GI Flashcards
(159 cards)
1
Q
Definition of Diarrhea
A
≥3 loose/watery stools x day
> frequent passage than usual
2
Q
Intoxication vs. Gastroenteritis
A
Intoxication:
faster onset <day
NO fever
3
Q
3 symptoms associated with Inflammatory Diarrhea
A
Fever
Tenesmus
Abdominal pain
4
Q
Type of diarrhea @Clostridium dificille
A
Inflammatory
5
Q
Type of diarrhea @V.cholerae
A
NONinflammatory
6
Q
Type of diarrhea @EIEC
A
Inflammatory
7
Q
Type of diarrhea @ETEC
A
NONinflammatory
8
Q
Type of diarrhea @EPEC
A
NONinflammatory
9
Q
Type of diarrhea @EAEC
A
NONinflammatory
10
Q
Type of diarrhea @EHEC
A
Inflammatory
11
Q
Type of diarrhea @Entaomeba hystolitica
A
Amebic Dysentery
12
Q
Acute Diarrhea
A
≤14 days
13
Q
Persistent Diarrhea
A
15-30 days
14
Q
Chronic Diarrhea
A
> 30 days
15
Q
Dx of not severe Inflammatory Diarrhea
A
Stool culture
16
Q
Management of Acute Noninflammatory Diarrhea with moderate to severe symptoms
A
For Travelers Diarrhea START empiric antibiotics
<72hrs symptom control
>72 hrs stool sample
17
Q
Possible causes of chronic diarrhea
A
Clostridium difficile
Entaomeba hystolitica
18
Q
Risk factors for C.dificille
A
Recent antibiotic tx
- clindamycin
- cephalosporins
- fluoroquinolone
Gastric acid suppression
Advanced age
19
Q
Complication @Salmonella infection
A
Permanent carrier status @gallbladder
20
Q
Pathogens to most commonly cause reactive arthritis as a complication
A
Salmonella
Shigella
21
Q
Pseudomembranous colitis is an associated disorder to which pathogen
A
Clostridium dificille
22
Q
Type of diarrhea that doesn’t change with fasting and is present @night
A
Noninflammatory secretory diarrhea
23
Q
Red flags @Diarrhea
A
Chronic illness or immunocompromised
>65 yo
Recent use of antibiotics
24
Q
Supportive Tx @Diarrhea
A
Bland diet
Oral rehydration
Pharmacotherapy (not usually recommended)
- antiemetics (ondasteron)
- anti motility (loperamide) ** consider @immunocompetent adults with acute diarrhea
25
When and why should anti motility drugs should be avoided?
Px with fever or inflammatory diarrhea
Because of the risk of developing megacolon
26
Empiric antibiotcs recommended @Diarrhea Tx
Azitromicina (Macrolido)
Ciprofloxacin (Fluoroquinolona)
27
Antibiotics @Noninflammatory Diarrhea
NO
28
Antibiotics @Infammatory + NO blood
NO
porque es >probable que sea EHEC
29
Antibiotics @Inflammatory + Blood
NO
30
Antibiotics @Inflammatory + Blood + Chills
YES
Suspects Bacteremia
31
Where does Shigella invade?
Colon
32
T or F: Shigella needs a HIGH infectious dose
F
Low, because it resists gastric acid
33
Virulence factor of Shigella
Shiga Toxin
--> enterocyte damage + bloody diarrhea
34
Serotypes @Shigella
4
35
Reservoir of Shigella
ONLY humans
36
T or F: Shigelllia infections is usually self limited
T
37
Onset of symptoms @Shigella
1-3 days
38
Pathogens that can cause Dysentery
Shigella
Salmonella
E.coli
39
T or F: Shigelliosis is predominant in all ages
F
Primarily a Pediatric Disease
40
Serotypes @Salmonella
>2500
41
Where does the Salmonella attach to?
Small Intestine
42
Replication of Shigellia occur @
Cytoplasm
43
Replication of Salmonella occurs @
Vacuole
44
Infectious Dose @Salmonella Typhi and Nontyphi
Typhi: Low, because they're resistant to gastric acid
Nontyphi: High
45
Which pathogen causing gastroenteritis have flagger motility?
