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Infection > Diarrhoea > Flashcards

Diarrhoea Flashcards

1
Q

Definition of gastroenteritis

A

Inflammation of the stomach/intestines often causing three or more loose stools per/day with accompanying features of vomiting and pain

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2
Q

What chart shows the different types of stools?

A

Bristol stool chart

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3
Q

Causes of gastroenteritis

A

Contamination of food stuff e.g. chicken and campylobacter
Poor storage of produce e.g. bacterial proliferation at room temperature
Travel related infections e.g. salmonella
Person to person spread e.g. norovirus (principally for viruses)

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4
Q

What is the commonest bacterial pathogen of infection?

A

Campylobacter

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5
Q

Differential diagnosis of gastroenteritis

A

IBD (history >2 weeks)
Spurious diarrhoea
Carcinoma

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6
Q

What is spurious diarrhoea secondary to?

A

Constipation

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7
Q

Treatment of gastroenteritis

A

Rehydration
- oral with salt/sugar solution
- IV saline
Antibiotics possibly (not in healthy patient with non-invasive infection)

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8
Q

Antibiotics are indicated in gastroenteritis for….

A 
Immunocompromised 
Severe sepsis or invasive infection 
Valvular heart disease 
Chronic illness
Diabetes
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9
Q

Incubation of campylobacter gastroenteritis

A

up to 7 days so dietary history may be unreliable

usually 2-3 days - a week unlikely

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10
Q

Do you get chronic infection with campylobacter gastroenteritis?

A

No - stools negative within 6 weeks

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11
Q

Post infective sequalae of campylobacter gastroenteritis includes;

A

Guillian-Barre syndrome

Reactive arthritis

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12
Q

What is the commonest cause of food poisoning in the UK?

A

Campylobacter

  • C. Jejuni
  • C. Coli
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13
Q

When does the symptoms for salmonella gastroenteritis usually occur after exposure?

A

Symptom onset usually <48 hours after exposure

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14
Q

How long does diarrhoea usually last with salmonella gastroenteritis?

A

< 10 days

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15
Q

Commonest salmonella infections in the UK

A

Salmonella enteriditis

Salmonella Typhimurium

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16
Q

What do S. typhi and S. paratyphi cause?

A 
Enteric fever (typhoid and paratyphoid) 
NOT gastroenteritis
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17
Q

What bacteria causes food poisoning from reheated rice?

A

Bacillus cereus

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18
Q

Definition of infection in respect to food poisoning

A

Ingesting the pathogen that duplicates

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19
Q

Definition of intoxication in respect to food poisoning

A

Damage to the host cells from the toxins that were in the food

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20
Q

What history is usually present with C. Diff diarrhoea?

A

Previous antibiotic treatment - “the 4Cs antibiotics”

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21
Q

What is Clostridium Difficile (C. Diff)?

A

Gram positive anaerobe

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22
Q

Does C. Diff form spores?

A

Yes, heat resistant anaerobic spores

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23
Q

What does C. Diff produce?

A

Enterotoxin (A)
Cytotoxin (B)
(C-diff transferase)

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24
Q

What does C. diff do to the gut?

A

Target enterocytes and cause necrosis which will damage the integrity of the gut

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25
Q

Severity of C. Diff

A

Ranges from mild diarrhoea to severe colitis

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26
Q

Treatment of C. Diff

A

Stop precipitating antibiotic (if possible)
Methonidazole (oral if no severity markers)
Oral vancomycin (if two or more severity markers)
Fidaxomicin
Stool transplants
Surgery may be required

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27
Q

Complications of C. diff infection

A

Pseudomembranous colitis

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28
Q

Prevention of C.diff infection

A

Reduction in broad spectrum antibiotic prescribing
Avoid 4Cs
Antimicrobial management team (AMT) and local antibiotic policy
Isolate symptomatic patients (due to spores spreading rapidly)
Wash hands in between patients (spores not affected by gels)

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29
Q

4Cs to avoid in the prevention of C. Diff infection

A 
Cephalosporins 
Co-Amoxiclav
Clindamycin 
Clarithromycin 
(Ciphrofloxacin)
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30
Q

What are protozoa and helminthes (parasites) generally diagnosed by?

A

Microscopy

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31
Q

Examples of UK parasites

A

Giardia lamblia

Cryptosporidium parvum

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32
Q

Where is giardia lamblia found?

