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49 Cards in this Set
- Front
- Back
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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)
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what is the osmolality of all stool?
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290 mosm
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what effect will carbs have on the pH of stool?
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decrease make more acidid
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in addition to the physical barrier of the ileal cecal valve, what other mechanism occurs there?
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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
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what diease can damage ileocecal valve?
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Crohn's
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what are normally absorbed in proximal small bowerl?
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Fe
folate Ca |
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what are clues for distal small bowel diseas?
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B12 def or bile acid def
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what does a high anion gap mean?
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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 |
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what does a low anion gap mean?
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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
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what are two things that can give you exogenous osmotic diarrhea?
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osmotic laxitives
sorbitol |
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what are some exogenous factors for secretory diarrrhea?
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stimulant laxatives
medications toxins- seafood, cafiene, whiskey preformed bacterial toxins gut allergy |
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what are some endogenous factors for secretory diarrhea?
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congenital
bacerial enterotoxins endogenous lax- bile acids, blood, long cain FA rare hormone tumors |
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what is the classic example of hypersensitivity inflammatory diarrhea?
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celiac disease
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what are two things that cause idopathic/autoimmune inflammatory diarrhea?
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UC and Crohn's
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what are three ways bismuth subsalicylate combats diarrhea?
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stim Na and water reabsorb
direct antibacterial effect binds enterotoxin |
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What is the presentation of Tropical Sprue?
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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 |
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what is post infecious IBS or Brainerd diarrhea?
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acte infection of gut; pathogen cleared but gut is disturbed and diarrhea continues for years
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what bug is associated with red meat/hamburgers?
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E coli 0157 H7
EHEC |
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what bug is associated with seafood?
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Vibrio Cholerae
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associated with peanut butter, reptiles, eggs?
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Salmonella
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associated iwth mayonaise? church picnics? potato salad?
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Staph aureus, clostridial
pre formed toxins (later salmonella and shigella) |
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foreign travel?
water in mexico Asia russia eastern euro |
ETEC
Campylobacter giardia |
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rice watery stool, dehydrations shock, death
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vibrio cholera
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fulminant liver failure
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b cereus
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immunocompromised with cirrhosis or iron overload?
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v vulnifiicus
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what are the most common chronic enteric pathogen diarrhea?
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giardia, crypto, and c diff
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relapsing diarrhea?
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classic for c diff, 20% can relapse
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HUS and TTP??
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EHEC 0157 h7
avoid antibiotics in HUS |
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arthritis?
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salmonella,
shigella campy yersinia |
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what can you do to increase yield in stool cultures?
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screen for fecal leukocytes
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cruise ship
acute gastroenteritis short incu and dura |
Norwalk virus
self limited; can do serology immunity is conferred weeks to months tx: supportive |
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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 |
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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 |
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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 |
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one heat labile, one stabile toxin
diarrhea (heat labile) vom (heat stabile) mitochondrial tox lactic acidiosis liver failure |
b cereus
dx clinical tx supportive |
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most common travelers diarrhea
toxins activate adenyalte cyclase and guanyalte cyclase--secretory diarrrhea mexico water, fecal oral |
ETEC
self limited take pepto bismuth |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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80% of antibiotic related diarrhea:
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change in bac flora--> canges in car and maybe bile acid metabolism
self limited, better after Abx no blood or pseudomembranes tx. stop abx |
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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 |
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most common cause of diarrhea in the world:
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IBS- watery diarrhea
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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 |
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endocwhat is carcinoid symdrom?
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comes from endocrine tuomrs; may cause secretory diarrhea; will not have osmotic gap
over produce 5HT |
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what kind of diarrhea is factitious disarrhea:
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secretory, laxative abuse
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