Salmonella
Vibrio cholera
46
Virulence factor: Vi capsule
Salmonella
= permite evasion of neutrophil chemotaxis
47
What serotypes of Salmonella are obligate pathogen
S.typhi and S.paratyphi
48
Resevoir of Salmonella
Animal
ONLY human @Typhi and Paratyphi
49
Incidence of Salmonella
Bimodal: <5yo + >60yo
summer-autumn
50
High Risk (need lower inculum) @Salmonella
Poor children @Developing countries
age
Inmmunosupresion
Low gastric acid
51
Route of Transmission of Salmonella
Poultry
Eggs
Diary
Poorly stored food
52
______ can cause septicemia causing localized suppurative infection --> osteomyelitis --> leukopenia
Salmonella
53
How does the Salmonella travel to the _______ and replicate @Enteric Fever
Engulfed by macrophages
Liver, Spleen, Bone Marrow
54
Enlarged spleen
Septicemia
55
Pathogen that causes symptomatic (chronic) colonization
Salmonella
56
Where does Salmonella acts as reservoir in chronic colinization
Gallbladder
57
Cultivo @Salmonella
SS
MacConkey
58
Suspected septicemia @Salmonella infected px, which dx exams
Blood culture
Mielocultivo
59
SS agar shows black bacteria growth
Salmonella
porque produce acido sulfidrico
60
Cultivo @Shigella
SS agar
61
T or F: Antibiotic Tx is indicated at all cases of Salmonella
F
ONLY if its severe, since it can cause chronic colonization @gallbladder
62
Antibiotic Tx vs. Salmonella
Ceftriaxone
Fluoroquinolonas
Porque se eliminan por vía biliar
63
T or F: There is a vaccine vs. Typhoid Fever
T
64
When is antibiotic tx indicated @Salmonella
Severe gastroenteritis
Bacteremia
High Risk Px
65
Signs of Bacteremia
Chills
Pilorection
Motted Skin
↑ RR
Fever
66
Type of E.coli that causes Travelers Diarrhea
ETEC
67
Type of E.coli that causes Pediatric Diarrhea
EPEC - Enteropathogenic
68
Type of E.coli that produces two enterotoxins
ETEC
heat-labile
heal-stable
69
Enterotoxin @E.coli that causes activation of adenylate cyclase --> ↑cAMP --> ↑Chloride secretion
Heat- LABILE
70
Type of enterotoxin produced by E.coli that causes activation of guanylate cyclase --> ↑cGMP --> ↓NaCl reabsorption
Heat-stable
ETEC
71
T or F: ETEC (enteropathogenic) E.coli causes invasion of the mucosa
F
72
T or F: ETEC causes NO inflammation of the mucosa
T
73
Type of E.coli thaT BLOCKS absorto by attaching to the apical surfaces of the intestinal epithelium causing villi to flatten
EPEC (enteropathogenic)
74
Type of E.coli with Type III secretion system
EPEC
75
Type of E.coli that causes auto agglutination in a "stacked-brick" arrangement over the epithelium
EAEC (enteroaggregative)
76
Type of E.coli associated with chronic diarrhea and growth retardation @children
EAEC (enteroaggregative)
77
Type of E.coli that forms biofilm
Enteroaggregative (EAEC)
78
Type of E.coli that produces Shiga-lika-Toxin
EHEC // STEC
79
Strain most commonly associated with HUS worldwide
O:157:H7
80
Incidence of EHEC
Warm months
<5yo
81
Raw beef, milk and veggies
EHEC // STEC
82
This type of bacteria are infected by bacteriophages that integrate genes into the bacterias genome, encoding for the production of toxins
EHEC
83
Infective dose of EHEC
<100
84
Hemolytic Uremic Syndrome
↓ urine
acute renal failure
petechiae
neurological manifestations
thrombocytopenia
85
Why are children more perceptible to have HUS as a complication of E.coli enterohemorragic?
They have more Gb3 receptors found @renal tissue
86
Verotoxin
EHEC
87
E.coli that act @small intestine
ETEC
EPEC
EAEC
88
E.coli that act @large intestine
EHEC
EIEC
89
T or F: E.coli is part of the microbial flora @GI tract
T
90
How often does E.coli replicate
cada 15min
91
Virulence factors og E.coli
Adhesins
Exotoxins
92
Enterobacteriae that is an opportunistic pathogen
E.coli
93
Culture of E.coli
MacConkey agar
94
Why isn't antibiotic tx indicated @EHEC?
Because it causes death of the bacteria which causes and increase of the toxin release that may lead to HUS and other exacerbtions
95
Enterobacteriae that grows at alkaline media (acid labile)
Vibrio cholerae
96
Where does Vibrio cholera act?
