Please enable JavaScript.

Coggle requires JavaScript to display documents.

Diarrhea (correlation of clinical features and anatomic origin (tenesmus,…

- - - - bloody; causes RF; contaminated meat
  - - - children can have an acute onset of illness; pain & severe diarrhea with blood/mucus (toxin damages mucosa); MSM; NLF → yellow on MacConkey agar
        PCR for stool culture (reflex culture after PCR to determine sensitivity)
    - - Salmonella Typhimurium
        outbreaks are usually food-related (poultry); NLF → yellow on MacConkey agar; pink with black spots (hydrogen sulfide) on XLD; nausea, vomiting, fever, cramps, myalgia, headache; can severely affect elderly
        Salmonella Typhi & Paratyphi
        not endemic in Australia → may be found in travellers; 'enteric fever', sepsis (possible); fever, chills, headache, possible constipation or diarrhea (may be asymptomatic); classic illness with complication (e.g. may ulcerate & cause gut perforation → air under diaphragm); Dx = blood cultures, follow-up with stool cultures; Rx = ceftriaxone, ciprofloxacin, azithromycin
        selenite = enrichment medium for specialised culture
        PCR for stool culture (reflex culture after PCR to determine sensitivity)
    - - enterotoxin-mediated; inflammatory diarrhea (fever, ulceration, blood); animal reservoir (e.g. chicken); Rx = macrolide (gentamicin); rare complications = Guillian-Barre syndrome, reactive arthritis
        PCR for stool culture (reflex culture after PCR to determine sensitivity)
    - - NLF → yellow on MacConkey agar
  - - - water-associated; enterotoxin has 5 subunits → irreversible overproduction of cAMP → Cl- pours into lumen of gut → Na+ and water follow; Dx = TCBS specialised culture, wet prep stool microscopy; Rx = fluid replacement (azithromycin, ciprofloxacin)
    - - ST toxin is pro-secretory; non-bloody; traveller's diarrhea
    - - NLF → yellow on maconkey
    - - eating oysters
  - - - produces spores that can survive the heat
        type 1 enterotoxin: emetogenic; poorly-kept rice/pasta
        type 2 enterotoxin: causes diarrhea; meat
    - - most common cause of non-bloody diarrhea; causes fever & vomiting; fluid support; Dx = antigen in stool or PCR;
    - - very infective (via vomitus, faeces, water in swimming pools); causes nausea & vomiting (self-limiting in 24-72 hrs); supportive care + quarantine (can cause serious disease in the elderly);
        hospital wards, barracks, cruise ships
    - - enterotoxin: 1-6 hrs after eating poorly-stored food (meat & creamy products); self-limiting
    - - eight types of toxin; blockages of excitatory & inhibitory nn.; mild diarrhea, vomiting, lassitude, difficulty speaking, blurred vision, descending weakness, floppy baby; Dx = suspicion, toxin in blood, culture (strict anaerobe) of stool/vomit/food; Rx = anti-toxin + mechanical ventilation may be necessary while nerves regenerate (NOT ANTIBIOTICS)
- - - - ingested substances
        
        laxatives
      - malabsorption
        
        lactose intolerance, coeliac disease, pancreatic insufficiency
  - - - bacteria
      - toxin damages mucosa
        
        C. difficile
        
        toxin A = enterotoxin (causes diarrhea), toxin B = cytopathic, binary toxin; severity varies; risk factors incl. antibiotic use, hospitalisation, residence in a nursing home; Rx = STOP ANTIBIOTICS, metronidazole (anaerobe); oral vancomycin (GPB), faecal transplant
        PCR for stool culture (reflex culture after PCR to determine sensitivity)
- - - - diverticulitis or IBD
      - hyperthyroidism
      - faecal impaction
      - medications (antibiotics, metformin)
      - mesenteric ischaemia