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9. Infection (Medical Knowledge) > 1.1. Diarrohea > Flashcards

1.1. Diarrohea Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the difference between Diarrhoea and Gastro-enteritis?

A
  1. Diarrhoea - subjective (A change in pattern indicated Diarrhoea)
  2. Gastro-enteritis - objective (Diarrhoea + other symptoms)
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2
Q

What changes during Diarrhoea?

A
  1. Fluidity of the stool
  2. Frequency of the stool
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3
Q

What are the features of Gastro-enteritis?

A
  1. 3+ loose stools per day
  2. Accompanying features
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4
Q

Is a positive stool culture needed to have Gastro-enteritis?

A

No, but need to have 3+ loose stools per day the other symptoms
Note - It is an objective finding but clinical, not always biological

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5
Q

What is Dysentery?

A

Large bowel inflammation due to infection

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6
Q

What is present with Dysentery?

A
  1. Bloody stools
  2. A lot of pain
    Note - it is quite obvious when someone has contracted Dysentery
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7
Q

What is the name of the chart which stools are measured against?

A

The Bristol Stool Chart:
1 - Separate hard lumps, hard to pass
4 - Sausage / Snake like, smooth and soft
7 - Watery, no solid pieces, entirely liquid

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8
Q

What are the types of Diarrhoea?

A
  1. Non-inflammatory Diarrhoea (e.g. cholera)
  2. Inflammatory Diarrhoea (e.g. Shigella Dysentery)
  3. Mixed-picture Diarrhoea (e.g. C. Difficile)
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9
Q

What mediates Non-inflammatory Diarrhoea?

A

It is secretory-toxin mediated - the toxin affects the way you transport Cl and Na:
1. Cholera - increases cAMP levels and therefore Chloride secretions (Salt shifts into the gut and takes the fluid with it)
2. Enterotoxigenic E. Coli (Travelers’ Diarrhoea)

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10
Q

What is the clinical signs / symptoms of Non-inflammatory Diarrhoea?

A
  1. Frequent watery stools
  2. Little abdominal pain
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11
Q

What is the mainstay of therapy for Non-inflammatory Diarrhoea?

A

Re-hydration Therapy

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12
Q

What mediates Inflammatory Diarrhoea?

A

Inflammatory toxin damage and mucosal destruction

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13
Q

What causes Inflammatory Diarrhoea?

A
  1. Bacterial infection
  2. Amoebic dysentery
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14
Q

What is assessed in Inflammatory Diarrhoea?

A
  1. Symptoms and their duration (History)
    Note - If > 2/52, unlikely to be infective cause
  2. Risk of food poisoning (Dietary, Contact, Travel History)
  3. Hydration (Postural B.P. (will drop by 20mmHg), Skin Turgor, Pulse)
  4. Features of inflammation (SIRS/Sepsis) (Fever, Raised WCC)
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15
Q

What needs to be assessed if there is a lot of fluid loss, due to Inflammatory Diarrhoea?

A

Hyponatraemia

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16
Q

What investigations would you perform in Inflammatory Diarrhoea?

A
  1. Stool culture (Most important)
  2. Blood culture
  3. Renal function (Assess the Na and K loss)
  4. Blood count (Neutrophilia, Haemolysis)
  5. Abdominal X-Ray (if the abdomen is distended and tender)
    Note - The X-Ray would be looking for toxic dilation of the bowel
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17
Q

What is the differential diagnosis for Inflammatory Diarrhoea?

A
  1. Inflammatory Bowel Disease
  2. Spurious Diarrhoea- secondary to constipation
  3. Carcinoma
  4. Sepsis outside of the Gut
18
Q

If Diarrhoea is caused by Sepsis outside of the Gut occurs, how will the patient present?

A
  1. Features of infection for another system
  2. Lack of abdominal pain / tenderness
  3. No blood / mucus in the stool
19
Q

What is the treatment of Inflammatory Diarrhoea?

A
  1. Rehydration Therapy
  2. Antimicrobials may be appropriate
20
Q

What is the most common Mixed-picture Diarrhoea?

A

Clostridium Difficile (C. Diff) Diarrhoea

21
Q

What is the range of C. Diff infection?

