Term
| What is the main outcome of GI infections? |
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Definition
DIARHHEA!
**The elderly are most at risk for death |
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Term
| What is the general clinical presentation of gastroenteritis? |
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Definition
Increased fluid output with 3+ watery bowel movements per day
- Acute - lasts less than 2 weeks
- Most food-borne illness from S aureus toxin, other from salmonella or C. diff |
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Term
| What are the differences between watery and inflammatory diarrhea? |
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Definition
- watery: MOST common, more overall volume, <10/day. Due to cholera, ETEC E. coli
- inflammatory: more stool production (>10/day), higher pH, + guaiac and fecal PMNs. Due to mucosal invasion. Due to shigella, salmonella, EHEC/O157
**Watery can lead to dehydration and shock |
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Term
| How do you evaluate a gastroenteritis patient? |
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Definition
Poor skin turgor, dry mucous membranes, altered mental status
Na/K/Cl, BUN, SCr
Pearl: if a patient has incr BUN/SCr, ratio will be NORMAL |
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Term
| Who is considered immunocompromised for gastroenteritis? |
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Definition
| chemo, transplant, steroid use, HIV, elderly, uncontrolled diabetes |
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Term
| What is the primary treatment for MILD TO MODERATE dehydration from gastroenteritis? |
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Definition
Oral rehydration > IV. 75 ml/kg over 4 hours every 2 min
**Saline or lactated ringer preferred |
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Term
| How are antibiotics and antimotility agents used for gastroenteritis? |
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Definition
- Abx - not essential for mild diarrhea. Have to use appropriate therapy
- Anti-motility - contraindicated in fever, bloody stool, toxin-mediated diarrhea. Can give relief to mild diarrhea. |
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Term
| How are GI infections prevented? |
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Definition
- Vaccines: 2 typhoid, rotovirus
- reporting: yellow fever, plague, E. coli O157, C. botulinium
- Safe practices and hand washing |
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Term
| What causes viral gastroenteritis? |
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Definition
- Rotavirus - common cause of diarrhea in kids. Highly contagious. Has a vaccine.
- Norovirus - adults, self-limiting. NON-bloody diarrhea in adults, vomiting in kids.
Produces watery diarrhea |
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Term
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Definition
Vibrio cholera - contaminated water causes rice water stools. A large # must be ingested - PPIs increases risk
**Vaccination not required. Tx: replacement of fluids, a single dose of doxy in severe cases |
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Term
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Definition
Causes gastroenteritis by enterotoxin production. EHEC/O157 especially virulent.
Tx: rehydration, FQN in severe cases. |
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Term
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Definition
Transmits person to person!
Complications include sepsis and meningitis. Fluid replacement is critical. FQNs can shorten duration |
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Term
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Definition
Primarily in birds: chicken and turkey. A large # needed for infection
- Carriers: remove their gallbladder
- replace fluids, cipro |
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Term
| What is campylobacteriosis? |
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Definition
Caused by campylobacter jejuni from contaminated food and water. See bloody diarrhea, fever, vomiting.
TX: fluid replacement, can use macrolides but generally not |
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Term
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Definition
- THE most common ANTIBIOTIC-associated diarrhea: cephalosporins, pcns, clinda, fqns
- Transmitted in the hospital. Diagnosis by C. diff toxins in stool
- Tx: metronidazole 500 mg TID x10-14 days, stop other abx. Can use oral vanc. |
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Term
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Definition
Thrives in cold weather, from contaminated food.
Tx: fluid replacement, abx when bacteremia develops: FQNs +/- 3rd gen cefs or AG |
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Term
| How is Traveler's diarrhea prevented? |
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Definition
Peel fruit, piping hot food, pepto bismol, purified water, packaged food
- High risk: FQN or Rifamixin |
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Term
| What should not be used in food poisoning? |
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Definition
| Do NOT use antimotility agents in the presence of fever, bloody diarrhea, or PMNs |
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