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137 Cards in this Set
- Front
- Back
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diarrhea and sometimes ulcerative and inflmmatory changes in small and large intestines.
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gastroenteritis
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What causes gastroenteritis?
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1) VIRUSES
2) bacteria 3) parasites |
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Deaths caused by gastroenteritis?
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worldwide problem 12,000 deaths/day in developing countries due to dehydration and electrolyte loss
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Is gastroenteritis acute, subacute or chronic?
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acute
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Signs and symptoms of gastroenteritis
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infectious diarrhea
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Common parasites that cause gastroenteritis?
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Giardelli
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What can gastroenteritis cause?
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-severe dehydration
-metabolic acidosis |
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S. flexneri gram-negative faculative anaerobe can cause what disease?
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shigella
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How is shigella transmitted?
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-fecal oral route
-contaminated food |
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Which part of the body does shigella invade?
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intestinal mucosa
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Age group for shigella
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young children in endemic areas
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Rice water stool
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shigella
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Incubation of shigella
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1-4 days
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Signs and symptoms of shigella
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-fever
-nausea -diarrhea -dehydration -rice water stools |
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flagellated gram-negative bacteria
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salmonella
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Which bacteria cause salmonella?
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food and water-borne
-S. enteritidis, -S. typhimurium |
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How is salmonella transmitted?
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-fecal-oral
-inadequate hygiene -water -flies -chicken |
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Signs and symptoms of salmonella
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-fever
-headache -arthralgia -phanyngitis -anorexia |
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Incubation period for salmonella
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8-14 days
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Incubation period for staphylococcal
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2-8 hours
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Signs and symptoms of staphylococcal
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-severe nausea
-vomiting -diarrhea -headaches -fever |
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Which foods may contain staphylococcal?
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-meat
-fish -custard -milk |
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How is staphylococcal transmitted?
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-food handler with skin infection
-food left at room temperature |
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Incubation period for clostridium?
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18-36 hours
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Signs and symptoms of clostridium
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-nausea
-vomiting -abdominal cramps -diarrhea |
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Bacteria that cause clostridium
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1) C. Botulinum
2) C. difficile 3) C. perfringens |
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What can cause clostridium outbreaks?
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seafood
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Which foods can carry clostridium?
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1) veggies
2) fish 3) fruits 4) beef 5) milk products 6) pork 7) poultry |
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What most commonly carries Clostridium botulinum?
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home canned foods
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comma shaped, flagellated gram-negative bacteria
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campylobacter
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Campylobacter jejuni is responsible for ____X the enteric disease of Salmonella, and ____X Shigella.
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-2
-4 |
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What can contain campylobacter?
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-eggs
-improperly cooked chicken |
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Signs and symptoms of campylobacter
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-watery and sometimes bloody diarrhea
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Incubation period for campylobacter
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1-10 days
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What is the 2nd most common infection that causes enteritis?
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campylobacter
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What is the most common infection that causes enteritis?
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E. coli
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travelers diarrhea
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E. coli
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AKA for traveler's diarrhea
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Montezuma's revenge
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What can cause gastroenteritis from Escherichia coli?
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-undercooked beef
-unpasteurized milk -contaminated water |
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Signs and symptoms for E. coli
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-severe abdominal cramps
-watery diarrhea that can become bloody -fever (low or absent) |
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What are the 2 types of E. coli?
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1) enterotoxigenic
2) entero-invasive |
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E.coli metabolic waste causes damage to tissues is called?
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ernterotoxigenic
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E. coli attacks cells and takes over for reproductive processes is called?
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entero-invasive
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What is the source of viral gastroenteritis?
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-contaminated water and food
-person-to-person |
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Which viruses are responsible for viral gastroenteritis?
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1) rota virus
2) caliciviruses (norwalk and sapporo) 3) adenovirus 4) astrovirus |
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What kind of virus is rota virus?
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dsRNA
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What kind of virus is calicivirus?
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ssRNA
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What kind of virus is adenovirus?
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dsDNA
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What kind of virus is astrovirus?
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ssRNA
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Signs and symptoms of viral gastroenteritis
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-nausea
-vomiting -watery diarrhea |
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Incubation period of rotavirus
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2 days
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Incubation period of caliciviruses
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1-3 days
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Incubation period of adenovirus
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3-10 days
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Incubation period of astrovirus
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2-3 days
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Age infected with rota virus
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6-24 months
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Age infected with caliciviruses
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Norwalk = child
Sapporo = adult |
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Age infected with adenovirus
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infants up to age 2
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Age infected with astrovirus
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children
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Which virus that causes viral gastroenteritis occurs in temperate climates (winter months)?
