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49 Cards in this Set

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  • Back
what is a rare lysosomal storage disease in which lysosomal products accumulate acn become toxic to the nerves?

a purely neorgenic diarrhea
sandhoff disease (hexosaminidase B def)
what is the osmolality of all stool?
290 mosm
what effect will carbs have on the pH of stool?
decrease make more acidid
in addition to the physical barrier of the ileal cecal valve, what other mechanism occurs there?
the ileal brake medi by pep YY which is released by glucose or faut in ileum feeds back to slow stomach transit and si transit and increase absorption
what diease can damage ileocecal valve?
Crohn's
what are normally absorbed in proximal small bowerl?
Fe
folate
Ca
what are clues for distal small bowel diseas?
B12 def or bile acid def
what does a high anion gap mean?
there is little Na and K in stool; characteristic of osmotic diarrhea. often see a reduced volume from fasting
malabsorptive disorders- Na and K are not absorbed into the body from food
what does a low anion gap mean?
there is a lot of Na and K in stool; combined with no reduction from fasting, it can be Dx for secretory diarrhea (body secretes Na and K to achieve isosmotic stool
what are two things that can give you exogenous osmotic diarrhea?
osmotic laxitives
sorbitol
what are some exogenous factors for secretory diarrrhea?
stimulant laxatives
medications
toxins- seafood, cafiene, whiskey
preformed bacterial toxins
gut allergy
what are some endogenous factors for secretory diarrhea?
congenital
bacerial enterotoxins
endogenous lax- bile acids, blood, long cain FA
rare hormone tumors
what is the classic example of hypersensitivity inflammatory diarrhea?
celiac disease
what are two things that cause idopathic/autoimmune inflammatory diarrhea?
UC and Crohn's
what are three ways bismuth subsalicylate combats diarrhea?
stim Na and water reabsorb
direct antibacterial effect
binds enterotoxin
What is the presentation of Tropical Sprue?
looks like celiac disease; people have been in 3rd world for a few months
proximal bowel and gut atrophy
inflammation
weight loss
treatable with prolonged Abx
what is post infecious IBS or Brainerd diarrhea?
acte infection of gut; pathogen cleared but gut is disturbed and diarrhea continues for years
what bug is associated with red meat/hamburgers?
E coli 0157 H7
EHEC
what bug is associated with seafood?
Vibrio Cholerae
associated with peanut butter, reptiles, eggs?
Salmonella
associated iwth mayonaise? church picnics? potato salad?
Staph aureus, clostridial
pre formed toxins

(later salmonella and shigella)
foreign travel?
water in mexico
Asia
russia eastern euro
ETEC
Campylobacter
giardia
rice watery stool, dehydrations shock, death
vibrio cholera
fulminant liver failure
b cereus
immunocompromised with cirrhosis or iron overload?
v vulnifiicus
what are the most common chronic enteric pathogen diarrhea?
giardia, crypto, and c diff
relapsing diarrhea?
classic for c diff, 20% can relapse
HUS and TTP??
EHEC 0157 h7
avoid antibiotics in HUS
arthritis?
salmonella,
shigella
campy
yersinia
what can you do to increase yield in stool cultures?
screen for fecal leukocytes
cruise ship
acute gastroenteritis
short incu and dura
Norwalk virus
self limited; can do serology
immunity is conferred weeks to months
tx: supportive
most common cause in children 60%
kills villious cells in small bowel
fecal oral
begins with n/v
rotavirus
adults asymptomatic
short duration
dx: rotazyme type A stool antigen
tx: supportive
most common preform toxin
heat stabile enterotoxin A
it affects enterocyte: inflamatory change
affects neurons: motility change
short duration
STaph Aureus
supporitve
look for bacteir ain stool but unneces
heat labile cytotoxic enterotoxin from gram pos spore forming rods
incubation short 8-24, dura 24
watery diarrhea, may have pseudomembranes
clostridium perfringens
suppporive tx
one heat labile, one stabile toxin
diarrhea (heat labile) vom (heat stabile)
mitochondrial tox
lactic acidiosis
liver failure
b cereus
dx clinical
tx supportive
most common travelers diarrhea
toxins activate adenyalte cyclase and guanyalte cyclase--secretory diarrrhea
mexico water, fecal oral
ETEC
self limited
take pepto bismuth
red beef/hamburger
watery stool that become bloody, very sick
inflamatory rxn
HUS TTP can cause hemolysis or renal fail
usually no fever
EHEC 0157: H7
supprotive tx
antibiotics increase HUS
3rd world, gulf coast oysters, LA, TX
colonizes small bowel and produces cytotoxin that activates adenylate cyclase
voluminous rice water secretory more than 1L
vibrio cholera
specifically culture in stool; alos PCR
supportive tx, hydration, tetracycline
most common cause of path diarrhea
short incubation
mucosal invasion: fever and bacteremia
sticks to heart vave,prostheses, cholecystist
Salmonella
supprotive tx antibiotics may PROLONG carrier state; use if pt is old or immune comp
not common in US
fever with few GI sympt
incu: 1-2 wsk
fever ha pulse temp disscoiat
gi sympt 4th week
rose sports on abdomen
salmonella typhi
dx by stool cultures
common in Asia
fecal oral, food chicken, water
1-3 days dura 1 wk
bloody diarhea frequently
reactive arthirtis, guiilain berre
camy jejuni
tx: erytromycin
person-person well water
small inoculum
2-3 inoc dura 1-30 days
may be sever
has enterotoxin
invader and systmeic response
biphasic: watery-->bloody w intense inflam rexn
extra intestin: reiter syndrom, reactive arthiritis, occainally HUS
shigella
all people treateed with anitbiotics
heat labile tox
likes to be near lymphoid tisue
infect and ulcerate the ileum
may mimic Crohns
may mimic appendicitis
react arthrits HUS sepsis in iron overload pt
yersinia enterocolitica
tx support, ocasion abx
80% of antibiotic related diarrhea:
change in bac flora--> canges in car and maybe bile acid metabolism
self limited, better after Abx
no blood or pseudomembranes
tx. stop abx
20 of ARD
with or withou bloody diarhea
secretory diarrhea inflamatory diarrhea
hospital 3 day rule
tends to relapse
c diff
dx: stool testing, meaure toxin, check mucosa of colon for pseudomembranes: cottage cheesy
tx; taper antibx, fecal transplant
most common cause of diarrhea in the world:
IBS- watery diarrhea
bile salt mediated diarrhea:
type I
type II
type II
severe diseas in term ileum
IBS, bile salts over made (platelet derived growth facteor 4 casues bile salt stim, tx with bile salt binding meds)
vagal nerve injury
endocwhat is carcinoid symdrom?
comes from endocrine tuomrs; may cause secretory diarrhea; will not have osmotic gap
over produce 5HT
what kind of diarrhea is factitious disarrhea:
secretory, laxative abuse