A

Contaminated water

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33
Q

Presentation of giardia lamblia

A 
Diarrhoea
Malabsorption (vit B12)
Failure to thrive
Flatulence
Greasy stools that are foul smelling
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34
Q

Definition of diarrhoea

A

A subjective term describing frequent loose/liquid stools

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35
Q

Definition of foodstuffs

A

Gastroenteritis caused by contaminated foodstuffs

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36
Q

Definition of dysentery

A

Infections of the intestines resulting in pain and often bloody/mucoid diarrhoea

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37
Q

What infections of viruses/parasites/bacteria cause localised infection in GI lumen?

A

Cholera
Rotavirus
Norovirus

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38
Q

What infections of viruses/parasites/bacteria cause toxin mediated disease?

A

E.coli 0157
C. Diff
Staphylococcus aureus

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39
Q

What infections of viruses/parasites/bacteria cause systemic infection +/- bacteraemia?

A

Campylobacter

Entamoeba Histolytica

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40
Q

How do you catch E. Coli 0157?

A

Agriculture

Animal faeces exposure

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41
Q

What does enterotoxigenic E. coli cause?

A

Travelers Diarrhoea

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42
Q

How do you catch salmonella spp?

A

Contaminated animal products

tortoises/terrapins/reptiles

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43
Q

How do you catch campylobacter spp?

A

Contaminated chicken

44
Q

How do you catch Clostridium Difficle infection?

A

Broad spectrum antibiotic usage

45
Q

How do you catch Vibrio Cholerae?

A

Contaminated water in developing countries/crisis zones

46
Q

Which bacteria is associated with Guillian Barre syndrome?

A

Campylobacter jejuni/coli

47
Q

What is E. Coli 0157 associated with?

A

Haemolytic Uraemia Syndrome

48
Q

What can C. diff infection lead to?

A

toxic megacolon, perforation and death

49
Q

What post infective condition can salmonella lead to?

A

IBS

50
Q

What organism causes cholera?

A

Vibrio Cholerae

51
Q

Where is entamoeba histolytica found?

A

Foreign travel to areas of poor hygiene

52
Q

What can entameoba histolytica result in (complication)?

A

Amoebic liver cysts

53
Q

What does entameoba histolytica cause?

A

Ameobic dysentery

54
Q

When would blood cultures be carried out?

A

To exclude invasive campylobacter/salmonella

55
Q

When would toxin testing be carried out?

A

To confirm C. Diff infection

56
Q

When would stool cultures be carried out?

A

To isolate bacterial pathogens e.g. campylobacter, salomonella, shigella, E. coli

57
Q

When would stool microscopy be carried out?

A

Parasitic causes - looking for ova, cysts and parasites along with relevant travel history

58
Q

When would Viral PCR/antigen testing be carried out?

A

To confirm norovirus/rotavirus infection

59
Q

How to assess fluid status in an infected patient?

A 
Fluid balance (in/out)
BP and HR (postural drop in BP is very sensitive for fluid depletion)
mucuous membranes (dry vs moist)
Weight (assess trend)
Leg raising test 
Skin turgor
60
Q

Using antibiotics when infected with what can make the infection worse?

A

E. Coli 0157

61
Q

Two forms of giardia lamblia

A
  1. Hard cyst
    - when in stable environment
  2. Trozozytes
    - in the gut the cyst exocytes itself into two trozozytes which live in the duodenum
  3. when they get back into the colon they endocyst themselves back into cysts
62
Q

Where are giardia lamblia cysts seen?

A

On stool microscopy

63
Q

Where is the “vegetative form” of giardia lamblia seen?

A

Duodenal biopsy

“String test”

64
Q

Treatment of giardia lamblia

A

Metronidazole

65
Q

Where is cryptosporidium parvum found?

A

Contaminated water (animal faeces) - have to filter water as not affected by chlorine

66
Q

Where are the cysts of cryptosporum parvum seen?

A

Microscopy

67
Q

Treatment for cryptosporum parvum

A

No treatment

68
Q

Cryptosporum parvum has a particular problem in who and why?

A

Immunocompromised patients, it can move loads of places in these patients e.g. pancreatic ducts, resp systems

69
Q

What does entamoeba histolytica form?

A

8 trophocytes

70
Q

What does entamoeba histolytica cause/presentation?

A

Ameobic dysentery - causes blood + mucus in stool
Can cause different ranges of damage
- mild inflammation which is asymptomatic to
- deep infiltration into portal circulation and so flow into brain, liver etc
vegetative form in symptomatic patient - “hot stool”
Cysts seen in asymptomatic patient
Ameobic liver abscess (long term complication - “anchovy pus”

71
Q

Treatment of entaemeba histolytica

A

Metronidazole

72
Q

What strains of adenovirus cause diarrhoea?

