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ICM - Infectious Disease > Infectious Diarrhea > Flashcards

Infectious Diarrhea Flashcards

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1
Q

Differentiate diarrhea from…

A

Pseudodiarrhea - Rectal urgency, infection related
Fecal incontinence - Sudden, surprise discharge, NM related
Overflow incontenence - So packed up, liquid distends and flows around and leaks out

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2
Q

Amount of fluid entering Small Intestine?
Entering Large Intestine?
Exiting in normal stool?

A

9 L
2 L
0.1 L

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3
Q

Diarrhea reflects increased water in stool from…

A
  1. Increased Intestinal Secretion of Water

2. Decreased intestinal reabsorption of water

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4
Q

Duration of Acute, Persistent, and Chronic Diarrhea

A

Acute - Less than 14 days
Persistent - 14-30 days
Chronic - More than 30 days

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5
Q

Three primary types of Chronic Diarrhea

A

Watery
Fatty
Inflammatory

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6
Q

Common causes of Watery Chronic Diarrhea

A

Secretory (Colitis, Laxatives)
Osmotic (Laxatives)
Functional (Irritable Bowel)

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7
Q

Way of differentiating between Secretory and other causes of chronic watery diarrhea

A

Secretory will persist despite fasting

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8
Q

Causes of chronic fatty diarrhea

A

Malabsorption (Giardiasis, Celiac)

Maldigestion (Pancreatitis, Cystic Fibrosis)

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9
Q

What should you look for as an identified of chronic fatty diarrhea from maldigestion

A

Meat fibers in the stool

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10
Q

Causes of inflammatory chronic diarrhea (pus/blood in stool)

A

IBD (Ulcerative Colitis, Crohn’s)
Invasive (C Diff)
Neoplasia (Colon carcinoma)

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11
Q

Causes of Acute Diarrhea

A
  1. Usually viral
  2. Bacteria (esp. w/ blood, pus, fever, abdom. pain)
  3. Rarely Protozoa
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12
Q

Value of Stool Cultures?

A

Rarely valuable, consider in cases in which other results aren’t seen

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13
Q

Enteric pathogens that have preformed toxins

Site of Action?

A

Small Bowel – C. perfringens, S. Aureus, B. cereus

Colon – None

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14
Q

Enteric pathogens with enterotoxin?

Site of Action?

A

Small – Vibrio Cholerae

Colon – None

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15
Q

Enteric pathogens that are enteroadherent?

Site of Action?

A

Small – Giardia lamblia

Colon – None

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16
Q

Enteric pathogens that act with a cytotoxin?

Site of Action?

A

Small – None

Colon – E. Coli 0157:H7

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17
Q

Enteric Pathogens that cause dysentery?

A

Small – Salmonella, E. Coli

Colon - Campylobacter, Shigella, Entamoeba histolytica

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18
Q

Viruses that affect the Small Bowel

A

Rotovirus

Norovirus

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19
Q

Viruses that affect the colon

A

CMV
Adeno
Herpes

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20
Q

Common Associations – Vomiting. Cream Pie/Potato Salad at a picnic

A

S. aureus

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21
Q

Common Associations – Vomiting. Leftover Fried Rice.

A

B. cereus

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22
Q

Common Associations – Vomiting. Cruise Ships.

A

Norwalk-like viruses

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23
Q

Common Associations – Inflammatory Diarrhea. Hamburgers at a picnic.

