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infectious small intestine and colon Flashcards

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1
Q

generic clinical presentation that suggests infectious enterocolitis

A

diarrhea, abd pain, urgency, perianal discomfort, incontinence, hemorrhage

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2
Q

with what population is infectious enter-colitis associated

A

children before 5

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3
Q

pediatric infectious diarrhea is associated with what kind of organism

A

enteric virsus

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4
Q

shape+type - cholera

A

comma shaped with flagella, gram (-), anaerobe, toxin producing

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5
Q

describe the virulence of cholera, and its activity within the GI tract

A

noninvasive, remain in intestinal lumen

have flagella, use to colonize

I A subunit, 5 B subunits
cholera toxin’s B subunits will bind the GM1 ganglioside on the membrane of the epithelial cell–> A subunit goes in–> Gs–> cAMP–> Cl- release via CFTR gene –> osmotic driving force that causes diarrhea

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6
Q

transmission, clinical presentation, complications of cholera

A

fecal-oral route, water, shellfish

endemic/epidemic or sporadic: asx or mild diarrhea OR abrupt RICE WATER profuse diarrhea may smell like fish

dehydration and electrolyte imbalances, LOC, death within 24 hours. if survive, last 1 week

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7
Q

what organisms will affect the small intestine specifically

A 
cholera
salmonellosis
typhoid fever
ETEC
EPEC
whipple ds
mycobacterial infection
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8
Q

what organism will act in the ileum, appendix, and right colon

A

yersinia

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9
Q

what organisms specifically affect the colon

A 
campylobacter
salmonellosis
EHEC
EIEC
EAEC
C Dif
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10
Q

what organisms affects the L colon and the ileum

A

shigellosis

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11
Q

transmission, clinical presentation, complications of campylobacter

A

poulty, milk, other foods, wild birds

children and travelers: watery or bloody diarrhea (dysentery)

reactive arthritis, guillain-barre, syndrome, enteric fever

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12
Q

transmission, clinical presentation, complications of shigellosis

A

fecal-oral, food, water

children, migrant workers, travelers, nursing home
(watery–>bloody+pus) diarrhea, fever, abd pain
SELF LIMITED= 1 week of sx, up to a month of constitutional sx
subacute presentation in adults: several weeks of waxing and waning
can be confused for UC

reactive arthritis, urethritis, conjunctivitis, HUS, toxic megacolon

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13
Q

transmission, clinical presentation, complications of salmonellosis

A

meat, poultry, eggs, milk

in children and older adults, watery or bloody diarrhea,
anywhere from loose stools to cholera like profuse diarrhea

sepsis, abscess

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14
Q

transmission, clinical presentation, complications of typhoid tumor

A

fecal-oral route

children, adolescents, travelers
bloody diarrhea (can persist for a week), fever (resolves within 2 days), anorexia, bloating, short asx phase that gives way to bacteremia and fever like flu sx
LLQ abd pain, rose spots on chest and abd

chronic infection, carrier state, encephalopathy, myocarditis, intestinal perforation

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15
Q

transmission, clinical presentation, complications of yersinia

A

pork, milk, water

clusters of people: abd pain, fever, bloodydiarrhea,
can mimic appendicitis

reactive arthritis, erythema nodosum

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16
Q

transmission, clinical presentation, complications of ETEC

A

food or fecal-oral,

infants, adolescents, travelers: severe watery diarrhea

dehydration, electrolyte imbalance

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17
Q

transmission, clinical presentation, complications of EPEC

A

fecal-oral route

infants: watery diarrhea

dehydration, electrolyte imbalance

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18
Q

transmission, clinical presentation, complications of EHEC

A

beef, milk produce

sporadic/epidemic: bloody diarrhea

HUS

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19
Q

transmission, clinical presentation, complications of EIEC

A

cheese, deli meats, water

young children, bloody diarrhea

–

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20
Q

transmission, clinical presentation, complications of EAEC

A

unknown

children, adults, travelers: non-bloody diarrhea, afebrile

–

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21
Q

transmission, clinical presentation, complications of C. Dif

A

us of abx in hospitals,

old, immunosuppressed, prolonged use of abx: watery diarrhea, fever, leukocytosis, cramps, dehydration, hypoalbuminemia

