GI Disease Flashcards
(42 cards)
1
Q
Travel
A
ETEC
2
Q
1-6 hours of incubation after eating
A
- Toxin mediates
- S, aureus (mayo, crea, ham, poultry)
- B. cereus (enterotoxin) fried rice
3
Q
8-14 hours of incubation after eating
A
• C. perfringes (beef, poultery, legumes, gravy)
• B. cerus (meat, vegetables, dried beans, cereals)
/
4
Q
> 16 hours of incubation after eating
A
- V. cholera – shellfish
- V. parahemolyticus (oysters, shellfish)
- ETECH (sald, cheese, meat, water)
- Salmonella (beed, pultry, eggs, dairy)
- Shigella (potato or egg salad, raw vegetables)
5
Q
Antbiotic use diarrhea
A
C, difficile
6
Q
Diarrhea associated with sex
A
Shigella
Hep A
7
Q
Diarahea at the extremes of age
A
Rota virus
Noravirus
8
Q
Diarhea with reptiles & amphibians
A
Salmonella enterica
9
Q
Diarrhea in pregnancy
A
Listeria
Hep E
10
Q
DIarrhea in HIV
A
- Crypyosporifum
- Microsporidium
- Cyclospora
- Isoposa
11
Q
Medications with diarhea
A
- NSAIDs
- Colchicine
- Meticlopramide
- Radition
12
Q
Non-inflmatory diarhea
Key Organisms
Location in GI tract
Stool/clinical findings
A
- V, cholera
- C. perfringens
- B. Cerus
- ETEC
- Rotavirus
- Giardia
- Cryptosporidium
• Proximal small bowl
- Watery stool
- No WBC
13
Q
Inflammatory Diarhea
Key Organisms
Location in GI tract
Stool/clinical findings
A
- Shigella
- Samonella (non typhi)
- Camplobacter
- EHEC
- EIC
- Colon/terminal ileum
- Dystenry (bloody stool)
14
Q
Penetrating Diarhea
Key Organisms
Location in GI tract
Stool/clinical findings
A
- S. typhi
- Y. enerocolittica
• Distal small bowel
- Enteric fever
- Fecal WBC
15
Q
Clinical definition of diarrhea
A
3 loose stools in 24 hrs
16
Q
Acute, Chronic & resistant diarrhea
A
- Acute diarrhea: 0-14 days
- Persistent: 14-30 days
- Chronic: > 30 days
17
Q
Workup for diarrhea
A
• Lactoferrin (WBC digestion product) • Fecal WBC Stool culture • Ova & Parasitis • C. diff toxin by PCR or antigen • Endoscopy: IBD, cancer
18
Q
Noravirus
Pathophysiology Epi Presentation Diagnosis Treatment
A
- Pathophysiology – damages brush border, preventing absorption of water and nutrients
- Epidemiology – outbreak association
- Clinical - acute onset of vomiting (especially in kids), low grade fever in 1/3, abdominal cramps
and/or nonbloody diarrhea (especially in adults) within 10-48 hours of exposure. 30% secondary attack
rate. Duration 1-2 days in normal host. - Diagnosis – PCR confirmation (state public health lab)
- Treatment – supportive
19
Q
Rotavirus
Pathophysiology Epi Presentation Diagnosis Treatment
A
- Pathophysiology: activated by proteolysis to infectious subviral particles
- Epidemiology:Main cause of pediatric diarrhea, important cause of global infant mortality. Highest
infection rates at ages 3-15 months - Clinical: 2 day incubation. Vomiting and watery diarrhea for 3-8 days, can be associated with fever
and abdominal pain. - Diagnosis: rapid antigen detection in stool.
- Treatment: Supportive. Preventative vaccine available.
20
Q
Shigella
Pathophysiology Epi Presentation Diagnosis Treatment
A
- Pathophysiology: invasion of colonic epithelial cells, causing superficial ulcerations, colitis with
crypt abscesses; impaired absorption of water and electrolytes through the colon produces diarrhea - Epidemiology: 12-72 hour incubation, fecal-oral transmission, predilection for children, daycare,
poor sanitation, MSM. - Clinical: dysentery, moderate to severe illness with fever and blood flecks in stool; lasting 1-2
weeks, children can develop hemolytic uremic syndrome due to shiga toxin, mortality
21
Q
Salmonella typhi
Nora Virus
Pathophysiology Epi Presentation Diagnosis Treatment
A
- Pathophysiology: ingested organisms reach small bowel, penetrate mucosa, carried to lymph nodes
and blood with secondary excretion into intestine from bile. - Epidemiology: 10 day incubation, human reservoir only.
- Clinical: systemic illness with insidious onset of malaise, myalgias, headache and high fever. Classic
rose spots and temperature-pulse disassociation. Complications include intestinal perforation
and chronic carriage. - Diagnosis: 80% positive blood cultures in early state, stool cultures positive late.
- Treatment: ampicillin, TMP/SMX, ciprofloxacin
- Prevention: live oral vaccine
22
Q
Salmonella enteriditis or typhimurium
Pathophysiology Epi Presentation Diagnosis Treatment
A
- Pathophysiology: pili adhere to small intestine where enterotoxin stimulates fluid secretion.
