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47 Cards in this Set

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What is the definition of gastroenteritis?
inflammation of the mucous membrane of the both the stomach and intestine, usually causing nausea, vomiting, diarrhea, and abdominal pain
What are some signs and symptoms that a patient experiences prior to vomiting?
- dilation of pupils (mydriasis) - nausea - rapid irregular heart beat - dizziness - sweating - pallor
What is dysentery?
fever and bloody diarrhea
What strain causes infantile gastroenteritis?
- rotavirus - incubation period is 2-4 days - symptoms lasting 3-5 days
What agent causes epidemic gastroenteritis?
- norwalk - incubation period of 16-48 hrs - duration 1-2 days
List 4 general etiologies for gastroenteritis, from most common to least common
1. Viral (50-70%) - Norwalk virus, Caliciviruses, Rotavirus, Adenovirus, Parvovirus, Astrovirus 2. Bacterial (15-20%) - Salmonella, Shigella, and Campylobacter are the top 3 leading bacterial causes WORLDWIDE 3. Parasitic (10-15%) 4. Other
What are the 3 most common causes of food-bourne illness?
1. Staphylococcus aureus 2. Salmonella 3. Clostridium
What are characteristics of invasive infection?
the organism enters the mucosal cells, destroys them, causing diarrhea usually with blood in the stool
What are characteristics of enterotoxic syndromes?
- the organism do not invade the mucose, but produce enterotoxins - enterotoxins act as chemical mediators causing hypersecretion of the fluid - little damage is done to tissue
What are symptomsof viral gastroenteritis?
- abdominal cramps (#1 complaint) - vomiting - profuse watery stools - myalgias - fever - headaches - arthralgias
What are key symptoms of bacterial dysentery?
- small volume stools - fever - tenesmus (sensation that you need to go) - bloody mucoid stols - suprapubic pain relieved by BM
What are physical exam findings of gastroenteritis?
- abdominal tenderness - dehydration symptoms - fever (usually indicates organism invasion) - hypotension (indicates dehydration and electrolyte imbalance) - must do a rectal exam with complaints of nausea, vomiting, diarrhea)
What are labs to order for gastroenteritis?
- stool culture - hemoccult of stool - fecal leukocytes (usually present with dysentery) - CBC (if WBC count is elevated, increased likelihood of bacterial infection) - if C. Difficile is suspected, request cytotoxin of stool
If eosinophils are present in the CBC of a patient with gastroenteritis, what should you be suspicious of?
parasitic infection
What are general causes of eosiniphila (increase in eosinophils)?
NAACP (pneumonic) - Neoplasm - Asthma - Allergies - Collagen Vascular Disorder - Parasites
Most causes of gastroenteritis will need only fluid replacement and electrolyte control. What causes are the exceptions?
- Giardiasis - Amebiasis - C. Difficile - Salmonellosis - Shigellosis
What are the incubation periods for chemical poisons? staphylococcal infection? salmonella & shigella infection? giardiasis infection? C. Difficile? Botulism?
1. Chemical poison - onset immediate after ingestion 2. Staphylococcal food poisoning - onset with hours after eating contaminated food 3. Salmonella & Shigella infection - onset usually with 24-48 hrs. 4. Giardiasis infection - onset of symptoms after 1 week 5. C. Difficile - antimicrobial use with the last 2 weeks 6. Botulism - associated nerological symptoms after eating canned food. symptoms with 24 hrs
What are the 3 most common causes of viral gastroenteritis?
1. Norwalk 2. Caliciviruses 3. Rotavirus
What are characteristics of Staphylococcal Gastroenteritis?
- from foods left at room temperature - within 8 hrs after eating, N/V/D/F/HA, cramps - complete recovering in 24 hours - fecal leukocytes are usually absent - history of similar illness in others eating same food
What are characteristics of Cholera?
- caused by Vibrio Cholerae - spread by fecal contaimination of water, seafood, and other products - "Rice-Water" stools, painless, non-bloody, secretory diarrhea
What are characteristics of Shigellosis?
- caused by Shigella - causes dysentery (blood diarrhea) - within 3 days, diarrhea becomes severe and bloody, often with pus and mucus - fecal leukocytes present - TX: fluid replacement, Bactrim or Cipro, do not give anti-diarrheals
What are the 3 types of Salmonella?
1. Gastroenteritis 2. Enteric Fever (Typhoid Fever) 3. Bacteremia
What are characteristics of Salmonella?
- caused by eating foods produced from infected animals and contaminated water - incubation period 8-48 hrs - nausea, cramps, watery or bloody diarrhea, fever,vomiting - Tx: IV hydration, Antibiotics (Bactrim, Amp, or Cipro indicated in patients with increased risk for mortality)
What are characteristics of Hemorrhagic Colitis?