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rota virus
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Functional bowel disorder
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irritible bowel disease
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Signs and symptoms of irritable bowel disease
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1) moderate to severe abdominal pain
2) constipation and bloating 3) diarrhea 4) feeling of urgency or feeling of incomplete bowel movement |
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Diagnosis of irritable bowel disease
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-primarily a diagnosis of exclusion
-rule out: 1) tumor 2) IBD 3) parasitic infections 4) lactose intolerance |
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2 types of IBD?
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1) ulcerative colitis
2) crohn's disease |
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Treatment of Irritable Bowel Disease
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-treat symptoms
-diarrhea (codeine) -constipation (laxatives) -cramps (antispasmodic med) -tricyclic antidepressents -improve diet (eat fiber) -probiotics |
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Prognosis for irritable bowel disease
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-treat symptoms for pt comfort
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What usually causes appendicitis?
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obstruction at neck of appendix
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How does the appendix swell up?
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-fills with mucus & swells causing intraluminal pressure, then vascular collapse
-ischemic injury then favors bacterial proliferation |
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Signs and symptoms of appendicitis
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-pain, vomiting, and fever
-Kosher's sign -Dunphy's sign -Blumberg sign -Rovsing's sign |
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Mid abdominal pain then moves to right lower quadrant is called?
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Kosher's sign
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Pain of lower right quadrant with cough is called?
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Dunphy's sign
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Rebound tenderness, deep palpationi with sudden release causes spike in pain?
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Blumberg Sign
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Diagnosis of appendicitis
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-pt history
-blood test (measure WBC count) -urine test (if appendix rubbing on bladder could have blood in urine) -X-ray, US, and CT scan |
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Treatment of appendicitis
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-pain management before surgery
-surgery (removal of inflamed appendix) - laparoscopic surgery |
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Prognosis for appendicitis
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-usually responds well with surgery
-if not treated in time, there may be peritonitis and possibly sepsis. |
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Condition of two's
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Meckel's diverticulum
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a remnant diverticulum of the vitelline duct or yolk sac
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Meckel's diverticulum
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Meckel's diverticulum is a remnant diverticulum of which 2 things?
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1) vitelline duct
2) yolk sac |
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What % of the population has Meckel's diverticulum?
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2%
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Where does Meckel's diverticulum occur?
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at the end of the ileum within 2ft of the ileocecal valve
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Signs and symptoms of Meckel's diverticulum
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-usually asymptomatic
-2% may have symptoms, and would present like appendicitis |
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Diagnosis for Meckel's diverticulum
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-rule out appendicitis
-X-ray -CT Scan |
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Treatment for Meckel's diverticulum
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if symptomatic, surgical removal
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malabsorption syndrome caused infectious agent found in tropical regions
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tropical sprue
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What occurs physiologically with a tropical sprue?
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flattening of the microvilli
inflammation of the small intestines |
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Where is tropical sprue an endemic?
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1) India
2) Southeast Asia 3) Africa 4) Caribbean |
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Signs and symptoms of Tropical sprue
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-diarrhea
-steatorrhea -abdominal discomfort -nutritional deficiences |
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fatty stools
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steatorrhea
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What causes symptoms from Tropical Sprue?
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-deficiencies of albumin, folic acid, calcium, vitamin B12, and iron
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Diagnosis of tropical sprue
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-blood test (megaloblastic anemia, vitamin levels, mineral levels)
-fecal test (steatorrhea) -endoscopic exam -biopsy of small intestine |
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Treatment of tropical sprue
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antibiotics
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What bacteria causes whipple's disease?
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infection by the bacteria Tropheryma whipplei
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What causes whipple's disease?
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malabsorption, but also can affect any other organ of the body
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Is whipple's disease more common in men or women?
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men
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Sign and symptoms of whipple's disease
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-anemia
-skin pigmentation -polyarthralgia/arthritis -weight loss -diarrhea -insufficient absorption of nutrients -steatorrhea -swelling (albumen deficiency) |
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Diagnosis of whipple's disease
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-intestinal biopsy (PAS + for macrophage inclusions
-biopsy (lymph nodes to detect foamy macrophages) -endoscopic exam (pale yellow mucosa with erythmatous eroded patches) |
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Treatment of Whipple's disease
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long term antibiotic use for 1-2 years
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Prognosis of whipple's disease
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-can be fatal if not treated
-if tx is not long enough, 40% chance of relapse |
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AKA for gluten sensitive enteropathy?
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celiac disease
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chronic condition characterized with mucosal lesions of small intestine, and impaired nutrient absoption, caused by allergic rxn to wheat gliadins.
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gluten sensitive enteropathy
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What are people who have gluten sensitive enteropathy allergic to?
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wheat gliadins
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What what occurs in patients with gluten sensitive enterophathy?
