Lecture 7 - GI infections 1

Question 1

Diarrhea definition

Answer 1

more than 3 stools per day

Question 2

Type of diarrhea

Answer 2

acute = < 2 weeks
Persistent = > 14 day
Chronic = > 30 days

Question 3

Clinical Presentation Diarrhea

Answer 3

Signs of volume depletion = weight loss, dec urine output, change skin turgor
Abnormal vitals = HR,Fever
Altered mental status
Abdominal tenderness

Question 4

Leading cause of diarrhea?

Answer 4

viruses

rotovirus in children
norovirus

Question 5

Most common cause of bacterial diarrhea?

Answer 5

Vibrio = world wide

Question 6

Watery Diarrhea classification

Answer 6

ie Watery
< 10 per day
reduce absorption
Absent or few PMNS

*** Flids, Electrolytes, Self-limiting **

Question 7

Dysenteric Diarrhea classification

Answer 7

ie. Bloody/Mucousy
> 10 per day
toxins, mucosal invasion
Many PMNS

* Antimicrobials (not EHEC), fluids and electrolytes**

Question 8

N/ vomitign is caused by….

Answer 8

toxins

Question 9

Food Poisoning info

Answer 9

Often caused by Staph

Due to contaminated food/handler

Rapid onset within 4-6hrs

Question 10

Vibrio cholera Diarrhea

Answer 10

causes “rice water” stools
can also cause skin lesions
Due to ingestion of contaminated water/food

Question 11

E.Coli diarrhea

Answer 11

most common cause of travelers
causes “cholera-like”
usually self limiting 24-48hrs

Question 12

Shigella Diarrhea

Answer 12

caused by poor sanitation and hygiene
High risk infants, elderly, immunocompromised
causes Dysenteric Diarrhea and can last a week

Question 13

Salmonella Diarrhea

Answer 13

S. Typhi = typhoid fever
S. enteriditis = chicken

N/V/ watery diarrhea, abdominal cramping, chills, headache, myalgia

Self limiting

increased mortality with bacteremia

Question 14

Rehydration therapy for mild-moderate diarrhea

Answer 14

ORT

100-150ml/kg/day
BRAT diet
Avoid high fiber, sodium, sugar
probiotics and zinc supplementation

Question 15

Rehydration therapy for therapy diarrhea

Answer 15

IV fluid replacement
Lactated ringers & normal saline

Question 16

Vibrio cholerae antibiotic treatments

Answer 16

Adults = Doxycycline 1 dose
Children/ TMP/SMX, erythromycin

Question 17

Salmonella antibiotic treatments

Answer 17

Cipro: 500mg BID X 3-7days
Azithromycin 1g po, then 500mg QD X 6 days

** no anti motility**

Question 18

prevention of food borne illness

Answer 18

Wash hands
Handle foods properly = cook thoroughly, clean areas, fridge leftovers
dont prepare foods if you’re sick

Question 19

Common causes of Travelers Diarrhea?

Answer 19

ETEC

Symptoms occurs within 48hrs
> 3 loose watery stools in 24hrs with cramping. lasts 3-7 days

prevention is key, peel it, boil it, cook it or forget it

Question 20

Traveler’s Diarrhea Prophylaxis = Bismuth subsalicylate

Answer 20

Bismuth subsalicylate (QID)
Reduces risk by 50%, dont use in Aspirin allergy, pregnancy or DI..dont use anticoagulant pts
SE = blackish stool and tongue

Question 21

Traveler’s Diarrhea Prophylaxis = Probiotics

Answer 21

Lactobacillus GG & Sacchromyces boulardii most data

Question 22

Travelers Diarrhea Prophylaxis = Abx

Answer 22

Rifaximin = 200mg QD/BID but not used much, minimally absorbed

In general, ABX not recommended for Prophylaxis

Question 23

if blood in stool or fever can you use loperamide/antimotility?

Answer 23

nah, only if they dont have those symptoms

Question 24

Travelers Diarrhea Treatment Fluids & food

Answer 24

Clear liquids and salty foods
ORT or mineral water containing Na/Glu

Question 25

Travelers Diarrhea Treatment Symptomatic relief

Answer 25

anti motility if no fever/blood stool

loperamide 4mg, then 2mg PO after each loose stool = 16mg max ****

Bismuth subsalicylate, max 8 doses/24hrs

Question 26

Travelers Diarrhea Treatment Abx

Answer 26

Cipro 3 day course or Azithro 3 day course if FQR & OK preg