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Infections of GI Flashcards

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1
Q

what is gastroenteritis?

A

inflammatory process of the stomach or intestinal mucosal surface, associated with ingestion of contaminated foods/water/poor sanitation

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2
Q

what is infectious gastroenteritis?

A

pathogen enters GI tract and multiplies, delayed appearance in symptoms (1-3 days), pathogens increase which increases damage, associated w fever

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3
Q

what is intoxication gastroenteritis?

A

ingestion of preformed toxin (exotoxin), sudden appearance of symptoms (2-10 hrs after consumption), fever not common

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4
Q

characteristics of stool that infection/intoxication gastroenteritis produces?

A
  • increases frequency (>3 stools/day)
  • increased volume (>200ml excreted/day)
  • soft, not formed
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4
Q

characteristics of stool that infection/intoxication gastroenteritis produces?

A
  • increases frequency (>3 stools/day)
  • increased volume (>200ml excreted/day)
  • soft, not formed
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5
Q

symptoms of gastroenteritis

A

abdominal pain/cramping, diarrhea, nausea/vomtiing, dehydration, wt loss, fatigue and fever

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6
Q

what are the two types of acute diarrhea?

A

inflammatory and non inflammatory

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7
Q

what is inflammatory acute diarrhea?

A

typically caused by bacteria (shigella app, salmonella enteric, campylobacter jejuni), characterized by an infection causing frequent, small volume and loose stools

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8
Q

what does the stool typically look like in inflammatory acute diarrhea?

A

blood (gross or occult) often present, presence of fecal leukocytes and mucous
- dysentery; severe diarrhea containing visible blood, mucous and or pus

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9
Q

what is invasive diarrhea?

A

sublet of inflammatory diarrhea, inflammatory diarrhea AND invasion of intestinal mucosa (increased risk of bacteremia), ex. salmonella spp, verocytotoxin-producting E coli

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10
Q

what symptoms must be present for a physician consultation?

A
  • fever (>38.5 C)
  • significant abdominal pain
  • dehydration
  • visible blood and mucis/pus in the stool
    as well as further lab testing and antimicrobial therapy
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10
Q

what should be gathered in a pt Hx?

A

(disease severity risk factors)
- symptom duration - fever, abdominal pain, nausea/vomiting, dehydration an fatigue
- description of diarrhea
- investigate for common source of outbreak
- travel Hx or recent antibiotic use

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11
Q

what does a short incubation period suggest?

A

ingestion of pre formed toxin

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12
Q

what should be considered when vomiting is a dominant symptom?

A

viral infection or food poisoning

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13
Q

risk factors:

A
  • age over 70
  • neonates
  • recent travel or camping
  • recent antibiotic use
  • immunosuppression (prednisone, chemotherapy, HIV/AIDS
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14
Q

what 4 factors are used to establish dehydration?

A
  • ortho hypotension
  • tachycardia
  • decreased skin turgor
  • dry mucous membranes
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15
Q

when should cultures be performed?

A

for pt with severe or persistent disease (>1 week)

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16
Q

when is a positive culture rare? (2-5%)

A

pt without fever and absence of occult blood or fecal leukocytes in the specimen

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17
Q

when is a culture not recommended?

A

if pt has been in hospital for 72 hours an has new onset diarrheal symptoms (can indicate c diff)

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18
Q

when are studies for ova and parasites indicated?

A
  • persistent diarrhea
  • international or wilderness travel, daycare centres
  • immunosuppression (eg. HIV/AIDS)
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19
Q

when does lab sensitivity increase to 98%

A

if 3 ova and parasite examinations are preformed on 3 separate days

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20
Q

molecular assays are becoming more available for the identification of:

A

salmonella app, shigella spp, campylobacter spp, and verocytotoxigenic E.coli

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21
Q

acute diarrhea may also be associated with what conditions?

A

IBS, bowel obstruction and GI hemorrhage

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22
Q

what medications can cause diarrhea?

