflammatory diarrhea
53
shigella clinical characteristics
invasive inflammatory diarrhea with very low inoculum required
54
campylobacter clinical characteristics
invasive inflammatory diarrhea, most common food pathogen
55
E coli 0157 clinical characteristics
shiga toxin causing diarrhea
56
salmonella treatment
no abx unless there is associated bacteremia
57
why no abx for salmonella
they increase shedding of bacteria in stool
58
what abx to use for salmonella if bacteremia is present
azithromycin or cipro
59
shigella tx
azithromycin or cipro
60
e coli 0157 tx
supportive, no abx
61
why no abx for e coli 0157
increase risk of HUS
62
campylobacter tx
azithromycin
63
tx for cholera
hydration, doxycycline, azithromycin, cipro
64
yersinia tx
only if ssx are severe, cipro, bactrim
65
c diff tx
PO vanc, fidaxomicin, metronidazole
66
giardia tx
metronidazole
67
cryptosporidium tx
no abx unless severely immunocompromised
68
viral diarrhea tx
supportive
69
entamoeba histolytica tx
paromomycin plus metronidazole
70
which diarrhea pathogens have azithromycin as primary treatments (if abx indicated)
salmonella, shigella, campylobacter, cholera
71
which diarrhea pathogens have metronidazole as a primary treatment if abx indicated
c diff (not first line), giardia, entoamoeba histolytica (with paromomycin)
72
which diarrhea pathogens have abx contraindicated
salmonella (unless associated bacteremia), E coli 0157, yersinia (unless ssx are severe), cryptosporidium (unless severely immunocompromised)
73
when to use antimotility agents
patients 2 and over with secretory diarrhea that is not toxin-producing
74
1st line antiemetic agent
ondansetron
75
first step of treatment for any diarrheal illness
address dehydration with oral rehydration solution or IV fluids if severe
76
general principle of abx treatment for diarrhea
not generally used as ssx are usually self-limiting; if used they are for a short course (1-3 days)
77
H. pylori morphology
gram-negative, microaerophilic, spiral
78
H. pylori transmission
saliva, vomit, feces, contaminated water
79
H. pylori diagnostics
stool antigen test, urea breath test, endoscopy with biopsy
80
H. pylori testing considerations
stop PPIs and bismuth 1-2 weeks prior to testing, test for eradication 4 weeks after abx are finished
81
triple therapy components
amoxicillin, clarithromycin, PPI
82
H pylori abx duration
14 days
83
quadruple therapy components
tetracycline, metronidazole, PPI, bismuth subsalicylate
84
clinical presentation cholecystitis/cholangitis
charcot's triad, murphy's sign
85
cholecystitis/cholangitis lab findings
leukocytosis, elevated alk phos and direct bili
86
cholecystitis/cholangitis pathogens
EEK (e coli, klebsiella, enterococcus), less commonly anaerobes
87
cholecystitis/cholangitis abx
ampicillin/sulbactam or cipro and metronidazole. ertapenem
88
cholangitis complications
hypotension, bacteremia, AMS
89
cholecystitis complications
perforation/peritonitis, bacteremia, liver abscess, emphysematous cholecystitis
90
pyogenic liver abscess labs findings
leukocytosis, elevated alk phos
91
pyogenic liver abscess causes
cholangitis, bacteremia, IBD, pancreatitis, diverticulitis, penetrating trauma
92
pyogenic liver abscess diagnostics
fine need aspiration for gram stain/culture, blood cultures
93
pyogenic liver abscess pathogens
polymicrobial
94
pyogenic liver abscess tx
surgical drainage plus 4-6 weeks of antibiotics
95
amebic liver abscess presentation
bloody diarrhea, anchovy paste aspirate from abscess
96
amebic liver abscess cause
ingestion of contaminated food/water with cysts of entamoeba histolytica
97
amebic liver abscess diagnostics
imaging, serum antibody test, O/P (not reliable)
98
amebic liver abscess pathogen
entamoeba histolytica
99
amebic liver abscess tx
metronidazole and paromomycin +/-surgery
100
what happens if you treat amebic liver abscess with metronidazole only
it will recur (metronidazole only treats the abscess, need paromomycin to eliminate it in the gut)
101
hydatid cyst presentation
may be asymptomatic, eosinophilia, elevated alk phos, anaphylaxis when it ruptures
102
hydatid cyst cause
ingestion of food/water contaminated by the feces of a tapeworm-infected dog
103
hydatid cyst CT findings
solitary large liver cyst with multiple daughter cysts
104
hydatid cyst diagnostics
CT, serology (ELISA), pathology
105
hydatid cyst pathogen
cysts of the tapeworm echinococcus granulosis
106
hydatid cyst treatment
surgical removal, albendazole x 30 days
107
spontaneous bacterial peritonitis risk factors
cirrhosis with ascites, peritoneal dialysis
108
spontaneous bacterial peritonitis route of infection
hematogenous, lymphogenous, transmural migration via intestinal lumen
109
spontaneous bacterial peritonitis infectious cause
cirrhosis: enteric gram negatives. Dialysis: Staph aureus, coagulase negative staph
110
spontaneous bacterial peritonitis treatment
ceftriaxone for GNR, vanc/nafcillin for staph
111
secondary bacterial peritonitis risk factors
intra-abdominal source of infection (bowel perforation/ischemia, PID)
112
secondary bacterial peritonitis pathogen
polymicrobial
113
secondary bacterial peritonitis treatment
source control, metronidazole plus ceftriaxone or cipro, ampicillin/sulbactam
114
intraperitoneal abscess risk factors
peritonitis, wound (appendicitis, perforated peptic ulcer, surgical complication)
115
intraperitoneal abscess infectious cause
polymicrobial
116
intraperitoneal abscess diagnosis
CT/US
117
intraperitoneal abscess tx
drainage, metronidazole plus ceftriaxone or cipro
118
which is more common, spontaneous bacterial peritonitis or secondary bacterial peritonitis
secondary
119
which hepatitis is fecal-oral
A and E
120
which hepatitis has no possibility of chronic infection
A and E
121
what is true about hepatitis B and risk of chronic infection
far greater in infants than adults
122
how to test for acute hep A and hep E infections
Hep A IgM, Hep E IgM
123
test for acute hep C infection
positive HCV viral load (antibody may or may not be positive)
124
test for acute Hep B infection
HBV surface antigen
125
test results indicating resolved hep B infection
core antibody positive, surface antigen negative
126
test results indicating hep B immunity
HBV surface antibody positive
127
test for hep A immunity
hep A total antibody (IgM and IgG)
128
test results indicating hep B immunity from vaccine
core antibody negative, surface antibody positive
129
test indicating high infectivity of Hep B
positive Hep B e antigen
130
initial test for HCV infection
HCV antibody
131
what to do if HCV antibody is positive
proceed to HCV RNA test
132
treatment for hep A
none
133
treatment for hep B
antivirals (lamivudine, etc), interferon
134
treatment for hep C
ribavarin, directly acting agents, interferon
