1. Mage- tarminfeksjoner

2. Hva står vi ovenfor ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende E coli – Yersinia – Listeria – Aeromonas – Plesiomonas – Vibrio spp Toxinmediert – Clostridium difficile – Bacillus spp – S aureus Parasitter – Giaridia lamblia – Cryptosporidium – Entamoeba histolytica – Cyclospora

3. Rutineundersøkelser Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende E coli – Yersinia – Listeria – Aeromonas – Plesiomonas – Vibrio spp Toxinmediert – Clostridium difficile – Bacillus spp – S aureus Parasitter – Giaridia lamblia – Cryptosporidium – Entamoeba histolytica – Cyclospora

4. Rutineundersøkelser ved kliniske opplysninger Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende E coli – Yersinia – Listeria – Aeromonas – Plesiomonas – Vibrio spp Toxinmediert – Clostridium difficile – Bacillus spp – S aureus Parasitter – Giaridia lamblia – Cryptosporidium – Entamoeba histolytica – Cyclospora

5. Hvem gjør hva hvor ?

6. Flere i en familie syke ? Sesong ? ”noe som går”? Virus – Norovirus – Rotavirus – Adenovirus – Astrovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende E coli – Yersinia – Listeria – Aeromonas – Plesiomonas – Vibrio spp Toxinmediert – Clostridium difficile – Bacillus spp – S aureus Parasitter – Giaridia lamblia – Cryptosporidium – Entamoeba histolytica – Cyclospora

7. Suspekte matvarer ? Hyperakutt start ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende E coli – Yersinia – Listeria – Aeromonas – Plesiomonas – Vibrio spp Toxinmediert – Clostridium difficile – Bacillus spp – S aureus Parasitter – Giaridia lamblia – Cryptosporidium – Entamoeba histolytica – Cyclospora

8. Suspekte matvarer – i Norge ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende E coli – Yersinia – Listeria – Aeromonas – Plesiomonas – Vibrio spp Toxinmediert – Clostridium difficile – Bacillus spp – S aureus Parasitter – Giaridia lamblia – Cryptosporidium – Entamoeba histolytica – Cyclospora

9. Suspekte matvarer ? Sjømat/Østers/muslinger ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende E coli – Yersinia – Listeria – Aeromonas – Plesiomonas – Vibrio spp Toxinmediert – Clostridium difficile – Bacillus spp – S aureus Parasitter – Giaridia lamblia – Cryptosporidium – Entamoeba histolytica – Cyclospora

10. Gravid ? Muskelstivhet/verk ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende E coli – Yersinia – Listeria – Aeromonas – Plesiomonas – Vibrio spp Toxinmediert – Clostridium difficile – Bacillus spp – S aureus Parasitter – Giaridia lamblia – Cryptosporidium – Entamoeba histolytica – Cyclospora

11. Nylig antibiotika eller institusjonsopphold ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende E coli – Yersinia – Listeria – Aeromonas – Plesiomonas – Vibrio spp Toxinmediert – Clostridium difficile – Bacillus spp – S aureus Parasitter – Giaridia lamblia – Cryptosporidium – Entamoeba histolytica – Cyclospora

12. Reise ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende E coli – Yersinia – Listeria – Aeromonas – Plesiomonas – Vibrio spp Toxinmediert – Clostridium difficile – Bacillus spp – S aureus Parasitter – Giaridia lamblia – Cryptosporidium – Entamoeba histolytica – Cyclospora

13. Halvkronisk/langvarig ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende E coli – Yersinia – Listeria – Aeromonas – Plesiomonas – Vibrio spp Toxinmediert – Clostridium difficile – Bacillus spp – S aureus Parasitter – Giaridia lamblia – Cryptosporidium – Entamoeba histolytica – Cyclospora

14. Blodig ? Virus – Norovirus – Rotavirus – Adenovirus Bakterier – Campylobacter – Salmonella – Shigella – Toxinproduserende E coli – Yersinia – Listeria – Aeromonas – Plesiomonas – Vibrio spp Toxinmediert – Clostridium difficile – Bacillus spp – S aureus Parasitter – Giaridia lamblia – Cryptosporidium – Entamoeba histolytica – Cyclospora

15. Clinical characteristics of patients from whose stool selected bacterial pathogens were recovered at 10 hospitals in the United States (n = 30,463 specimens). Guerrant R L et al. Clin Infect Dis. 2001;32:331-351 © 2001 by the Infectious Diseases Society of America

16. Når lete ? Blodig diare Feber Dehydrerte tiltrengende iv væske IBD Immunsupprimerte Institusjonaliserte – Fæcal leukocytter – Fæcal lactoferrin

17. Behandling

20. Tiltak Rehydrering – Peroralt (ORT) ”Det man klarer” ½ ts salt – 6 ts sukker – 1 liter vann Eplejuice og Farris 1:4 – Intravenøst Ringeracetat evt med ekstra elektrolytter (K)

21. Kost – banan, ris, fiberfattig Antiperistaltikk medikament – Loperamid – Opiumsdråper – Diphenoxylat…. Anticholinergika – atropin, skopolamin… Absorberende – aktivt kull, vismut, aluminiumforbindelser… Probiotika – Laktobacillus, Saccharomyces Guideline for the management of acute diarrhea in adults

22. Antisekretorisk – NSAIDs (aspirin, indometacin) chlorpromazin…. – Serotoninreopptakshemmere (5HT3) – Enkephalinase-hemmer (”Racecadotril”) – Octreotid Guideline for the management of acute diarrhea in adults

23. Hvem skal vurderes for antibakteriell behandling ? Dehydrerte tiltrengende sykehusinnleggelse ? Blodig diare ? Feber Puss og/eller mucus IBD Immunsvekkede Eldre Over en ukes varighet ? Acute infectious diarrhea in immunocompetent adults - NEJM 2002

24. Hvordan behandle ?