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Acute diarrhea (Pt: < 2 weeks of diarrhea (Acute) (Blood fever :fire:…

- - - - C Diff: Abx use
      - ETEC: Montezuma revenge
      - Vibrio Cholera: fecal oral :poop: in water source
      - S Aureus: proteinaceous food (egg salad)
      - B. Cereus: reheated rice :rice:
      - Giardia: camping/rivers :tent:
  - - - Salmonella :fish: :chicken: : poultry
      - Shigella :gorilla: HUS
      - EHEC O157:H7 : uncooked :hamburger:
        
        TTP
        
        Pt: Bloody diarrhea after eating uncooked :hamburger:
        
        w/ renal failure
        
        anemia
        
        usually a kid :boy::skin-tone-2:, but not necessarily (fast food epidemic)
        
        Board question
        
        uncooked meat :hamburger:
        
        bloody diarrhea
        
        high Cr
        
        low Hbg
        
        RF is not AKI (volume depletion)
        
        Microangiopathic hemolytic anemia :balloon:
        
        Dx: Blood smear has schistocytes?
        
        1 more item...
      - Campylobacter :fire::tent::bear:: #1 common cause of invasive bloody diarrhea
      - E. Histolytica: immunocompromised HIV/AIDS
  - - - :warning: if Asx, no scary red flags :red_flag: assume gastroenteritis
        
        :check: Gastroenteritis
        
        almost always Viral
        
        Tx: rehydrate (PO>IV) :ocean:& wait
        
        (Pretest FM): Pt ok to eat starchy foods (:rice:, :bread:), yogurt, :carrot: boiled Veggies.
        
        avoid milk products :forbidden::glass_of_milk:
        
        :pencil2: Loperamide OK option
      - :green_cross: Investigate further :red_flag::red_flag::red_flag:
        
        Hi fever :fire::fire:
        
        severe abdominal px (10/10)
        
        immunocompromised :wheelchair:
        or
        
        recent Abx use :pill:
        
        bloody stool
        
        obvious pus :volcano:
        
        severe electrolyte derangement :battery:
        
        ≥ 3 days duration :calendar:
        
        1. C Diff testing
        
        :check: :checkered_flag: C diff positive
        
        Tx: Abx
        
        metro :bullettrain_side: PO
        
        Vanc :truck: PO
        
        metro IV & vanc PO :bullettrain_side: :truck:
        
        Fidaxomyicin PO
        
        Fecal transplant
        
        :green_cross: 2. Stool WBC and Stool RBC
        
        :pencil2: could get Lactoferrin now (same as WBC test)
        
        :check: stool WBC/RBC
        
        suspect Invasive organism
        
        3. Stool Culture :poop:
        Colonoscopy :telescope:
        
        3 more items...
- - - - :pencil2: everyone has C diff.
        :no_entry:Don't treat C Diff if they are :check:NAAT (+) and have solid stool :poop:
      - :checkered_flag: Tx
        
        Tx: Abx
        :stars:metro :bullettrain_side: PO :pill: ( :money_mouth_face: Cheap)
        
        1st recurrence
        
        & 2nd recurrence
        
        :pencil2:PO metro :bullettrain_side: = PO vanc :truck: in effectiveness
        
        Fecal transplant
        
        refractory cases only
        
        Vanc :truck: PO :pill:
        
        can use on 2nd recurrence
        
        Fidaxomyicin PO :pill:
        
        on 3rd recurrence
        
        metro IV & vanc PO :pill::bullettrain_side: :truck:
        
        if scary signs :red_flag:
        
        fever :fire:
        
        leukocystosis
        
        megacolon (tympanic abn, or CT scan) :snake:
        
        renal failure (Bun/Cr)
        
        severe C Diff
    - - Not sensitive test, only good if incidentally found on colonoscopy