relapse, toxic megacolon

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22
Q

transmission, clinical presentation, complications of whipple ds

A

–

caucasian men, farmers and others working with exposure to soil/animals
rare: malabsorptive diarrhea, weight loss, arthralgia

arthritis, CNS disease

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23
Q

transmission, clinical presentation, complications of mycobacterial infection

A

immunosuppressed, endemic: malabsorption

pneumonia, infection at other sites

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24
Q

trx for cholera

A

timely fluid replacement, oral rehydration

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25
most common enteric pathogen in developed countries, traveler's diarrhea
campylobacter jejuni
26
virulence factors of campylobacter
flagella, cholera toxin-like enterotoxin
27
what patients are especially likely to develop reactive arthritis with a campylobacter infection
those with an HLA-B27
28
describe the etiology of Guillain-Barre w campylobacter
molecular mimicry as Ab against C. jejuni lipopolysaccharide cross react with PNS and CNS gangliosides
29
shape+type - campylobacter
comma shaped, flagellated, G(-)
30
how do you diagnose campylobacter
stool culture, showing increased neutrophil infiltrates, cryptitis+crypt abscesses with crypt architecture is preserved
31
shape+type - shigella
G(-), unencapsulated, nonmotile, FACULTATIVE ANAEROBE
32
most shigella infections and death occur in ___
children under 5
33
outline the etiology of a shigella infection
resistant to the harsh acidic environment of the stomach so can get through into the stomach, get to the intestine where it will be taken up by M cells, phagocytosed by Mø at which point they cause apoptosis ensuing inflammation--> shigella now has access to an invasion route
34
shigella has a tropism for what cell
M cells (lymphoid cells)
35
with shigella infection, while duration is much shorter in ___ than ___, severity is often much ____
children than adults | greater
36
what complication triad presents with Shigella, and which population is most likely to develop this
reactive arthritis, urethritis, conjunctivitis HLA-B27 (+) men between 20 and 40
37
what syndrome can develop post shigella or shiga-like toxin (EHEC/S. dysenteria) infection
HUS
38
describe treatment methods for shigella
abx treatment shortens the clinical course and reduces the duration of organism shedding in stools ampcillin or flouroquinolone ANTIDIARRHEAL MEDS ARE CONTRAINDICATED
39
shape+type - salmonella
enterobacteriaceae family of G(-) bacilli
40
causative agent of typhoid/enteric fever
salmonella typhi
41
causative agent of salmonellosis
nontyphoid salmonella
42
when is salmonella incidence highest
summer and fall
43
salmonella virulence
type 3 secretion system, transferring bacterial proteins into M cells and enterocytes, through peyer's patches trigger actin rearrangement via Rho GTPase and bacterial endocytosis flagellin --> TLR5 --> increase local inflammatory response some prevent TLR4 activation
44
what population is at a high risk of disseminated salmonellosis
genetic defects in Th17 immunity, immunosuppression
45
____ can prolong the carrier state or cause relapse of salmonella infection and doesn't help with shortening diarrheal duration
abx
46
what populations are at a high risk of severe illness due to salmonella
``` malignancies immunosuppressed alcoholics CV dysfunction sickle cell hemolytic anemia ```
47
gallbladder colonization w S. typhi/paratyphi can be associated with..
gallstones | chronic carrier state
48
describe the path of S. typhi in the body
survive through the stomach, once in the small intestine are taken up by and invade M cells disseminate via lymphatic and blood vessels
49
what histologic changes can be seen with salmonella infection
peyers patches in the terminal ileum enlarge and plateau-like elevate draining mesenteric LNs are also enlarged large oval ulcers small and scattered perenchymal necrosis typhoid nodules= in the BM, LN, hepatocytes replaced by Mø (phagocyte hyperplasia)