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t-cell mediated inflammatory response with an autoimmune component
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Signs and symptoms of gluten sensitive enteropathy
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-classic presentation w/diarrhea, flatulence, weight loss, and fatigue
-skin blistering -neurologic symptoms |
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Diagnosis gluten sensitive enteropathy
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-blood test (low iron, albumin, calcium, potassium, and sodium) (High alkaline phosphatase)
-improvement w/restriction of gluten intake -anti-tTG antibodies (transglutaminase) -endoscopic biopsy of small intestine (look for atrophied villi) |
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Treatment for gluten sensitive enteropathy
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-remove gluten from diet
-supplementation w/vitamines & minerals -within several wks mucosa begins to heal |
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Prognosis for gluten sensitive enteropathy
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-gluten removal brings individual back to health, may develop intestinal lymphoma if dx was not controlled over a long period (scalloped fold or cracked mud look)
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inability to breakdown milk sugar due to absence of lactase from brush border (columnar cells produce lactase).
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lactose intolerance
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Is lactose intolerance an inherited disorder?
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rarely
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an acquired condition usually following a viral or bacterial enteric infection
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lactose intolerace
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What % of adults could develop lactose intolerace?
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up to 75%
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Signs and symptoms of lactose intolerace
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-bloating
-diarrhea -borborygmi -flatus -nausea -abdominal cramps |
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Diagnosis of lactose intolerance
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-breath test for Hydrogen (lactose digested by bacteria in gut produces lots of hydrogen)
-challenge test (give pure lactose to see if causes symptoms |
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Treatment of lactose intolerance
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-avoid eating foods with lactose
-take lactaid before ingesting milk or other dairy foods |
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inflammatory bowel disease
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ulcerative colitis
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Age affected by ulcerative colitis
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seen mostly b/t ages 15-30
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Where does ulcerative colitis begin?
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begins in rectum/sigmoid region and extends proximally
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What part of the colon does ulcerative colitis affect?
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mucosa and submucosa
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Which systemic disorders are seen with ulcerative colitis?
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1) polyarthritis
2) AS 3) uveitis 4) sacroilitis 5) hepatic involvlement |
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Signs and symptoms of ulcerative colitis
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-bloody diarrhea
-fever -gas and bloating -cramps Also: -apthous ulcer -pyoderma gangrenosum |
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Diagnosis of ulcerative colitis
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-blood test = test for anemia, thrombocytosis (high platelet count)
-barium x-ray (lead pipe sign) -endoscopic exam = pseudopolyps, continuous ulceration, erythema -stool test |
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Treatment of ulcerative colitis
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-avoid raw fruits & veggies due to mechanical trauma during digestion
-aminosalicylates (sulfasalazine) -corticosteroids -surgery (removal of diseased colon) -fish oil (anti-inflammatory) -probiotics |
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Prognosis for ulcerative colitis
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-risk of colorectal cancer increases
-disease can go into remission -effect on lifespan of individual not known, but quality of life is decreased |
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a chronic inflammatory disease affecing more commonl dstal ileumand colon
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crohn's disease
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transmural lesions with thickened rubbery intestinal wall, seen affecting specific areas with intervening unaffected segments
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crohn's disease
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can fissure and causd fistulas, also has noncaseating granulomas
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crohn's disease
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Age for crohn's disease
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all ages but peak is 2nd and 3rd decade of life
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string sign due to hypertrophy of muscular wall
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crohn's disease
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creeping fat sign
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crohn's disease
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Signs and symptoms of Crohn's disease
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-diarrhea
-fever -abdominal pain -weight loss -palpable mass -initially mild intermittent attacks which can be spaced by weeks to months |
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Complications which may arise from Crohn's disease
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-fibrosing strictures
-fistulas -malabsoption syndromes |
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What are some extraintesinal manifestations of Crohn's disease?
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1) AS
2) polyarthritis 3) erythema nodosum 4) sacroilitis |
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Diagnosis of Crohn's disease
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-barium x-ray = skip lesions, string sign
-Hx of GI symptoms which present with: *unexplained arthritis, erythema nodosum *perianal fistulas or abscesses -blood test = anemia, leukocytosis, hypoalbuminemia, and elevated ESR or c-reactive protein -endoscopic exam |
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Treatment of Chron's disease
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-no specfic therapy known
-can use anti-inflammatory or corticosteroid meds for acute stage for pt comfort -surgery = remove portion of bowel if blockage is excessive -probiotics & supplementation |
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Prognosis of crohn's disease
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-no cure
-try to limit flare-ups -does not decrease life span |
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Acute primary peritonitis vs secodary peritonitis
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Primary = rare, infection vi bloodstream
Secondary = most commonly perforation of GI tract |
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Sign and symptoms of peritonitis
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-abdomial pain, tenderness, guarding
-abdominal rigidity -fever, tachycardia -possible intestinal paralysis (no bowel sounds) |
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Diagnosis of peritonitis
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-hx or presentation of symptoms
-abdominal x-ray = check for abdominal perforation by lookig for gas pocket -blood test = leukocytosis |
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Treatment of perotinitis
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-antibiotics for infection
-surgery = if needed to correct underlying probem |