Small intestine
97
T or F: V.cholerae is invasive of the intestinal epithelia
F
98
Rice Water Diarrhea
Vibrio cholerae
99
Enterobacteriae that is oxidase positive
Vibrio cholerae
100
Serotypes of epidemic cholerae
O1 and O139
101
Raw or undercooked seafood
V.cholerae
102
Enterobacteriae with aquatic reservoir
Vibrio cholera
= Brackish estuarine water
103
Complication of cholera
Severe dehydration
metabolic acidosis
hipokalemia
hypovolemic shock
104
Tx of Cholera
Reposición de líquidos
105
Incubation period of cholera
0-2 days
106
Inoculation dose for V.cholerae
High
107
Virulence factor of Vibrio cholerae
Cholera toxin
--> ↑cAMP -->↑ chloride secretion
108
Enterobacteriae transmission by reptiles (snakes, turtles)
Salmonella
109
T or F: Rotavirus is an enveloped virus
F
110
Serotypes @Rotavirus
7
A, B and C causing human disease
111
Causes mucosal damage + villous atrophy @GI tract
Rotavirus
112
Where does Rotavirus act?
Small intestine
113
Incubation period of Rotavirus
1-3 days
114
NSP4 protein
@Rotavirus
acts as a toxin by ↑Ca+ influx into enterocytes and enteric nervous system signaling causing alterations in H2O absoprtion
115
Outer cased proteins @Rotavirus
VP7 and VP4
116
T or F: Rotavirus does NOT survive well at furniture and toys
F
117
Mayor cause of severe diarrhea @infants and children worlwide
Rotavirus
118
Incidence of Rotavirus
@Winter
Worldwide
119
At what age can a Rotavirus infection be serious?
Infants <24 months
120
Is Rotavirus a self-limited disease?
YES
121
Dx of Rotavirus
Usually clinical
122
Vaccine for Rotavirus?
YES
Monovalente (rotarix) - 2 doses
Pentavalente (rotaeq) - 3 doses
123
What age should the Rotavirus vaccine no longer be applied?
>8 months
Because of risk of intestinal invagination
124
______ has mechanical vectors such as flies and coackroaches
Entamoeba hystolitica
125
Incubation period of Entaomeba hystolitica
1-4 weeks
126
Routes of transmission of Entamoeba hystolitica
Infected stools
contaminated water
Ora-anal sex
127
T or F: Both Trophozoite and Cysts of Entamoeba hystolitica survive @external enviorment
F
Trophozoites DO NOT survive
128
Pathogen that causes Flasked shaped ulcerations @intestinal mucosa
Entamoeba hystolitica
129
T or F: Amebae are found in O2 rich enviorments
F
ONLY at LOW O2 environments, protozoa are killed at ambient O2 concentrations
130
What enables E.hystolitica cysts turn into trophozoites?
Gastric Acid @Stomach
131
Infecting form fo Entamoeba hystolitica
Cysts
132
Extraintestinal amebiasis
Heart
Brain
Liver
as a Trophozoite
133
Where does Entamoeba hystolitica causes damage?
Colon
134
Incubation period of extra intestinal amebiasis?
Weeks-years
135
Px traveling to tropical or subtropical destinations with persistent diarrhea
Entamoeba hystolitica
** high risk of recurrence by self inoculation
136
Popo Seca con sangre
Amebic Dysentery
137
Stool analysis of Entamoeba hystolitica
Lugol
138
Tx of asymptomatic intestinal amebiasis
Luminal agents
= in order to prevent development of invasive disease and shedding of cysts
139
Tx of symptomatic intestinal or extra intestinal amebiasis
Metronizadole + Luminal agents
140
GI: Bacteria that can cause pseudo appendicitis
Yersenia enterocolitica
141
Bacteria found at pork products that causes gastroenteritis
Yersenia enterocolitica
142
Bacteria associated with causing Guillian Barre Syndrome
Campylobacter jejuni
143
Bacteria that causes gastroenteritis found at bird meat
Campylobacter jejuni
144
Most associated with gastric cancer and gastritis
H.pylori
145
Acid Stable Enterobacteriae
Shigella
146
T or F: EHEC can grow @Sorbitol agar
F
147
Enterobacteriae that ferments lactose
E.coli
148
Neonatal Meningitis
E.coli
149
Catalase + Enterobacteriae
E.coli
150
“Pea soup diarrhea”
Salmonella Typhi
151
Enterobacteriae with polysaccharide capsule
Salmonella
E.coli
152
Type of E.coli that flattens villi and inhibits absorption
EPEC
153
Antimicrobial Tx @Salmonella
Generally not required
It prolongs the duration of fecal shedding
154
T or F: Antidiarrheal drugs are indicated @Shigella infection
F
Because they delay the fecal shedding
155
Antimicrobial Tx @Shigellia
Shorten the duration of symptoms
Reduce fecal shedding
156
T or F: All E.coli cause fecal leucocitosis
F
ETEC is the only that doesn’t.
157
Shellfish consumption associated with…
V.cholerae
158
Pathogen that causes osmotic diarrhea
Rotavirus
159
GI infection that causes right upper cuadrante pain
E. hystolitica