50
during the febrile phase of typhoid fever, almost all ____ are positive and ____ can prevent further disease progression, and the phase can last up to ___
blood cultures abx 2 weeks
51
what are some complications of typhoid fever
encephalopathy, meningitis, seizures, endocarditis, myocarditis, pneumonia, cholecystitis
52
what population is particularly susceptible to salmonella osteomyelitis
sickle cell disease
53
agent for pulmonic and bubonic plague
Y. pestis
54
when are yersinia infections most common
winter
55
what does yersinia do in the body
invade M cell, use adhesins to bind to host B integrins--> increase iron import to stimulate systemic dissemination
56
what populations are more likely to develop sepsis and death from a yersinia infection
chronic anemics or hemochromatosis | too much iron in body
57
where does yersinia preferentially infect
ileum, appendix, right colon
58
histologic changes w yersinia infection
regional LN and peyer patch hyperplasia, bowel thickening
59
enteritis and colitis secondary to yersinia is common in what population
younger children
60
extraintestinal sx of yersinia
pharyngitis, arthralgia, erythema nodosum
61
how do you detect yersinia
stool culture and yersinia selective agar LN/blood cultures fecal leukocytes (+) [clinically indistinguishable from salmonella + shigella)
62
what are post infectious complications of yersinia infection
reactive arthritis with urethritis and conjunctivitis, myocarditis, erythema nodosum, and kidney ds
63
shape+type - E Coli
G-
64
what is the main type of EHEC
E Coli O157:H7
65
predisposing factor for C Dif
immunosuppression + PPI use
66
etiology of C. Dif infection
toxins released lead to disruption of epithelial cytoskeleton, tight junction barrier loss, cytokine release, apoptosis
67
histologic changes seen w C Dif
pseudomembranes dense infiltrates of neutrophils and occasional fibrin thrombi within capillaries distended crypts w abscesses, volcanic like disruptions IS PATHOGNOMONIC
68
trx for C Dif
metronidazole | vancomycin
69
complications with C. Dif
recurrent infections
70
pathogenesis of Whipple
malabsorption (-->malabsorptive diarrhea), lymphadenopathy, arthritis
71
histologic changes with whipple
foamy Mø, large numbers of argyrophilic rods in the LNs sx appear when organism laden Mø accumulate within the small intestine and mesenteric LNs--> lymphatic obstruction white-yellow plaques HALLMARK: dense accumulation of foamy macrophages in the small intestine
72
what stains can be done for whipple disease
PAS + acid fast stain to differentiate from TB
73
whipple ds, you can find bacteria laden Mø built up in
mesenteric LN, synovial membranes of effected joints, cardiac valves, brain
74
family+type - norovirus
single stranded DNA | caiciviridae gamily
75
most common cause of acute gastroenteritis requiring medical attention
norovirus
76
top to causes of severe diarrhea in infants and young children
1. rotavirus | 2. norovirus
77
ASCARIS LUMBRICOIDES method of invasion+ morphology clinical presentation + epidemiology diagnostic feature
nematode=roundworm fecal oral: ingested eggs hatch in intestine and penetrate the intestinal mucosa--> splanchnic Vs--> systemic circulation--> grow in alveoli--> swallow and mature in intestine physical obstruction of the intestine or biliary tree can form hepatic abscess ascaris pneumonitis diagnosis with eggs in stool
78
STRONGYLOIDES method of invasion+ morphology complications
=roundworm larvae live in fecally contaminated tropical ground soil, can penetrate through unbroken skin--> migrate through lungs--> mature in intestine--> hatch and release larvae that penetrate the mucosa--> autoinfection can persist for life, immunosuppressed can developing overwhelming autoinfection induce peripheral eosinophilia
79
NECATOR+ANCYLOSTOMA DUODENALE method of invasion+ morphology clinical presentation + epidemiology test
hookworms larval penetration through skin-->lungs-->trachea-->swallowed--> in duodenum will suck blood and reproduce cause significant morbidity multiple superficial erosions, focal hemorrhage, inflammatory infiltrates, irone deficiency anemia diagnose by finding eggs in fecal smears
