GI 7 highlights

Question 1

Medications (esp. metformin) are one of the most common etiologies of what?

(important)

Answer 1

Acute diarrhea

Question 2

Recent travel puts you at risk for what form of acute diarrhea?

Answer 2

traveler’s diarrhea

Question 3

Non-inflammatory acute diarrhea: What are the main Sx? Is it usually severe?

Answer 3

Watery, non-bloody; usually mild

Question 4

What is an important lab value w non-inflammatory diarrhea?

Answer 4

No tissue invasion (no leukocytosis)

Question 5

__________ and __________ indicates tissue damage caused by invasion or toxin

Answer 5

Fever and bloody diarrhea

(acute inflammatory diarrhea)

Question 6

What is a key lab finding with acute inflammatory diarrhea?

Answer 6

Fecal leukocytes (usually present)

Question 7

Acute diarrhea: >_____% acute non-inflammatory is mild & self-limited

Answer 7

90%

Question 8

What is really important when evaluating acute diarrhea?

Answer 8

Distinguish mild from serious illness (ex/IBD)

Question 9

List the main differences between Gastroenteritis vs food poisoning

Answer 9

1) Gastroenteritis: Norovirus; very easily spread
2) Food poisoning: Vomiting; Staph aureus; Not passed person to person.

Question 10

Salmonella: Nontyphoidal salmonellosis is a leading cause of watery diarrhea in __________-rich settings.

Answer 10

resource

Question 11

Shigella or salmonella?: n/v/d and fever are typical; the diarrhea is not usually grossly bloody.

Answer 11

Salmonella

Question 12

Salmonella:
1) Most common way of transmission?
2) When do symptoms occur?

Answer 12

1) Poultry, eggs, and milk products or fresh produce
2) 8 - 72 hours following exposure.

Question 13

The classic cause of colonic or dysenteric diarrhea is what?

Answer 13

Shigella

Question 14

Shigella:
1) How is it transmitted?
2) What are some important symptoms? When do they usually occur?
3) Shigella: What is needed during testing? Why?

Answer 14

1) Direct person-to-person spread & from fecally contaminated food or water.
-in school and child-care based settings
-among men who have sex with men
2) Mucoid or bloody diarrhea + fever
-1-7 days following exposure.
3) Need C&S because can be resistant to some ATBs

Question 15

____________ is transmitted via undercooked contaminated poultry in resource-rich settings

Answer 15

Campylobacter

Question 16

______% of retail poultry is contaminated with Campylobacter

Answer 16

80%

Question 17

Campylobacter:
1) What is the main symptom?
2) What is unique abt the stool cultures?

Answer 17

1) Bloody diarrhea
2) Use special plates

Question 18

What can also cause skin infection that rapidly develops into bacteremia and systemic disease (esp in immunocomprimised)?

Answer 18

Vibrio

Question 19

Vibrio:
1) How is it transmitted usually?
2) What is the main symptom?
3) What is important to know about testing?

Answer 19

1) Consumption of raw seafood and shellfish during the summer
2) Grossly bloody diarrhea
3) Lab needs to know to specifically test for it; most labs don’t use the medium needed for routine stool cultures.

Question 20

EnterotoxigenicE. coli(ETEC) causes diarrhea in resource-________ settings.

Answer 20

limited

Question 21

EnterotoxigenicE. coli:
1) What is important to know abt symptoms?
2) How is it transmitted?
3) What is important abt testing?

Answer 21

1) Diarrhea 1-3 days after travel to in resource-limited
2) Cruise ship diarrhea outbreaks via fecal contamination of food or water from an infected person (usually very young or very old)
3) Need to test for it specifically

Question 22

Shiga toxigenicE. coli(STEC):
1) What is important to know abt symptoms?
2) What is important abt testing?

Answer 22

1) Usually self – limited in 5-8 days.
2) Need to test for it specifically.

Question 23

List 2 situations where prompt medical eval is indicated with acute diarrhea

Answer 23

1) Bloody
2) Dehydration

Question 24

DO NOT GIVE ATBs for what condition?

(important)

Answer 24

STEC

Question 25

Acute diarrhea: IV fluids preferred in ____________ dehydration

Answer 25

severe

Question 26

Antidiarrheals are safe in ______________ illness

Answer 26

mild-moderate

Question 27

List 3 things that are contraindications for antidiarrheals

Answer 27

Bloody diarrhea, high fever, systemic toxicity

Question 28

_________________________ is contraindicated in acute diarrhea (may cause toxic megacolon)

Answer 28

Diphenoxylate/atropine (Lomotil)

Question 29

What is Usually not indicated for acute, community-acquired or some cases of inflammatory diarrhea caused by invasive pathogens?

