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Zero Paeds > 3.5 Gastroenteritis > Flashcards

3.5 Gastroenteritis Flashcards

1
Q

8 differential diagnoses for diarrhoea / loose stools?

A
  • infection (gastroenteritis)
  • IBD
  • lactose intolerance
  • coeliac disease
  • CF (+steatorrhoea)
  • Toddler’s diarrhoea
  • IBS
  • meds eg Abx
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2
Q

Viral causes of diarrhoea?

A

Viral:

  • rotavirus
  • norovirus
  • (adenovirus, more subacute diarrhoea)
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3
Q

Bacterial causes of diarrhoea?

A

Bacterial:

  • E. coli
  • Campylobacter jejuni
  • Shigella
  • Salmonella
  • Bacillus cereus
  • Yersinia enterocolitica
  • Staph aureus toxin
  • Giardiasis (parasite)
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4
Q

How can you spread E. coli?

A
  • infected faeces, unwashed salad, contaminated water

(normal intestinal commensual)

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5
Q

What strain of E. coli is worst and why?

A
  • 0157 strain produces Shiga toxin
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6
Q

What does the shiga toxin from O157 E. coli do?

A
  • Shiga toxin destroy RBCs and leads to haemolytic uraemia syndrome (HUS)
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7
Q

Along with shiga toxin what else increases the risk of HUS in E. coli gastroenteritis?

A
  • Abx increase HUS risk

AVOID Abx in E. coli

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8
Q

What is the most common bacterial cause of gastroenteritis worldwide?

A

Campylobacter jejuni

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9
Q

What causes travellers diarrhoea?

A

Campylobacter jejuni

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10
Q

How can you get Campylobacter jejuni gastroenteritis?

A
  • raw / undercooked poultry, untreated water, unpasteurised milk
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11
Q

What is a typical presentation / symptoms of Campylobacter jejuni gastroenteritis?

A
  • cramps
  • diarrhoea maybe with blood,
  • vomit
  • fever

incubate 2-5, Sx resolve after 3-6days

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12
Q

If you isolate Campylobacter jejuni what should you consider giving?

A

severe symptoms or HIV or heart failure, then treat:

Abx: azithromycin or ciprofloxacin

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13
Q

How is shigella spread?

A
  • faeces in drinking water or swimming pool or food
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14
Q

Typical symptoms and course of shigella?

A
  • bloody diarrhoea, cramps and fever
  • 1-2 days incubation, Sx resolve in a week
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15
Q

What can the toxin from shigella cause?

A

shiga toxin (like O157 e. coli)

causes HUS

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16
Q

How would you treat severe cases of shigella?

A

Abx: azithromycin or ciprofloxacin

17
Q

How is salmonella spread / aquired?

A
  • raw eggs or poultry, or reptile infected food
18
Q

Typical salmonella symptoms and course?

A
  • watery diarrhoea maybe mucous or blood
  • incubation 12hr to 3days and Sx resolves in 1week
  • abx only in severe and guided by stool C+S
19
Q

How is Bacillus cereus spread / acquired?

A
  • inadequately cooked food / not refrigerated eg rice
  • gram +ve rod
20
Q

What causes you to cramp and vomit with 5hrs of Bacillus cereus infection?

A
  • cereulide toxin; cramp and vomit within 5hours
21
Q

What is the typical course / symptoms of Bacillus cereus?

A
  • cereulide toxin; cramp and vomit within 5hours
  • watery diarrhoea within 8hrs
  • resolves within 24hrs

classic course so exam worthy

22
Q

If Bacillus cereus is a gram +ve rod, what is a gram -ve bacillus?

A

Yersinia enterocolitica

23
Q

How do you spread / acquire Yersinia enterocolitica?

A
  • pigs, so undercooked pork
  • urine or faeces of rats / rabbits
24
Q

Typical course / symptoms of Yersinia enterocolitica?

A
  • 4 to 7 days incubation
  • watery or bloody , fever, pain
  • lymphadenopathy
25
Q

How can Yersinia enterocolitica present in older children / adults?

A

fever and right sided abdo pain

= mesenteric lymphadenitis

(gives appearance of appendicitis)

26
Q

What else can, like Bacillus cereus, see recovery within 24hrs?

A

STAPH AUREUS TOXIN:

  • enterotoxins on eggs, diary or meat
  • start within hours and settle within 12 to 24
  • D+V, cramps, fever
27
Q

How do you diagnose and treat giardia?

A
  • stool microscopy
  • metronidazole
28
Q

Key facts about each of the bacterial causes of gastroenteritis? - E. coli

  • Campylobacter jejuni
  • Shigella
  • Salmonella
  • Bacillus cereus
  • Yersinia enterocolitica
  • Staph aureus toxin
  • Giardiasis (parasite)
A

E. COLI:

  • infected faeces, unwashed salad, contaminated water
  • 0157 strain produces Shiga toxin
  • Shiga toxin destroy RBCs and leads to haemolytic uraemia syndrome (HUS)
  • Abx increase HUS risk
  • avoid Abx in E. coli

CAMPYLOBACTER JEJUNI:

  • most common bacterial cause worldwide - travellers diarrhoea
  • raw / undercooked poultry, untreated water, unpasteurised milk
  • incubate 2-5, Sx resolve after 3-6days
  • cramps, diarrhoea maybe with blood, vomit, fever
  • Abx if bacteria identified or risks eg HIV or heart failure
  • Abx: azithromycin or ciprofloxacin

SHIGELLA:

  • faeces in drinking water or swimming pool or food
  • 1-2 days incubation, Sx resolve in a week
  • bloody diarrhoea, cramps and fever
  • Shiga toxin and HUS
  • severe then use Abx azithromycin or ciprofloxacin

SALMONELLA:

  • raw eggs or poultry, or reptile infected food
  • incubation 12hr to 3days and Sx resolves in 1week
  • watery diarrhoea maybe mucous or blood
  • abx only in severe and guided by stool C+S

BACILLUS CEREUS:

  • gram +ve rod
  • inadequately cooked food / not refrigerated eg rice
  • cereulide toxin; cramp and vomit within 5hours
  • watery diarrhoea within 8hrs
  • resolves within 24hrs
  • classic course so exam worthy

YERSINIA ENTEROCOLITICA:

  • gram -ve bacillus
  • pigs, so undercooked pork
  • urine or faeces of rats / rabbits
  • 4 to 7 days incubation
  • watery or bloody , fever, pain
  • lymphadenopathy
  • mesenteric lymphadenitis in older children (appears like appendicitis)

STAPH AUREUS TOXIN:

  • enterotoxins on eggs, diary or meat
  • start within hours and settle within 12 to 24
  • D+V, cramps, fever

GIARDIASIS:

  • G. lamblia parasite in mammals
  • cysts from faecal oral transmission
  • chronic
  • stool microscopy
  • metronidazole
29
Q

Principles of gastroenteritis management?

A
  • isolate and barrier nursing
  • oral fluid challenge every 10 mins and keep it down and not dehydrated then can go home
  • dioralyte ie ORS
  • dehydrated / cant keep fluid challenge down the IV fluids
  • avoid loperamide (antidiarrhoeal) and anti-emetics
  • abx only if at risk and ID on organism
30
Q

4 post gastroenteritis complications?

A
  • lactose intolerance
  • IBS
  • reactive arthritis
  • Guillain-Barre syndrome

Zero Paeds (38 decks)

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