GI Re-Up #7 Flashcards by Tyler Cichowski

Noninvasive Infectious Diarrhea has general symptoms of….

Vomiting, water voluminous diarrhea (no fecal WBC’s or blood)

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MC overall cause of gastroenteritis in adults in North America and MCC of viral gastroenteritis worldwide.

Where is an outbreak of this found (transmission route, etc.)

-Norovirus Gastroenteritis

-Fecal-oral route transmission (outbreaks on cruise ships, hospitals, restaurants)

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Symptoms of Norovirus Gastroenteritis

-Treatment?

-Vomiting predominant symptom. Nausea, non-bloody diarrhea that lacks mucus, and fecal leukocytes.

-Fluid replacement (orally) is the treatment

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Rotavirus Gastroenteritis is MC seen in __________

Treatment?

-Young, unimmunized children ages 6 months - 2 years old

Oral rehydration

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Staphylococcus Aureus Gastroenteritis is an infection due to a heat-stable enterotoxin B. This incubation period is ________.

How do you get this type of gastroenteritis?

-Short (within 6 hours)

-Food contamination MC source (dairy products, mayo, meats, eggs, salads) at room temperature

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Again, treatment for Staph A Gastroenteritis is _______

Who should you consider this condition in?

oral fluid replacement

Those who attend a picnic, as food it outside at room temperature

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On the same note, Bacillus Cereus Gastroenteritis also has a short incubation period of about 6 hours. What is one common contaminated food that this bacteria comes from?

Fried rice

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The MCC of traveler’s diarrhea is

Risk factors for this type of gastroenteritis

-Enterotoxigenic E. Coli

-Contaminated food and water. Unpeeled fruits washed in the water, untreated drinking water, etc.

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What is the treatment for Enterotoxigenic E. Coli Gastroenteritis?

Oral rehydration first line
-Loperamide, Bismuth if needed

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What area is non-invasive diarrhea usually affecting?

Small bowel (large voluminous stool)

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Vibrio Cholerae is a gram-negative comma-shaped rod transmitted via __________.

Outbreaks may occur during poor sanitation and overcrowding conditions (especially abroad).

Explain the pathophysiology of this type of gastroenteritis

Contaminated food and water

Exotoxin causes a secretory diarrhea which may cause profound dehydration and hypovolemia

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Symptoms of vibrio cholerae gastroenteritis

-Vomiting
-Copious watery diarrhea
-Rice water stools: grey with flecks of mucus and may have a fishy odor but no blood or pus

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Treatment for vibrio cholerae gastroenteritis

-Oral rehydration and electrolyte replacement
-Tetracyclines first line if needed

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Vibrio Parahaemolyticus and Vulnificus are transmitted via ________________

Symptoms of both kinds

What should be remembered about Vulnificus?

-Raw or undercooked shellfish consumption and seawater

-Parahaemolyticus: gastroenteritis
-Vulnificus: gastroenteritis, necrotizing fasciitis, cellulitis.

Vulnificus is the MCC of death from seafood consumption in the US

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Risk factors for bacteremia in vibrio Parahaemolyticus and Vulnificus?

-Underlying liver disease (cirrhosis, alcoholism, hemochromatosis)
-Immunocompromised (DM)

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If the patient has cellulitis from Parahaemolyticus and Vulnificus, what medication class should you use?

Tetracyclines

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Clostriodiodes Difficile (C. Diff) is a spore-forming toxin-producing Gram-positive anaerobic bacteria. What are some risk factors for this type of gastroenteritis?

Symptoms of this type

-RF: Recent antibiotic use (Clindamycin), advanced age gastric suppression therapy (PPI, H2 blockers)

-Watery, non-bloody diarrhea, cramps, fever, tenderness
-Complications include: toxic megacolon, bowel perforation

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Initial test of choice for C. Diff

What is also seen on labs?

What is seen on sigmoidoscopy which is only performed in select patients?

-C. Difficile toxin (stool)

-Leukocytosis and increased WBC count

Pseudomembranes

Treatment for C. Diff

-Discontinue offending ABX
-Contact precautions and washing hands with soap
-Oral Vancomycin or Oral Fidaxomicin (Metronidazole is alternative)

What are some general symptoms of invasive infectious diarrhea?

What part does invasive diarrhea affect?

-high fever, blood and fecal leukocytes in diarrhea, not as voluminous, mucus

Large intestine (many, small volume stools)

Yersinia Enterocolitica is a gram-negative coccobacillus with what unique shape?

Sources of this bacteria

Bipolar staining (safety pin appearance)

Contaminated pork MC in US, milk, water, tofu

Symptoms of Yersinia Enterocolitica diarrhea

Treatment

-Fever, abdominal pain pain mimic acute appendicitis
-Can cause mesenteric lymphadenitis (producing guarding and abdominal tenderness)

-Fluid and electrolyte replacement
-Severe: Fluoroquinolones (-oxacin)

Campylobacter Jejuni is the MCC of bacterial enteritis in the US. It is also the MC antecedent event in post-infectious _________.

