Dr. Krumpelbeck presented a great case of undifferentiated shock that was likely 2/2 infectious colitis. Below, we outline some of the diagnosis and rx of INFECTIOUS colitis. BONUS: how to differentiate between Colonic vs Mesenteric Ischemia!
Etiologies (bloody vs nonbloody):
Bloody diarrhea (Inflammatory)
Salmonella, Campylobacter, and Shigella
Vibrio parahemolyticus, Yersinia, Aeromonas
Entamoeba histolytica
STEC
Watery Diarrhea
norovirus, rotavirus, adenoviruses, astrovirus
Cryptosporidium parvum, Giardia, Cyclospora, Entamoeba
Giardia lamblia
Listeria monocytogenes
Cyclospora cayetanensis
ETEC
C. Difficile, perfringes
Staphylococcus aureus or Bacillus cereus
Work up for Suspected acute Infectious Diarrhea: (From the IDSA and American College of Gastroenterology)
Consider testing in Large vs small volume
Lab Testing options– stool cx, ova and parasites, Shiga toxin, fecal leukocyte/lactoferrin test , molecular panels(WI diagnostics website)
Reasons to pursue testing
◦Profuse watery diarrhea with signs of hypovolemia, >6 unformed stools/ 24 hours, Severe abdominal pain, hospitalization, bloody diarrhea, Fever
◦Age ≥70 Comorbidities, such as cardiac disease, Immunocompromised status, Inflammatory bowel disease, Pregnancy, MSM
Antibiotic initiation and choice- appropriate in high risk and severe infections as above
*Avoid anti-microbials with STEC infections!!
Contrast this with.....Ischemic Colitis!
Making the Dx of Ischemic Colitis:
•History as well as CT imaging findings consistent with ischemic colitis
- edema and thickening of the bowel wall in a segmental pattern
•Colonoscopy with minimal air insufflation may show edematous, friable mucosa; erythema; and interspersed pale areas
- Better performed in the first 48 hours
•Conventional catheter-based arteriography usually not useful but can be attempted
•If signs of bowel necrosis or free air, consider surgery
- Pneumatosis coli
•primarily supportive, including Antibiotics
Contrast this with....Acute Mesenteric Ischemia!
Major differences between mesenteric and colonic ischemia:
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