80
ENTEROBIUS VERMICULARIS method of invasion+ morphology clinical presentation + epidemiology test
pinworms fecal oral route--> from intestine migrate to the anal orifice at night and cause intense irritation rarely cause serious illness rectal and perineal pruritis, contamination of the fingers diagnosis with cellophane tape on the perianal skin
81
TRICHURIS TRICHIURA clinical presentation + epidemiology diagnostic feature
whipworms infect young children does not penetrate intestinal mucosa, so doesn't cause serious disease blood diarrhea and rectal prolapse with heavy infection
82
SCHISTOSOMIASIS method of invasion+ morphology clinical presentation + epidemiology
in the intestines, adult worms reside within the mesenteric Vs one version bone in the portal V--> esophageal varices sx present when eggs are trapped within the mucosa and submucosa, granulomatous immune reaction can cause bleeding and/or obstruction
83
intestinal cestodes method of invasion+ morphology clinical presentation + epidemiology diagnostic feature
tapeworms three types: fish, pork, and dwarf tapeworms ingestion of raw/under-cooked meat and fish attached to intestinal mucosa, gets its nutrients from the food stream and enlarges into a proglottids adult worms can grow up to METERS abd pain, diarrhea, nausea (via tiniea d. ) B12 deficiency--> megaloblastic anemia (t solium) --> cystacercosis= seizures and eye ds dx by finding proglottids and eggs in stool
84
ENTAMOEBA HISTOLYTICA ``` method of invasion+ morphology clinical presentation + epidemiology diagnostic feature complication prognosis trx ```
protozoan that causes amebiasis spread the fecal oral route reside in cysts= chitin wall and four nuclei, resistant to gastric acid so can get to small intestine colonize the epithelial surface of the colon and release trophozites--> reproduce anaerobically seen in india, mexico, and columbia, causes dysentery and liver abscess, abd pain, weight loss most common cause of dysentery worldwide create FLASK SHAPED ulcers with a narrow neck and broad base can penetrate the splanchnic vessels and embolize to the liver, persisting after the infection has passed go on to lung, heart, kidneys, brain huge abscess, persist after the acute illness has passed necrotizing colitis and megacolon significant mortality metronidazole
85
where do E. histolytica most often effect
cecum and ascending colon
86
GIARDIA method of invasion+ morphology clinical presentation + epidemiology diagnostic feature complication
fecal-oral route resistant to chlorine cause decreased expression of brush border enzymes, microvillous damage, apoptosis of small intestine epithelium found in rural streams, campers-->swallowed while swimming villous blunting with increased intraepithelial lymphocytes chronic diarrhea, malabsorption, weight loss characteristic pear shaped, two nuclei despite oral antimicrobial therapy, recurrence is common
87
most common parasitic pathogen in humans
giardia
88
what elements are responsible and necessary for clearance of giardia
secretory IgA and mucosal IL-6
89
at risk populations for giardia
immunosuppressed agammaglobulinemic malnourished
90
classic clinical presentation with cryptosporidium
chronic diarrhea in AIDS is acute and self-limited in the immunologically normal host
91
cryptosporidium method of invasion+ morphology clinical presentation + epidemiology diagnostic feature
resistant to chlorine so is present in unfiltered water ingested oocyte will release sporozoites upon activation--> enterocyte will engulf the parasite --> Na malabsorption, chloride secretion, increased tight junction permeability watery diarrhea in children and the immunosuppressed causes villous atrophy, crypt hyperplasia, inflammatory infiltrates
92
intestinal TB has a similar infiltrate as __. how do you differentiate between the two?
Whipple W= no acid fast, TB= acid fast

GI2 E1 (19 decks)

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