What is one source of this condition?

Symptoms

-Guillain-Barre Syndrome

Raw or undercooked poultry MC, raw milk, dairy cattle, contaminated water, PUPPIES

-Fever, crampy pain, may mimic appendicitis, nausea
-Diarrhea watery then progressing to bloody

On Stool Culture, what is seen in C. Jejuni?

What is the treatment for this type?

-Gram-negative “S, comma or seagull shaped” organisms.

-Fluid and electrolyte replacement
-Macrolides (Azithromycin) first line

Enterohemorrhagic E. Coli 0157:H7 diarrhea -Sources -Pathophysiology -Symptoms -Treatment

-Sources: undercooked ground beef, unpasteurized milk or apple cider, day care centers, and contaminated water. -Shiga-like toxin causes endothelial damage leading to hemorrhage -Watery diarrhea progressing to bloody. Cramps, vomiting, fever absent or low-grade -Treatment: Fluid replacement

What is one thing that should be avoided in E. Coli 0157:H7 and why?

Avoid ABX in children due to increased incidence of Hemolytic Uremic Syndrome

Typhoid (Enteric) Fever is caused by __________ and is likely in someone with a history of _________. Symptoms (unique)

-Salmonella typhi -Travel to areas where sanitation is poor (South-Central Asia) -Headache, intractable fever, chills, abdominal pain, constipation --> non bloody diarrhea --> pea soup green diarrhea

What are some unique exam findings in a patient with Typhoid Fever?

-Hepatosplenomegaly -Fever with bradycardia -Rose spots (faint pink or salmon colored macular rash that spreads from trunk to extremities)

Treatment for Typhoid Fever

-Oral hydration and electrolyte repletion first line -Fluoroquinolones (Ciprofloxacin, Ofloxacin)

On the other hand, nontyphoidal salmonella is one of the MC food borne diseases in the US. What are some sources of this bacteria? Symptoms are similar to that of Typhoid Fever. What are they? Treatment?

-Poultry, eggs, fresh produce, mild products, contact with REPTILES -Nausea, vomiting, fever, diarrhea (pea soup green in color), malaise, headaches -Oral rehydration and electrolyte replacement -Fluoroquinolones if needed

Shigellosis is MCC by _________ Who is at the highest risk for this condition? This condition is highly virulent from fecal-oral contamination. The Shiga enterotoxin is neurotoxic, cytotoxic, and enterotoxin. Therefore, what are the symptoms?

-Shigella sonnei -Children < 5 years old in daycares -Lower abdominal pain, explosive watery diarrhea that progresses to mucoid and bloody. -Febrile seizures -High fever

Treatment for Shigellosis

-Oral rehydration and electrolyte replacement

Patients with HLA-B27 may develop _______ from a Shigellosis infection

Reactive Arthritis (Reiter Syndrome)

__________ is a protozoan parasite associated with sporadic or episodic diarrheal illness. It comes from contaminated water from remote streams/wells AKA Beaver's Fever or Backpacker's Diarrhea. What are some symptoms?

-Giardia Lamblia -Symptoms: frothy, greasy foul-smelling diarrhea (steatorrhea) with no blood or pus, cramps, bloating, malabsorption.

What is the treatment for Giardiasis?

-Rehydration mainstay -Metronidazole

Amebiasis, from entamoeba histolytica, has symptoms that include....

-Mild diarrhea to severe dysentery -Liver abscess: fever, RUQ pain, anorexia.

Management for Amebiasis if: -Colitis: -Liver abscess:

-Colitis: Metronidazole followed by intraluminal parasitic such as Parmomycin -Liver abscess: Metronidazole + Paromomycin + Chloroquine

Whipple's Disease, caused by Tropheryma whipplei, has symptoms such as (think of the stomach and neuro)

-Malabsorption: chronic diarrhea, fever, LAD, non deforming arthritis -Neuro Sx: memory impairment, confusion, rhythmic motion of the eye while chewing

What is seen on duodenal biopsy for Whipple's Disease?

-Periodic acid-Schiff (PAS)-positive macrophages, dilation of lacteals

Treatment for Whipple's Disease

-Prolonged ABX therapy (usually 1-2 years) --Penicillin or Ceftriaxone followed by oral Bactrim as maintenance therapy

Phenylketonuria (PKU) is an autosomal recessive disorder of amino acid metabolism associated with phenylketonuria neurotoxicity due to accumulation of phenylalanine in the urine and blood. Symptoms

-Presents after birth with vomiting, mental delays, increased DTR's, intellectual disability. -Children often blonde haired, blue eyed with fair skin.

Diagnostics for PKU

-Increased serum phenylalanine -Urine with musty (mousy) odor -Newborn screening performed at 24 weeks GA

Management for PKU

-Lifetime dietary restriction of phenylalanine + increase tyrosine supplementation -Avoid foods high in phenylalanine (milk, cheese, nuts, chicken, meats, eggs, legumes, diet sodas)