A 52-year-old man comes to see you complaining of HTN and HLD. He hasn't seen a doctor in 2 years. He has a 30 pack-year history and BMI of 23. What prevention measure should you do to prevent GI/hepatic disease in this patient?
You need to do grade A screening for colorectal cancer between ages 50-75: annual FOB testing, sigmoidoscopy every 5 years + FOB every 3 years or colonoscopy every 10 years.
C recommendation for colorectal cancer screening?
Counsel against routine screening for colorectal cancer in adults age 76-85 due to complications.
D recommendation for colorectal cancer screening?
Don't screen in people > 85 years old because risks outweigh benefits
I statement for colorectal cancer screening?
There is insufficient evidence of value of screening with CT colonography or fecal DNA testing
B recommendation for hepatitis B screening?
Screening patients at high risk for infection has good benefits
A recommendation for hepatitis A screening?
Pregnant women should definitely be screened
B recommendation for hep C screening?
High risk people and one time screen for people born 1945-1965
D recommendation fo pancreatic cancer
Do not screen regularly for pancreatic cancer in asymptomatic adults
After exposure to a known infected patient (Hep B, C and HIV) what is the likelihood of getting infected?
HBV = 30%, HCV = 3%, HIV = 0.3%
Protocol for HBV pre-exposure vaccination for health care workers
3 shot series then test for HBsAb 1-2 months later. If negative redo 3 shot series.
Protocol for HBV post-exposure prophylaxis
Give HBIg and HBV vaccine booster if the patient is HBsAG positive and the worker is HBsAb negative
Protocol for HBA post-exposure prophylaxis
HAIg (infants and 40+, immunocompromised) or HA vaccine (1-40 years) within 2 weeks of exposure
Vaccine preventable GI diseases
What is responsible for most traveler's diarrhea? How does this affect your treatment in a patient?
80% of traveler's diarrhea is bacterial so you would give them abx before they go. Note that they should not self treat for dysentery, but can self treat with normal watery traveler's diarrhea.
Group preferred for azithromycin when traveling
Pregnant woman and children due to potential for MSK disorders w/fluoroquinolones. SE asia due to campylobacter resistant bacteria.
Pre-exposure prophylaxis for traveler's diarrhea
Most important steps in a foodborne outbreak
Confirm the existence of an outbreak and confirm the diagnosis.
2-6 hours vomiting/diarrhea from food handlers
B. cereus incubation
1-15 hours, vomiting/diarrhea w/rice
6-48 hours, associated with animal foods
2-5 days, sporadic, milk/poultry
Most important prevention for norovirus
Highly transmissible in crowded settings via water source. Treating it?
Cholera. Field sanitation and water sanitation
Chronic diarrhea w/cramping after camping trip w/insidious onset. Treatment?
Giardia. Treated w/metronidazole.
Methods for water treatment?
Heat, halogenation, coagulation/flocculant (clumps particles), filtration (viruses can still get through)
Deployed environment workhorse for water
Reverse osmosis water
What does chlorinated water not kill?
Cryptosporidium or cyclospora