A

metformin, colchicine, diuretics, ACE inhibitors, PPIs magnesium containing antacids, antibiotics

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23
what is the goal of management for acute diarrhea?
to pass relatively dilute urine every 2-4 hours
24
how can you treat acute diarrhea?
- oral fluids (eg. water, pedialyte, hydralyte) usually sufficient - IV fluids recommended in cases of severe dehydration or persistent emesis - patients should eat until stool is formed
25
agents to control diarrhea:
- bulking agents, bismuth compounds, anti motility drugs (loperamide) - should only be used in cases of non inflammatory diarrhea
26
when is empiric antimicrobial therapy recommended?
in severe cases of infectious bacterial gastroenteritis
27
what must be confirmed right before antimicrobial therapy is started?
positive stool culture or parasite examination - then therapy should be started to treat specific pathogen
28
infection control
- routine practices and contact precautions - case notification and outbreak notification - source control to prevent new cases
28
is campylobacter jejuni gram neg or pos and what's the shape?
gram negative, helical shaped bacteria
29
what are the symptoms of campylobacter jejuni?
fever, abdominal pain/cramping, blood streaked, inflammatory diarrhea (>10 BM/day)
30
when do symptoms typically resolve in campylobacter jejuni?
within 1 week
31
what is the leading cause of food borne illness in North America?
campylobacter jejuni
32
80% of retail chicken is contaminated with what?
campylobacter jejuni
33
approx 60% of cattle excrete what in faces and milk?
campylobacter jejuni
33
how is campylobacter jejuni transmitted?
ingestion of contaminated food and water (fecal oral route)
34
what is the infectious dose of campylobacter jejuni?
100-10,000 organisms
35
what is the infection control (community) for campylobacter jejuni?
- good hygiene after handling raw poultry, dog and cat feces -proper refrigeration - pasteurization of milk and chlorination of water supply
36
is salmonella enterica gram neg or pos and what is the shape?
gram neg, bacillus shaped bacteria
37
salmonella enterica is associated with what two conditions?
- typhoid (enteric) fever (typhi & paratyphi) - salmonellosis
38
what is the treatment for salmonella enterica?
requires antibiotic therapy due to increased risk of life threatening complications
39
what are the symptoms of salmonellosis?
abdominal pain, cramps, inflammatory diarrhea (neg for blood), fever, nausea, loss of appetite, headache, myalgia, malaise
40
when do symptoms typically resolve with salmonellosis?
within 1 -2 weeks
41
what is the Tx for salmonellosis?
require supportive therapy only, antibiotics reserved for severe cases
42
how is salmonellosis transmitted?
ingestion of contaminated food an water (raw/undercooked meats, eggs, raw fruits an veggies, seafood) - fecal oral route (pets an people, eg. turtles an iguanas)
43
what is the infection control (community) for salmonellosis?
- proper refrigeration - avoid cross contamination of uncooked foods with raw foods that may contain salmonella enterica - good hand hygiene after handling animals
44
is enterotoxigenic E.coli gram neg or pos and what's the shape?
gram neg, bacillus shaped bacteria
45
what is enterotoxigenic E.coli commonly referred to as?
"travellers diarrhea"
46
what are the symptoms of enterotoxigenic E.coli?
water non inflammatory diarrhea, 4-5 loose/watery stools per day, abdominal cramps, bloating, nausea an vomiting, fever
47
when do symptoms typically resolve in enterotoxigenic E.coli?
1-3 days
48
how is enterotoxigenic E.coli transmitted?
- ingestion of contaminated food an water - person to person (fecal oral)
49
what is the infectious dose in enterotoxigenic E.coli?
100 organisms
50
in a severe case of enterotoxigenic E.coli, what symptoms will you experience?
dehydration, bloody stools, persistent vomiting, an high fever (>38.9 c) - antibiotic Tx reserved for severe cases
51
what is the infection control (community) for enterotoxigenic E.coli?
"boil it, cook it, peel it or forget it" and avoid consuming non-sterile sources of water
52
what is the Dukoral (oral vaccine)?
- adults an children minimum 2 yrs old - contains killed V. cholerae an attenuated V cholerae enterotoxin
53
what is the most common strain in Canada?
enterhemorrhagic E.coli (EHEC)
54
what are the symptoms of verocytotoxigenic E. coli (VTEC)?