Answer 29

Empiric abx

Question 30

Acute diarrhea: If rapid testing not available & stool cultures pending, name one thing to consider treatment for:

Answer 30

No suspicion for STEC-bloody diarrhea from contaminated water source, contact with farm animals, undercooked beef

Question 31

List 2 important components of Empiric Antibiotic Therapy for acute diarrhea

Answer 31

1) PO fluoroquinolones (cipro 500 mg) for 1-3 days 2) Metronidazole500 mg PO Q6-8 hrs x 7-14 days

Question 32

Treatment with specific abx is recommended for which infectious bacterial diarrhea?

Answer 32

Shigellosis & C. difficile

Question 33

Treatment with specific abx is NOT recommended for which infectious bacterial diarrhea? (important)

Answer 33

Campylobacter or STEC

Question 34

Traveler's diarrhea: 1) What symptom is rare? 2) What is a significant risk factor for development after traveler's diarrhea resolves?

Answer 34

1) Fever 2) IBS

Question 35

What is a key part of preventing traveler's diarrhea?

Answer 35

Don't use ice

Question 36

List 2 important features of non-inflammatory infectious diarrhea

Answer 36

1) Non-bloody 2) Mild cramps

Question 37

List 2 main symptoms of IBS

Answer 37

Urgency + correlation with stress and meals,

Question 38

IBD: 1) List 2 important Sx with Crohn's 2) What abt for UC?

Answer 38

1) WL + rectal bleeding 2) May have blood + tenesmus

Question 39

Non-infectious diarrhea: Microscopic colitis: 1) What is an important symptom? 2) Who is it usually found in?

Answer 39

1) Watery stools 2) Middle aged females

Question 40

Non-infectious diarrhea: When is Post-cholecystectomy diarrhea worse?

Answer 40

After fatty or greasy foods

Question 41

Non-infectious diarrheas: Many meds can cause diarrhea, so what do you need to do?

Answer 41

Thorough review of current meds

Question 42

List some meds that are notorious offenders for diarrhea

Answer 42

metformin Lactulose Magnesium Abx Sugar substitutes (Sorbitol)

Question 43

List 2 post-diarrhea complications

Answer 43

1) Post-Infectious Reactive Arthritis (ReA) 2) Post-Infectious Guillain-Barre Syndrome (GBS) 3) Post-Infectious Irritable Bowel Syndrome (IBS)

Question 44

Post diarrhea complications; Reactive arthritis: 1) When may it occur? 2) What is it frequently associated with?

Answer 44

1) 2 weeks post-enteric infection 2) HLA-B27

Question 45

Post diarrhea complications: Most common associated enteric pathogen with _______________ is Campylobacter

Answer 45

Guillain-Barre Syndrome

Question 46

Post diarrhea complications: When would GBS start?

Answer 46

1-3 weeks following acute viral or bacterial infection

Question 47

Post diarrhea complications: Studies show persistent symptoms of what months to years after inciting infection?

Answer 47

IBS

Question 48

Abx associated diarrhea: 1) When does it occur? 2) What is it NOT due to?

Answer 48

1) During abx exposure 2) C. diff

Question 49

Abx assoc. diarrhea: 1) What are the Sx of C. diff? 2) What do most severe or fulminant disease pts have?

Answer 49

1) Abx assoc. diarrhea 2) Up to 30 stools/ day (profuse diarrhea)

Question 50

Prior antibiotic administration causes alteration of the normal ______________ bacterial flora, which can cause C. Diff

Answer 50

enterocolonic

Question 51

C. Diff is diagnosed by + C. difficile cytotoxin or C. difficile toxin B gene in _________________

Answer 51

stool samples

Question 52

Patients with suspected C. difficile infection should be placed on ______________ precautions preemptively pending diagnostic evaluation

Answer 52

contact

Question 53

Hand sanitizer does not kill ___________; must use soap & water

Answer 53

C. diff

Question 54

_________ vancomycin can be used to Tx C. Diff

Answer 54

Oral

Question 55

Fecal microbiota transplant (FMT) $$$ may be used to treat what?

Answer 55

C. Diff

Question 56

List 3 prevention measures for C. Diff

Answer 56

1) Minimizing antibiotic use 2) Avoiding gastric acid suppression (PPIs) **especially in hospital** 3) Probiotics not recommended (inconsistent data)