GASTROENTEROLOGY ARTICLE OF THE WEEK
September 17, 2009
Holtz LR, Neill MA, Tarr PI. Acute bloody diarrhea – a medical emergency for patients of all ages. Gastroenterology 2009;136:1887-1898.
1. Clinical characteristics that suggest infection with E coli O157:H7 include:
a. Bloody diarrhea from the onset of symptoms
b. No fever
c. Pain worse on defecation
d. Stool loaded with WBC
e. No bandemia on CBC
f. Non-tender abdomen
2. Which of the following causes of acute bloody diarrhea benefit from antibiotics
a. E coli O157:H7
b. Salmonella in an otherwise healthy person
c. Shigella
d. Campylobacter
True or False
3. Antibiotics should be started immediately in people with acute bloody diarrhea and fever.
4. Diarrhea that is bloody from the first bowel movement is less likely to be infectious
5. Use of opiod narcotics or anti-motility agents in patients with proven or presumed O157:H7 infection can increase the risk of HUS
6. The more severe and persistent vomiting is, the more likely the cause of bloody diarrhea is a bacteria
7. Routine blood cultures may not be the optimal way for diagnosis of vibrio, yersinia, aeromonas or E coli O157:H7, unless the lab has procedures in place to properly culture these organism
8. Aggressive hydration with normal saline may help decrease the incidence of HUS in people infected with E coli O157:H7
9. Patients with E coli O157:H7 infection should be hospitalized until there is clear clinical improvement and the platelet count increases or stabilizes.