- caused by E. Coli 0157:H7, which produces a toxin that damages GI mucosa and vascular endothelial cells - S/S: acute, severe abdominal cramps and watery diarrhea that progresses to bloody diarrhea, low grade fever - uncomplicated cases last 1 week - complicated cases cause high fever, hemolytic uremic syndrome (HUS) or thrombocytopenic purpura (TTP)
Pseudomembranous colitis is commonly caused by what organism?
Clostridium difficile, caused by antibiotic therapy
What are 3 most common causes of Traveler's Diarrhea?
Most commonly caused by bacteria (80%), 1. Enterotoxigenic E. coli 2. Shigella 3. Campylobacter jejuni
What is Reye's syndrome?
- a severe, non-inflammatory, progressive encephalitis of children that is accompanied by fatty infiltration of the liver - can be caused giving a salicylate (aspirin or pepto-bismol) to children with a viral infection
What are signs and symptoms of protozoal infection?
- abdominal pain - wheezing of hemoptysis due to Loffler's Syndrome - dermatitis - diarrhea - dysentery - pruitis - rectal prolapse - steatorrhea - passage of paraities - bowel obstruction
What are physical finds of protozoal infection?
- weight loss - excessive gas or abdominal distention - hyperperistalsis - perianal infection - wheezing
What are tests done when protozoal infections are suspected?
- fecal smears (look for WBCs, RBCs, ova & parasites - stool cultures - CBC: eosinophilia, iron deficiency - Graham's Test (scotch tape test)
What are characteristics of pinworms?
- caused by Enterobius Veermicularis - transmitted by fecal-oral ingestion - key symptom is rectal pruritis - organism is nocturnal - test is the scotch tape test - Tx: Vermox, Antiminth (one dose, then repeat in one week)
What are characteristics of Giardia (Giardiasis)?
- symptoms are diarrhea, abdominal pain, flatus, steatorrhea - an upper GI parasite - Tx: Flagyl
What is the most common water borne infection?
Giardia (Giardiasis)
What are characteristics of Amebiasis?
- caused by Entamoeba hitolytic - foundin 4% of the population - found mostly in cecum & ascending colon, invading the mucosa - can travel to liver, lung, and brain - Tx: Flagyl
What are signs and symptoms of Amebiasis?
- asymptomatic to diarrhea - abdominal cramps - flatus, fever, hepatitis - shoulder pain due to hepatitis - bloody diarrhea - perianal ulcers - RUQ tenderness - pulmonary (pneumonia-emphysema)
What are characteristics of Ascariasis?
- most common intestinal helminth - caused by Ascaris lumbricoids (large intestine worm) - penetrate the intestine & invade liver, lung, and heart - pulmonary phase (Loffler's syndrome) and intestinal phase - Tx: Albendazole and Pyrantel pamoate
What is cysticercosis?
an infection caused by a tapeworm, Taenia solium
What is Trichuriasis?
- parasitic infection with whipworm - lives in the cecum and appendix - symptoms: allergic reactions, anemia, vague GI complaints, diarrhea, and abdominal distention - Tx: Albendazole, Mebendazole
What is the definition of diarrhea as a sign and as a symptom?
1. symptom: an increased frequency or volume of stool (3 or more liquid or semisolid stool daily for at least 2-3 consecutive days) 2. sign: diarrhea is formally defined as stool weight > 200 g/24hr
What are characteristics of acute diarrhea?
- present for less than 2 weeks - usually due to infectious agent, bacterial toxin, drugs
What are the 2 types of acute diarrhea?
1. non-inflammatory 2. inflammatory
What are characteristics of non-inflammatory diarrhea?
- S/S: watery, nonbloody diarrhea, abdominal cramps, bloating, N/V - a small bowel enteritis that disrupts the normal absorption & secretory process of the small bowel - diarrhea can be voluminous & cause electrolyte imbalance
What are characteristics of acute inflammatory diarrhea?
- S/S: fever, dysentery - colonic tissue damage cause by invasion of bacteria or toxins - involve the colon and diarrhea is smaller volume - associated with LLQ pain
What are mechanisms of chronic diarrhea?
1. Osmotic load: increase in amounts of poorly absorbable osmotic active solutes in the gut of the lumen (ex. lactose interolerance) 2. Excessive secretion: increase CL & H20 w/o sodium resorption 3. Exudation of protein (inflammatory) 4. Altered intestinal motility (IBS)
What is the effect of fasting on secretory diarrhea? on osmotic diarrhea?
- secretory diarrhea will persist with fasting - osmotic diarrhea will improve with fasting
Name 5 causes of bloody diarrhea?
1. Shigella 2. Salmonella 3. Campylobacter 4. E. Coli O157:H7 5. Yersinia enterocolitica
What are common causes of diarrhea in AIDS patients?
- Cryptosporidium - Isospora - CMV