CBL - Gastroenteritis

Question 1

What are the important questions to ask when taking a history from a patient with acute diarrhoea? [6]

Answer 1

1. Food history
2. Ill contacts
   
   • significant in teachers who come in with acute diarrhoea (since they work in environment where vomiting/diarrhoea is common due to children)
3. Travel history
4. Past medical history
   
   • important when thinking about a non-infectious aetiology for the patient’s diarrhoea
5. Occupational history
6. Risk factors for Clostridium difficile infection (CDI)

Question 2

Which foods tend to cause gastroenteritis? [3]

Answer 2

1. undercooked poultry
2. reheated rice
3. frozen food that has been incompletely defrosted prior to cooking

Question 3

What are the 3 risk factors for clostridium difficile infection (CDI) and when should CDI be considered as a cause for a patient’s diarrhoea? [4]

Answer 3

1. age >65yrs
2. recent hospitalisation
3. recent course of antibiotics
4. should be considered as a cause for diarrhoea when 2 or the 3 risk factors are present

Question 4

What are the important non-infectious causes of acute diarrhoea? [7]

Answer 4

1. inflammatory bowel disease
   
   • (Crohn’s disease/Ulcerative colitis)
2. bowel cancer
3. diverticular disease
4. chronic pancreatitis
5. HIV infection
6. ischaemic bowel
7. sepsis syndrome (e.g. pneumococcal bacteraemia)

Question 5

What are the presenting features of inflammatory bowel disease causing acute diarrhoea? [4]

• hints:
  
  • who gets it?
  • characteristics of diarrhoea?
  • history?
  • red flag?

Answer 5

1. Often younger patient
2. bloody diarrhoea
3. will often give history of an “irritable” bowel
4. may have weight loss

Question 6

What are the presenting features of bowel cancer causing acute diarrhoea? [3]

• hints:
  
  • who gets it?
  • characteristics of diarrhoea?
  • red flag?

Answer 6

1. often older person
2. altered bowel habits
3. prominent weight loss

Question 7

What are the presenting features of diverticular disease causing acute diarrhoea? [3]

• hints:
  
  • who gets it?
  • history?
  • cause of localised infection?

Answer 7

1. Often older patients
2. history of alternating constipation and diarrhoea
3. Diverticulae can become impacted with faeces leading to localised infection, so called “diverticulitis”.

Question 8

What are the presenting features of ischaemic bowel causing acute diarrhoea? [5]

• hints:
  
  • who gets it?
  • history? (x2)
  • presenting symptoms? (x2)

Answer 8

1. Often in older patients
2. history of:
   
   • vascular disease or
   • atrial fibrillation
3. Presents with:
   
   • diarrhoea and
   • abdominal pain

Question 9

How can sepsis cause acute diarrhoea? [1]

Answer 9

Due to shunting of blood away from splanchnic circulation

Question 10

What are the microbiological causes of gastroenteritis? [6]

Answer 10

1. Campylobacter species
2. Salmonella species
3. E.coli 0157
4. Norovirus
5. Rotavirus
6. Giardiasis

Question 11

What is the most common aetiologic agent in travellers’ diarrhoea? [1]

Answer 11

enterohaemmorhagic E.coli

Question 12

What is the typical reservoir for campylobacter sp. and what symptoms can it cause? [5]

Answer 12

1. reservoir = poultry
2. symptoms:
   
   • loose stool
   • nausea
   • colic
   • sometimes bloody stool

Question 13

What is the typical reservoir for salmonella sp. and what symptoms can it cause? [4]

Answer 13

1. reservoir = poultry
2. symptoms:
   
   • loose stool
   • nausea
   • colic

Question 14

What is the typical reservoir for E.coli and what symptoms can it cause? [4]

Answer 14

1. reservoir = ruminants (beef)
2. symptoms
   
   • bloody diarrhoea
   • colic
   • low grade fever

Question 15

What is the typical reservoir for norovirus and what symptoms can it cause? [4]

Answer 15

1. reservoir = person to person
2. symptoms
   
   • nausea
   • vomiting
   • loose stool

Question 16

What is the typical reservoir for rotovirus and what symptoms can it cause, and who usually gets affected? [4]

Answer 16

1. reservoir = person to person
2. symptoms
   
   • vomiting
   • non-bloody diarrhoea
3. most often affects children

Question 17

What is the typical reservoir for giardiasis and what symptoms can it cause? [4]

Answer 17

1. reservoir = contaminated food and water
2. symptoms
   
   • loose stool
   • bloating
   • excess wind

Question 18

What is the typical reservoir for enterohaemorrhagic E. coli and what symptoms can it cause? [4]

Answer 18

1. contaminated food and water
2. symptoms
   
   • loose stool
   • nausea
   • colic
3. occurs in travellers (traveller’s diarrhoea)

Question 19

How do you manage a patient with acute gastroenteritis? [3]

Answer 19

1. rehydration
   
   • oral rehydration salts (ideally) or IV fluids
2. antibiotics are not recommended
   
   • however, in patients with significant co-morbidity or in those with prolonged symptoms, antibiotics may be used to shorten the duration of diarrhoea
   • C. diff risk
3. infection control
   
   • as most causes are transmissible from person to person