A

Salmonella

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24
Q

Common Associations – Inflammatory Diarrhea. Hamburgers, Spinach

A

E. Coli 0157:H7

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25
Common Associations -- Inflammatory Diarrhea. Sushi
V. parahemolyticus
26
Common Associations -- Inflammatory Diarrhea. Raw oysters in a place they probably shouldn't be serving them.
V. vulnificus
27
What happens if you eat C. perfringens toxin. (Think home canned foods)
Toxin mediated acute GI symptoms | Gastroenteritis
28
What happens if you eat C. perfringens bacteria.
``` Pig Bel (Necrotizing Enteritis) (Look for high fever, distended abdomen) ```
29
Effects of C. botulinum
Paralytic neurotoxin released in anaerobic environment | Weakness, diplopia, progresses to paralysis
30
Effects of C. tetani
Excitatory neurotoxin formed by bacteria present in wounds | Lockjaw
31
Effects of C difficile
Toxin mediated colitis from C dif overgrowth | Pseudomembranous Colitis
32
Virus associated with daycare exposure
Rotavirus
33
Virus associated with cruise ships
Norovirus
34
Virus associated with MSM, Shellfish, Food workers
Hep A
35
Protazoa associated with travel, surface water.
Giardia lamblia
36
Bacteria associated with Traveler's Diarrhea (travels to the developing world)
ETEC
37
Bacteria associated with antibiotic use in the past 3-6 months.
C. difficile
38
Bacteria associated with Caesar salad, ice cream, ducklings, lizards
Salmonella
39
Seven components of a full diarrhea history
``` Onset Frequency Presence of mucous/blood Getting up at night? Associated symptoms Exposures (Travel, Camping, Other sick people, etc.) Recent AB use? ```
40
Describe a Bristol Stool Chart Type 1
Separate hard lumps, like nuts | Hard to pass
41
Describe a Bristol Stool Chart Type 2
Sausage shaped, but lumpy
42
Describe a Bristol Stool Chart Type 3
Like a sausage, but with cracks on the surface
43
Describe a Bristol Stool Chart Type 4
Like a sausage or snake | Smooth and soft
44
Describe a Bristol Stool Chart Type 5
Soft blobs with clear cut edges
45
Describe a Bristol Stool Chart Type 6
Fluffy pieces with ragged edges | Mushy
46
Describe a Bristol Stool Chart Type 7
Watery, No solid pieces
47
Signs of a surgical abdomen
Guarding, Rebound, increased pain/tenderness | Distended, No Bowel Sounds
48
Why should you be looking at the skin in a diarrhea physical exam
There are rashes associated with some pathogens. | Ex. Look for a on-blanching rash (Vasculitis)
49
Specifically mentioned piece of information gathered in a rectal exam.
Hemoccult
50
Other phrase for hemorrhoids
Sentinel Piles
51
What is an anal fissure? How does it happen? | Worry about it?
A tear in the anus Typically associated with trauma (Anal sex, BM) and hematochezia Usually not super pathological
52
What is hematochezia
passage of fresh blood through the anus
53
What is an anal fistula? How does it happen? | Worry about it?
Chronic abnormal communication between the epithelialised surface of the anal canal and the perianal skin associated with IBD. Associated with much higher risk of severe anorectal disease.
54
When a patient comes in claiming to have hemorrhoids, what should you check to make sure it isnt
HPV/Anorectal Warts
55
Describe the evaluation steps for an acute diarrhea patient.
Initial Eval -- Dehydration, inflammation Symptomatic Therapy If not severe, wait a week with symptomatic aids If severe, test for fecal leukocytes, stool culture Antibiotics if inflammatory, symptomatic if noninflammatory
56
What might be an indicator you need to check for Ova/parasites in stool?
``` Persistent Diarrhea Travel (Russia, Nepal) Exposure to infants in daycare centers MSM, AIDS Community Outbreak Bloody with few/no leukocytes ```
57
What do you do if you have persistent bloody diarrhea but your bacterial + cultures are getting you nowhere
Endoscopy (Look for tricky Inflammatory Bowel Disease)
58
Recipe for oral rehydration mix
half tsp salt half tsp baking soda 4 tbs sugar 1 L water
59
Three commonly used symptomatic therapies for diarrhea
Loperamide (Immodium) -- Anti-motility agent Diphenoxylate (Lomotil) -- Anti Motility agent Bismuth subsalicylate (Pepto-bismol)
60
5 commonly used steps in treatment of acute diarrhea
``` Oral Rehydration Symptomatic Therapy Probiotics Dietary Alterations Empiric antibiotics ```
61
Two commonly used probiotics
Align, Culturelle
62
Commonly recommended dietary alterations for acute diarrhea patients
``` Avoid Dairy (temporary lactase loss) Low Residue Diet (white foods, cooked vegetables, low fat meats) ```
63
Most commonly used empiric antibiotics for diarrhea
Fluoroquinolone (Cipro, levofloxacin) | Metronidazole
64
Where should you look for stones in an abdominal x-ray
Ureter rides along in the psoas shadow
65
Two types of abdominal x ray
KUB (kidney, ureter, bladder) | Upright

ICM - Infectious Disease (11 decks)

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