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56 Cards in this Set

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Definition of SIRS
widespread inflammatory response
abnormal temp, High HR &/or RR (also low PaCO2), Left shift &/or abnormal WBCs (nrml is 4000-12,000)
Sepsis
SIRS + evidence of infection
Severe Sepsis
SIRS + evidence of infection + end organ failure
(CV, Renal, Pulm, GI, Renal)
Septic Shock
SIRS + evidence of infection + end organ failure + hypotension
Pathogenesis of SIRS
Cytokines (TNF & IL-1)
Bacterial Factors (endotoxin or staph enterotoxin or TSS)
Complement Activation
Cellular injury (ischemia, less surface area, apoptosis, hypoxia b/c rigid RBCs & poli adhesion, cytotoxicity b/c endotoxin, TNF, NO)
Cytokines in SIRS
TNF alpha & IL-1
Bacterial factors in SIRS
LPS, Staph enterotoxin, TSS
Cellular injury in SIRS
ischemia b/c poor perfusion
decreased surface area for O2 exchange
apoptosis
hypoxia b/c RBC rigid & PMN sticky
direct cytotoxicity from endotoxin, TNF & NO
Cause of Acute Renal Failure
48% can be attributed to SIRS
mortality is higher if SIRS
Patients at Risk for SIRS
bacteremic
Comorbidities- AIDS, Renal/Liver Failure, CA, middle age/elderly
Useful treatment for SIRS
manage fluids
Glycemic ctrl (insulin)- PMNs need
ABs
Ionotropes
Activated Protein C- avoid clots
Hydrocortisone (for renal insuff)
Failed Treatments for SIRS
High Dose Corticosteroids
TNF alpha inhibitors
Anti-endotoxin ABs
Ibuprofen
Two types of diarrhea & bugs
Inflammatory- usually bacteria (salmonella, campylobacter, shigella)
Non-inflammatory- bacillus cereus, viral, giardia, cholera
Signs/Symptoms of Inflammatory Diarrhea
Abdominal pain & fever
Positive stools- WBC & RBC, possibly toxin
Mechanism of Inflammatory Diarrhea
direct inflammation of gut wall
Mechanism of Non-inflammatory diarrhea
Secretory:
disrupted homeostasis
1. Change in gut villi (blunting)- Bacillus Cereus (reheated rice), Giardia
2. Viral- direct effect on endos
3. Toxin- cholera
Organisms in Viral Diarrhea
Rotavirus
Norwalk
Enteric adenovirus- Ad40 &41
small children/infants
Enterovirus- echovirus, may cause meningitis
Coronavirus- astro
Rotavirus
most common cause diarrhea in children
sudden onset, low fevers
villous changes
watery diarrhea, +/-URI
SEVERE DEHYD w/in 1 HOUR
(member of Reo)
Treatment of Rotavirus Diarrhea
tx: fluids, possible hospitalization
Norwalk
seen in all age groups
especially outbreaks in winter
cramps, NV watery diarrhea, HA, malaise, myalgias, lw fever
(member of Calcivirus)
Treatment of Norwalk Diarrhea
fluids, prevent spread, antiemetics
Common Bacteria Causing Diarrhea
Listeria & Clostridium- only G+ (bacilli)
Salmonella-enterobacter (G- bacilli) (Non-motile)
Shigella- enterobacter (has PS capsule)
E Coli- enterobacter (ferments lactose)
Cholera- G- vibrio
Vibrio Vulnificus- vibrio, shellfish
Characteristics of Cholera
G- vibrio
pandemics
classical biotype is E1
emerging biotype is 0139
Does NOT invade-colonize & multiply in gut
Treatment of Cholera
doxycycline, Bactim (0139 is resistant), quinolones
Signs & Symptoms of Cholera
Rice Water Diarrhea, rushing, fullness, vomiting
0139
bactim resistant emerging Cholera biotype
Characteristics of Salmonella
G- bacillus (enterobacter)
Invades & multiplies in M cells of Peyers Patches
typhimurium & enteriditis are most common
DT104 is emerging & resistant
Risk Factors for Salmonella
animals fed w/antibiotics, reptiles, PPI & H2 blocker, sickle cell
S&S of Salmonella
N/V, fever, myalgias, HA
loose/watery
secondary sites b/c hem spread
Treatment of Salmonella
Quinolones, PCN (extended), 3rd gen Cephalosporins
NO ABs in Healthy Adults (increases shedding time)
Characteristics of Shigella
Enterobacter, non-motile, fecal/oral trnsmission
most communicable bacterial diarrhea
shiga toxin highly contagious
RNAase
endotoxin causes watery diarrhea
S & S of Shigella
summer/fall, refuge camps
fever, cramps, watery diarrhea
bloody mucous or stool
Toxic megacolon
complication of shigella
also septicemia, keratoconjunctivitis, reiters like autoimmune, Ikari syndrome in kids
treatment for shigella
fluids & ABx
Characteristics of E Coli
G- bacilli
ferment lactose
Vero toxin (sim to shigella toxin)
S & S of E Coli
persistant, relapsing, watery diarrhea
bloody stool but no WBCs
Treatment for E Coli
Supportive only
NO ABx!
Characteristics of Listeria
G+
found in herd animals
S & S of Listeria
self limiting gastroenteritis
fetal toxicity
bacteremia
CNS
Treatment of Listeria
High Dose Ampicillin (+/- gentomycin or bactrim)
Clostridium
dificile- from ABx, assocd w/ colitis
Perfringens- gas gangrene
Botulinum- preformed toxin, spores
Vibrio Vulnificus
G- rod
"hazzard of halfshell"
skin infection
Cause of Food Poisoning
Staph Aureus b/c ingest preformed enterotoxin

Bacillus Cereus from reheated rice
Red Currant Jelly diarrhea
Entamoeba Histolytica
Protazoa associated with AIDS
cryptosporidium
Bug in dental caries
strep mutans
characteristics of normal flora in mouth
gingival crevice has higest number (along with colon)
low O2 tension so anaerobes
Strep Mutans is normal flora in ...
dental caries (gingival crevice)
Prevotella intermedia is normal flora in ...
gingivitis
veillonella parvula is normal flora in ...
saliva- common infection from human bite
Normally Sterile sites
Airway below larynx
Eustacian Tube
Sinus
Uterus
Fetus
Bladder
GI & Vagina until birth
Male GU (UTI implies underlying pathology)
Normal Bugs in oro/nasopharynx
GAS most common
strep pneumo, staph aureus, HIB, HSV (80% of adults)
Normal Bugs in UR tract
Anaerobes- veillonella, actinomyces, peptostrepto, fuso
Aerobes- HIB, Strepto, staph, neisseria
Fungi- candida
Normal Bugs in stomach
lactobacillus & H Pylori
Lactobacillus
important normal flora in stomach (with H pylori)
homeostasis
Normal Bugs in small intestine
peptostrepto, prevotella
produce volitile FAs that protect (salmonella)
candida
giardia