A

40/41

73
Q

Who gets the rotavirus?

A

Children < 5 years

74
Q

When is rotavirus common?

A

Winter

75
Q

How is rotavirus diagnosed?

A

Antigen detection

76
Q

Transmission of norovirus

A

Faecal-oral route

Ingestion of aerosol particles from vomit in surrounding air

77
Q

outbreaks of norovirus are common where?

A

In isolated areas e.g. cruise ships, community, hospital

78
Q

Diagnosis of norovirus is done by…

A

PCR

79
Q

How infectious is norovirus?

A

Very infectious - do not need many viral particles to pass on the infection

80
Q

Defence against enteric infections

A

Hygiene
Stomach acidity (antacids + infection)
Normal flora (C. Diff diarrhoea)
Immunity (HIV - salmonella)

81
Q

Diarrhoeal illness is predominately one of two pictures

A
  1. Secretory

2. Inflammatory

82
Q

An example of non-inflammatory secretory diarrhoeal illness would be….

A

Cholera

83
Q

An example of an inflammatory diarrhoeal illness would be….

A

Shigella dysentery

84
Q

An example of a mixed picture of inflammatory and secretory diarrhoeal illness would be…

A

C. Difficle diarrhoea

85
Q

Presentation of non-inflammatory diarrhoeal illness

A

Frequent watery stools with little abdominal pain

86
Q

Pathology of cholera as a secretory-toxin mediated infection

A

Increased cAMP levels
Increased Cl secretion
Rise in osmotic pressure in gut lumen so lose a lot of fluid

87
Q

Definition of travellers diarrhoea

A

Any diarrhoea that occurs on holiday

88
Q

Treatment of non-inflammatory secretory diarrhoea

A

Rehydration

89
Q

Presentation of an inflammatory diarrhoeal illness

A

Diarrhoea with pain and fever

90
Q

Pathology of an inflammatory diarrhoeal illness

A

Inflammatory toxin damage and mucosal destruction

91
Q

Treatment of inflammatory diarrhoeal illness

A

Antimicrobials may be appropriate but rehydration alone is often sufficient

92
Q

Over how many days of the history does it mean it is unlikely to be gastroenteritis?

A

> 14 days

93
Q

Things to ask in the history of diarrhoeal illness

A

Dietary
Contact
Travel

94
Q

Features of dehydration and inflammation in babies/children

A 
fever
raised WCC
sunken eyes and cheeks 
few/no tears
Decreased skin turgor 
sunken fontanelle
Sunken abdomen 
Dry mouth/tongue
95
Q

Investigations of diarrhoeal illness

A 
Stool culture (3)
Blood culture (invasive or not)
Renal function 
Blood count (neutrophilia, haemolysis)
Abdominal X ray if distended or tender
96
Q

Secretory diarrhoea fluid and electrolyte loss

A

1-7l fluid per day containing 80-100mmol Na
Hyponatraemia due to sodium loss with fluid replacement by hypotonic solutions
Hypokalaemia due to K loss in stool (40-80mmol/l of K in stool)

97
Q

In E. Coli 0157, what does O stand for?

A

Somatic antigen

98
Q

How to catch E. coli 0157

A

Contaminated meat
Person-to-person spread (low inoculum)
Can be imported
Strong link to cattle and slurry

99
Q

Presentation of E. coli 0157 infection

A

Frequent bloody stools

100
Q

Pathogenesis of E. Coli 0157

A

Produces (verocyto-) toxin
Stays in gut but toxin gets into the blood
Toxin can cause haemolytic uraemic syndrome (HUS)

101
Q

What does haemolytic uraemic syndrome (HUS) consist of?

A

Renal failure
Haemolytic anaemia
Thrombocytopenia

102
Q

Forms of E. Coli that cause diarrhoea

A

0157
Enteropathogenic
Enterotoxic (travellers diarrhoea)
Enteroinvasive

103
Q

Diagnosis of E. coli strains

A

Routine diagnosis not possible

Only E. coli 0157 is easily distinguishable from “ordinary” E . coli

104
Q

Treatment of E. coli infection

A

Supportive

Antibiotics NOT indicated

105
Q

Pathology of haemolytic uraemic syndrome

A

Toxin binds to globotriaosylceramide
Platlet activation stimulated
Micro-angiopathy results
Attach to endothelial, glomerular, tubule and mesangial cells

Infection (16 decks)

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