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52 Cards in this Set
- Front
- Back
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diarrhea is defined as what
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>3 loose/watery stools
increased volume or fluidity |
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inflamm v non inflamm diarrhea
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inflamm: WBC, RBC present. Invasion or cytotoxin. fever (except EHEC O157H7)
non inflamm: watery, cramps, bloat, NV |
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acute v chronic diarreha
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Acute: usually viral cause
Chronic: medical- malabs, carcinoid, ZE, chrons, IC |
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inflamm bacteria bc of bacterial invasion
1 2 3 |
1. salmonella
2. shigella 3. campylobacter **bloody diarrhea with fever, cramps |
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cytotoxin induced inflamm diarrhea
1 2 |
1. C diff
2. EHEC (O157H7) inflamm so bloody, fever (not EHEC) but happens prettyquick bc ots a preformed toxin |
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NON inflamm diarrhea bc of preformed toxin (food poision)
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1. staph aureus
2. bacillus 3. clostridium |
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most common cause of acute diarrhea...
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viral
Non inflamm- noro, roto, adeno |
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non inflamm VIRAL diarrhea is caused by
1 2 3 |
1. norovirus- cruise ship
2. rota- right outta the... Kids in winter 3. enteric adeno- family outbreaks in winter |
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what bacterial cause of diarrhea can mimic appendicitis
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yersinia- its a cause of inflammatory invasive diarreha (in the same cetagory as salmonella shigella and campylobacter)
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the diarrhea caused by EHEC (O157H7) is...
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bloody, WBC, cramps. NO FEVER. caused by PREFORMED shiga like toxin
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food poisioning can be classified as what type of diarreha
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non invasive
non inflammatory preformed toxin ex staph, bacillius, c perforinges |
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what are the 2 bacteria that make toxins that are not preformed. they cause non invasive diarrhea
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ETEC
Vibrio cholera |
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other than bugs what can cause acute diarreha
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1. meds
2. sweeteners 3. Mg ant acids 4. laxatives caffiene, EtOH, antiarrhythemics metformin ZE, carcinoid, hyperthyroif |
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onset of diarrhea...
1. <24 hrs 2. >24 hrs |
1. <24 hrs: food poision, preformed toxin- staph or bacillius. non inflamm
2. >24: invasive bacterial, ETEC/vibrio- toxin forms AFTER ingestion |
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if diarrhea lasts...
1-3 days >3 weeks |
1-3 days- viral, acute
>3 weeks- look for a chronic cause |
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diarreha during day only
diarrhea at night |
day- stress
night- DM |
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if you have a hx that includes COPIOUS amts of fluid lost what are you thinking
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1. rehydration (low K and high Na- balance this)
2. cholera 3. Abnormal bowel secretion |
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diarrhea + fever + chills
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invasive bacteria- salmonella, shigella, campylobacter
OR cytotoxic- C diff, entamoeba histolytica |
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diarrhea + weight loss
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1. CA
2. HIV 3. Hyperthyroid 4. malabs |
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constipation + diarrhea
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1. IBS
2. CA- obstruction, water trickles through the rocks |
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besides bacterial causes of diarreha what else can be the cause of bloody diarreha
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1. bacterial (shigella, salmonella, campylobacter)
2. IBS 3. Ischemia 4. CA |
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if you have foul smelling stool its caused by... and other PE findings
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malabs- sprue, protozoa
PE- bloat, flatulance |
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common foods that give food poision
when is the onset |
1-6 hours, otehr ppl are sick
1. custard- s aureus 2. rice- bacillus **preformed toxins |
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most common cause of travelers diarrhea
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ETEC- enterotoxic
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does a fever and tachy make you think bacterial or steer away from bacterial cause of acute diarreha
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indicated bacterial origin
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BS increased or decreased with diarrhea
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increased
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arthritis + uveitis + iritis + erythema nodosum =
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IBD
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goiter + tremor + tachy + diarrhea =
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hyperthyroid
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tell me about invasive inflammatory diarrhea
1. amt of poo, presence of RBC, WBC etc 2. incubation/onset 3. duration 4. abd pain 5. PE 6. Etiology: bacterial, viral, parasite |