inflammatory diarrhea (10 or more BM/day), abdominal cramping, pain, tenderness, low grade fever - hemorrhagic colitis in 6% of patients, usually 24 hours after symptom onset
55
what are the symptoms of verocytotoxigenic E. coli (VTEC)?
inflammatory diarrhea (10 or more BM/day), abdominal cramping, pain, tenderness, low grade fever - hemorrhagic colitis in 6% of patients, usually 24 hours after symptom onset
56
when do symptoms typically resolve in verocytotoxigenic E. coli (VTEC)?
within 1 week (in healthy adults)
57
how is verocytotoxigenic E. coli (VTEC) transmitted?
- contaminated milk, fruit juice, ground beef, an produce (spinach, sprouts) - person to person (fecal-oral)
58
what is the infection control (community) for verocytotoxigenic E. coli (VTEC)?
avoid consuming non sterile sources of water, watch for contaminated foods and proper cooking of contaminated meats
59
what symptoms occur in hemolytic ureic syndrome (HUS)?
fever, abdominal pain, pale skin tone, fatigue an irritability, small bruises or bleeding from nose/mouth, decreased urination, swelling of face/hands/feet
60
what is the complication (HUS) associated with?
branch of verocytotoxigenic E. coli (VTEC), associated with age extremes, occurs 3-7 days after onset
61
what does verocytotoxin do in the bloodstream?
invades blood stream an destroys RBCs, damaged RBCs clog the microvasculature of the kidney, causing kidney failure
62
what is HUS aggravated by?
anti motility drugs an antibiotics
63
what is the Tx of verocytotoxigenic E. coli (VTEC)?
RBC an platelet transfusions, plasma exchange, kidney dialysis
64
what is the leading cause of acute kidney failure in children?
hemolytic uremic syndrome (HUS)
64
is shigella spp. gram neg or pos and what is the shape?
gram neg, rod shaped bacteria
65
what is the most common species in North America?
S. Sonnei (branch of shigella spp.)
66
what population are most susceptible to S. Sonnei (shigella spp.)?
children between 2 an 4 years
67
how is S. Sonnei (shigella spp.) transmitted?
contaminated food an water, person to person (fecal-oral) - most commonly associated with poor hygienic conditions an overcrowding
68
what is the infectious dose for Sonnei (shigella spp.)?
10-100 organisms
69
what symptoms occur with shigellosis ?
inflammatory diarrhea (bloody an may contain mucous), abdominal cramps, rectal pain, fever an nausea
70
when do symptoms typically resolve for shigellosis?
2-3 days (carrier status, 4 weeks)
71
what is shigella dysenteriae?
severe purulent (mucous an pus) bloody stools, antibiotic therapy required, produce a shiga toxin similar verocytotoxin (VTEC)
72
is C diff gram pos or neg and what shape?
gram pos, endospore forming bacteria
73
how does inflammation occur in the colon in C. diff?
produce exotoxins that cause inflammation of the colon accompanied by increased fluid secretion an permeability of intestinal mucosa - enterotoxin (toxin A): diarrhea an inflammation - cytotoxin (toxin B): induces cell damage and facilitates lesion formation
73
when should C. diff be suspected?
any client who has diarrhea in association with broad spectrum antibiotic exposure (<2 months of symptoms) - fluoroquinolones, clindamycin, penicilin
74
what are symptoms of c diff?
water, foul smelling diarrhea, mild abdominal cramping an tenderness
75
what is a complication of c diff?
- pseudomembranous colitis (>10 bloody stools/day, intestinal lesions; on colonoscopy, the colonic mucosa contains small, raised, yellowish plaques) - bowel perf due to damage in intestine - toxic megacolon, gross distention of colon
76
what is the Tx for c diff?
discontinuation of antimicrobial agent an supportive therapy - if symptoms do not resolve give vancomycin - relapse in 10-20% of patients (fecal transplants)
77
is viral or bacterial gastroenteritis more severe?
bacterial
78
what are symptoms of viral gastroenteritis?
secretory diarrhea, abdominal cramping, nausea/vomiting, fever, chills, clammy skin, wt loss an lack of appetite
79
when do symptoms commonly appear in viral gastroenteritis?
within 24 hours of infection an resolve within 12 to 60 hours after symptom onset
80
viruses infect epithelial cells of the intestinal tract where they undergo which process?
lytic replication
81
in viral gastroenteritis, what happens once epithelial cells are destroyed?
replacement cells grow an function is restored
82
how is viral gastroenteritis transmitted?
contaminated food and water, person to person, aerosols from vomit

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