A
  1. Mild Diarrhoea
  2. Severe Colitis
22
Q

What is the main risk factor for C. Diff infection?

A

Prior antibiotic therapy with the “4 ‘C’ Antibiotics:
1. Cephalosporins
2. Co-Amoxiclav
3. Clindamycin
4. Clarithromycin

23
Q

What is the pathology of C. Diff infection?

A

C. Diff produces:
1. Enterotoxin (A)
2. Cytotoxin (B)
These cause damage to the colonocytes and cause a local inflammatory response

24
Q

What is the best prevention of C. Diff infection?

A
  1. Reduction in broad spectrum antibiotic prescribing
  2. Avoid “4 ‘C’ Antiobiotics:
  3. a) Cephlasporin
  4. b) Co-Amoxiclav
  5. c) Cindamycin
  6. d) Clarithromycin
  7. Anitmicrobial Management Team (AMT) and local antibiotic policy
  8. Isolate symptomatic patients
  9. Wash hands between patients
25
Q

What is the best management of C. Diff infection?

A
  1. Stop precipitating antibiotics (if possible)
  2. a) If no severity markers - Oral Metronidazole
  3. b) If 2+ severity markers - Oral Vancomycin
    Note - Vancomycin is not absorbed through the GI tract and so is useful for this
  4. Fidaxomicin (new and expensive)
  5. Stool transplant
  6. Surgery may be required
26
Q

Is Parasitology, related to Diarrhoea common in the UK?

A

No

27
Q

What forms of Parasites are associated with Diarrhoea?

A
  1. Protozoa
  2. Helminths
28
Q

In relation to Diarrhoea, what are the 2 most common Parasites found in the UK?

A
  1. Giardia Lamblia
  2. Cryptosporidium Parvum
29
Q

With Giardia Lamblia infection, what is the:
1. Most common route of infection?
2. Clinical Signs / Symptoms?
3. Treatment?

A
  1. Contaminated Water
  2. a) Diarrhoea
  3. b) Malabsoprtion
  4. c) Failure to Thrive
  5. Metronidazole
30
Q

With Cryptosporidium Parvum infection, what is the:
1. Most common route of infection?
2. Condition this is recognized alongside?
3. Treatment?

A
  1. Contaminated Water (with animal faeces)
  2. AIDS (Advanced HIV infection)
  3. No treatment
31
Q

Where can other parasites, causing Diarrhoea, come from?

A

They can be imported and so there is a large range of possibilities

32
Q

What is the most common imported parasite?

A

Entamoeba Histolytica (more commonly known as Amoebic Dysentery)

33
Q

How is Entamoeba Histolytica (Amoebic Dysentery) treated?

A

Metronidazole

34
Q

How are parasite infections, causing Diarrhoea, diagnosed?

A

Using Microscopy (Send a stool with request for Parasites, Cysts and Ova (P, C and O)):
1. Giaradia Lamblia - cysts seen on stool microscopy
2. Cryptosporidium Parvum - cysts seen on stool microscopy
3. Entamoeba Histolytica (Amoebic Dysentery) - Cysts seen in asymptomatic patient

35
Q

What can be a long term complication of Entamoeba Histolytica (Amoebic Dysentery)?

A

Amoebic Liver Abscess

36
Q

What is the most common Viral causes of Diarrhoea in children (especially under 5’s)?

A
  1. Rotavirus
  2. Adenovirus
37
Q

When are viral infections, causing Diarrhoea, most commonly seen?

A

Winter

38
Q

How are viral infections, causing Diarrhoea, diagnosed?

A

Antigen detection
Note - this is a very common cause but it is not looked for as it is self-limiting

39
Q

What is used in prevention of Rotavirus infection?

A

Vaccine

40
Q

What is the most common Viral causes of Diarrhoea in adults?

A

Noroviruses - previously known as:
1. Small round structured viruses (SRSV)
2. Norwalk like viruses
3. Winter vomiting disease

41
Q

How is Norovirus diagnosed?

A

PCR

42
Q

How infectious is Norovirus?

A

Very (spread via contact / aerosol):
1. Can cause ward closures
2. Strict infection control measures are needed

9. Infection (Medical Knowledge) (29 decks)

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