1. poo: frequent, small volume, RBC, WBC, mucous. NO WBC with EHEC
2. incubation/onset: 3 day incubation, with gradual onset 3. duration: ~week 4. abd pain: common, tenesmus- urge to poo 5. PE: fever (NOT EHEC), abd tenderness 6. Etiology: bacterial: shigella, salmonella, campylobacter, yersinia, C diff viral: parasite: enantomeba |
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tell me about non inflammatoru acute diarreha
1. amt of poo, presence of RBC, WBC etc 2. incubation/onset 3. duration 4. abd pain 5. PE 6. Etiology: bacterial, viral, parasite |
1. amt of poo, presence of RBC, WBC etc: TONS of watery poo, no RBC/WBC
2. incubation/onset: short incubation with sudden onset 3. duration: way shorter than invasive ~2 days 4. abd pain: mild, cramp 5. PE: no fever, mild abd discomfort 6. Etiology: bacterial- vibrio cholera, ETEC, Staph, bacillus viral- roto, noro parasite- giardia |
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what are NON INFECTIOUS causes of WBC in poo
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1. UC
2. Chrons 3. IC |
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what are some things with diarrhea that warrant w/u or hospitalization
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1. bloody
2. dehydration 3. temp 4. >6 stools/24 hrs 5. AB use, hospitalized pts 6. community outbreak 7. immunocomprimised host 8. older pt |
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what does BUN and creat do in pts with diarrhea
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BUN is way higher than creat- due to dehydration
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do all pts with diarreha get a stool culture
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nope only if WBC + or if pt is a food handler
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when do stool for ova/parasite
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after travel
needs several samples bc the oova are shed at various times |
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what is the most important tx for pt with diarrhea
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1. rehydration/prevent dehydration
2. oral is best- water, salt, K, glucose gatoraid, carbonated drink and juice are NOT idea for kids- too much sugar! |
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HUS is associated with what organism
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EHEC (O157 H7)
**HUS can be triggered with antimotility agents, dont use in kids/old, bloody, fever |
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anti peristaltic agents and diarrhea
when to use, when not to use |
CI: bloody diarrhea, fever, kids
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ok so oral rehydration for diarrhea is best, when do you use IV
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severe dehydration
shock altered consciousness cant take oral fluids use NS with KCL |
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how do you reintroduce foods to a person with diarrhe
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clear liquids- full liquids- solids
BRAT Banana Rice Apple sauce Toast *starches- potato, rice, whear, noodles, soup, boiled veggies **kids should get refeeding as early as tolerate and should eat age appropriate foods |
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Kaolin pectin do what
Bismuth Salicalicylate will do what |
KP- bulk up the poop but wont alter course of disasee
pepto- will alter course of disease (AB properties) |
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antiemetics
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1. prochlorperazine
2. promethazine |
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prophylaxis for ETEC
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prevent travelers diarreha with rifaximin
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who gets emperic tx for diarreha
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1. mod/severe travellers diarrhe ETEC
2. dehydration tx with flouroquinalone **if the pt is a kid- NO tx unless pathogen is ID **if the pt has bloody and NO fever, NO tx |
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incubations...
1. preformed toxin ex bacillus 2. enterotoxin formed in bowel ex ETEC 3. inflammatory ex shigella |
1. preformed 1-6 hrs
2. enterotoxin formed in bowel 1-3 days 3. inflammatory 1-3 days |
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do ischemic colitis and IBD like UC make WBC/lactoferrin
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WBC- YES
lactoferrin NO **lactoferrin + is better for + invasive diarrhea than the WBC fecal leukocyte |
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when do you get a stool culture on a pt with diarrhea
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hx PE indicate invasive (bloody, fever, chills)
WBC + food handler AB in past 8 weeks |
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sx tx for pt with...
1. viral non inflamm 2. bloody diarrhea and fever |
1. viral non inflamm-
2. bloody diarrhe and fever- pepto, NOTHING if they have bloody diarrhe and NO fver, no fever is seen in EHEC and this can cause HUS |
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what is the DOC for emperic AB for acute bloody diarreha
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flouroquinolone
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EHEC O157 H 7 is associated with ...
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bloody diarrhea
no fever HUS undercooked meat pressed apple cider |
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pts dc w/ acute NON inflamm diarreha are advised what
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no cola, ceffeine, milk Etoh
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whos diarrhea needs to be reported
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within 24 hrs report if...
1. food handler 2. daycare 3. healthcare |