- Epidemiology: 12-36 hour incubation, numerous animal reservoirs (poultry, eggs)
- Clinical: gastroenteritis with sudden onset of nausea, crampy abdominal pain, diarrhea and fever.
- Diagnosis: stool culture
- Treatment: mild cases treated with fluids. Treat only for severe disease, immune compromise or
extremes of age (TMP/SMX or ciprofloxacin).
23
Q
Campylobacter jejuni
Pathophysiology Epi Presentation Diagnosis Treatment
A
- Pathophysiology: invasive disease of ileum and colon with inflammatory diarrhea
- Epidemiology: 1-7 d incubation, many animal reservoirs, transmission in poultry, unpasteurized
milk, water. - Clinical: 12-24 prodrome of HA, myalgias, fever then acute diarrhea with >10 loose, non bloody
BM/day. Lasts 5-7 days. - Diagnosis: stool culture
- Treatment: controversial. (Cipro effective in vitro.)
24
Q
EPEC
ETEC
EIEC
EHEC
A
- Enteropathogenic E coli (EPEC): adheres to and destroys microvilli, important cause of childhood
diarrhea in developing countries. - Enterotoxigenic E coli (ETEC): milder, cholera-like watery diarrhea from production of enterotoxin
(LT or ST). Often causes traveler’s diarrhea. - Enteroinvasive E coli (EIEC) shigella like inflammatory diarrhea
- Enterohemorrhagic E coli (EHEC): cytotoxin causes bloody diarrhea, may be complicated by hemolytic
uremic syndrome, 0157:H7 often implicated (poorly cooked hamburger outbreaks).
25
C. difficile
```
Pathophysiology
Epi
Presentation
Diagnosis
Treatment
```
1. Pathophysiology: anaerobic toxin producing bacteria causes diarrhea and can cause pseudomembranous
colitis.
2. Epidemiology: antibiotic associated, 4-9 day incubation
3. Treatment: Oral metronidazole. Oral vancomycin for severe illness.
26
Yesina enterocolitic
```
Pathophysiology
Epi
Presentation
Diagnosis
Treatment
```
1. Pathology: mucosal ulcerations and mesenteric adenitis, intracellular pathogen.
2. Epidemiology: animal reservoir with outbreaks from food and water.
3. Clinical: appendicitis like syndrome from mesenteric adenitis, diarrhea and fever.
4. Diagnosis: slow growth makes fecal isolation difficult.
5. Treatment: tetracycline, TMP/SMX
27
V. parahemolyticus
```
Pathophysiology
Epi
Presentation
Diagnosis
Treatment
```
Vibrio parahemolyticus
1. Pathophysiology: mild tissue damage and watery diarrhea suggesting both invasion and toxin formation
2. Epidemiology: 24-hour incubation, inadequately cooked seafood
3. Clinical: explosive watery diarrhea with low grade fever
4. Diagnosis: stool culture (requires special media)
5. Treatment: supportive
28
V. cholera
```
Pathophysiology
Epi
Presentation
Diagnosis
Treatment
```
Vibrio cholera
1. Pathophysiology: non inflammatory toxin acts on small bowel; adenylate cyclase stimulation leads
to increased cAMP and massive isotonic fluid loss
2. Epidemiology: 1-2 d incubation, food and water borne, seafood. Pandemics.
3. Clinical: watery diarrhea (rice-water stool) and dehydration without fever.
4. Diagnosis: stool culture, (requires special media)
5. Treatment: IV/PO fluid replacement. Tetracycline.
29
Listeria monocytogenes
```
Pathophysiology
Epi
Presentation
Diagnosis
Treatment
```
1. Pathophysiology: intracellular pathogen, passes through intestines into macrophages and causes
disseminated infection
2. Epidemiology: Incubation period 2-6 weeks. Coleslaw, dairy products, cold processed meats. Immunocompromised
host, extremes of age and pregnant women.
3. Clinical: Fever, myalgias, bacteremia and meningitis.
4. Diagnosis: Blood or CSF cultures
5. Treatment: Ampicillin
30
Main cause of pediatric diarrhea
Vaccine?
Rotavirus
Yes
31
Gram + with predilection for children, daycare,
| poor sanitation, MSM
Shigella
32
Live oral vaccine to prevent diarrhea from this bacteria
S. typi
33
Diarrhea & rose spots
S. yphi
34
Transmitted by poultery, unpasturized milk & water
C. jejeunum
35
E. coli that causes diarrhea in developin countries
EPEC
36
E. coli causting travelers diaarrhea
ETEC
37
E. coli with shigella like inflmaatory diarrhea
EIEC
38
E. coli associated with poorly cooled hamburgers
EHEC
39
Bacteria that mimicks apendicitus
Yersinia enterocolitica
40
V. cholerea toxin mechanism
non inflammatory toxin acts on small bowel; adenylate cyclase stimulation leads
to increased cAMP and massive isotonic fluid loss
41
Rice water stool
V. cholerea
42
Diarrhea & myalgia or meningitis
Listeria monocytogenes
