GI-Acute Diarrhea

Question 1

Evaluation of Acute Diarrhea

Answer 1

Severe
- Fever greater than or equal to 104, Blood/Pus, E-Lytes, ABx use, Duration > 3 days, Immuno decreased

Step 1: C. diff

Step 2: Stool WBC and RBC

Step 3: No WBC, no RBC (right arrow) Ova + parasites;
+ WBC, + RBC (right arrow) colonoscopy

Step 4: C. diff (right arrow) Treat

Question 2

C. Diff

Answer 2

Path: overgrowth after recent abx use

Pt: watery diarrhea, smell

Dx: C. diff NAAT

Tx; 1st = PO MTZ = PO Vanc
2nd = PO MTZ = PO Vanc
3rd = Fidaxomycin

F/u: Refractory: Fecal Transplant

Question 3

Diarrhea Etiology to Risk Factor

Answer 3

Entero:
C. diff - Antibiotic Use

Toxic:
ETEC - Traveler's....Central America 
Vibrio cholera - 3rd World, no boiling 
S. aureus - proteinacious foods 
B. cereus - Reheated rice 
Giardia - camping, fresh water 

Invasive:
Salmonella - Raw eggs, poultry
Shigella - HUS
EHEC (O157:H7) - HUS, Raw meat
Campylobacter - most common
E. Histolytica - HIV/AIDs

Question 4

HUS/TTP

Answer 4

Path: EHEC O157:H7

Pt: Blood, Diarrhea after meat
Increased BUN/Cr
Anemia

Dx: Smear = MAHA = Schistocytes
Shiga-like toxin

Tx: Supportive care
Plasma exchange transfusion