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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
Severity of C. Diff
Ranges from mild diarrhoea to severe colitis
26
Treatment of C. Diff
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
27
Complications of C. diff infection
Pseudomembranous colitis
28
Prevention of C.diff infection
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)
29
4Cs to avoid in the prevention of C. Diff infection
``` Cephalosporins Co-Amoxiclav Clindamycin Clarithromycin (Ciphrofloxacin) ```
30
What are protozoa and helminthes (parasites) generally diagnosed by?
Microscopy
31
Examples of UK parasites
Giardia lamblia | Cryptosporidium parvum
32
Where is giardia lamblia found?
Contaminated water
33
Presentation of giardia lamblia
``` Diarrhoea Malabsorption (vit B12) Failure to thrive Flatulence Greasy stools that are foul smelling ```
34
Definition of diarrhoea
A subjective term describing frequent loose/liquid stools
35
Definition of foodstuffs
Gastroenteritis caused by contaminated foodstuffs
36
Definition of dysentery
Infections of the intestines resulting in pain and often bloody/mucoid diarrhoea
37
What infections of viruses/parasites/bacteria cause localised infection in GI lumen?
Cholera Rotavirus Norovirus
38
What infections of viruses/parasites/bacteria cause toxin mediated disease?
E.coli 0157 C. Diff Staphylococcus aureus
39
What infections of viruses/parasites/bacteria cause systemic infection +/- bacteraemia?
Campylobacter | Entamoeba Histolytica
40
How do you catch E. Coli 0157?
Agriculture | Animal faeces exposure
41
What does enterotoxigenic E. coli cause?
Travelers Diarrhoea
42
How do you catch salmonella spp?
Contaminated animal products | tortoises/terrapins/reptiles
43
How do you catch campylobacter spp?
Contaminated chicken
44
How do you catch Clostridium Difficle infection?
Broad spectrum antibiotic usage
45
How do you catch Vibrio Cholerae?
Contaminated water in developing countries/crisis zones
46
Which bacteria is associated with Guillian Barre syndrome?
Campylobacter jejuni/coli
47
What is E. Coli 0157 associated with?
Haemolytic Uraemia Syndrome
48
What can C. diff infection lead to?
toxic megacolon, perforation and death
49
What post infective condition can salmonella lead to?
IBS
50
What organism causes cholera?
Vibrio Cholerae
51
Where is entamoeba histolytica found?
Foreign travel to areas of poor hygiene
52
What can entameoba histolytica result in (complication)?
Amoebic liver cysts
53
What does entameoba histolytica cause?
Ameobic dysentery
54
When would blood cultures be carried out?
To exclude invasive campylobacter/salmonella
55
When would toxin testing be carried out?
To confirm C. Diff infection
56
When would stool cultures be carried out?
To isolate bacterial pathogens e.g. campylobacter, salomonella, shigella, E. coli
57
When would stool microscopy be carried out?
Parasitic causes - looking for ova, cysts and parasites along with relevant travel history
58
When would Viral PCR/antigen testing be carried out?
To confirm norovirus/rotavirus infection
59
How to assess fluid status in an infected patient?
``` 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
Using antibiotics when infected with what can make the infection worse?
E. Coli 0157
61
Two forms of giardia lamblia
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
Where are giardia lamblia cysts seen?
On stool microscopy
63
Where is the "vegetative form" of giardia lamblia seen?
Duodenal biopsy | "String test"
64
Treatment of giardia lamblia
Metronidazole
65
Where is cryptosporidium parvum found?
Contaminated water (animal faeces) - have to filter water as not affected by chlorine
66
Where are the cysts of cryptosporum parvum seen?
Microscopy
67
Treatment for cryptosporum parvum
No treatment
68
Cryptosporum parvum has a particular problem in who and why?
Immunocompromised patients, it can move loads of places in these patients e.g. pancreatic ducts, resp systems
69
What does entamoeba histolytica form?
8 trophocytes
70
What does entamoeba histolytica cause/presentation?
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
Treatment of entaemeba histolytica
Metronidazole
72
What strains of adenovirus cause diarrhoea?
40/41
73
Who gets the rotavirus?
Children < 5 years
74
When is rotavirus common?
Winter
75
How is rotavirus diagnosed?
Antigen detection
76
Transmission of norovirus
Faecal-oral route | Ingestion of aerosol particles from vomit in surrounding air
77
outbreaks of norovirus are common where?
In isolated areas e.g. cruise ships, community, hospital
78
Diagnosis of norovirus is done by...
PCR
79
How infectious is norovirus?
Very infectious - do not need many viral particles to pass on the infection
80
Defence against enteric infections
Hygiene Stomach acidity (antacids + infection) Normal flora (C. Diff diarrhoea) Immunity (HIV - salmonella)
81
Diarrhoeal illness is predominately one of two pictures
1. Secretory | 2. Inflammatory
82
An example of non-inflammatory secretory diarrhoeal illness would be....
Cholera
83
An example of an inflammatory diarrhoeal illness would be....
Shigella dysentery
84
An example of a mixed picture of inflammatory and secretory diarrhoeal illness would be...
C. Difficle diarrhoea
85
Presentation of non-inflammatory diarrhoeal illness
Frequent watery stools with little abdominal pain
86
Pathology of cholera as a secretory-toxin mediated infection
Increased cAMP levels Increased Cl secretion Rise in osmotic pressure in gut lumen so lose a lot of fluid
87
Definition of travellers diarrhoea
Any diarrhoea that occurs on holiday
88
Treatment of non-inflammatory secretory diarrhoea
Rehydration
89
Presentation of an inflammatory diarrhoeal illness
Diarrhoea with pain and fever
90
Pathology of an inflammatory diarrhoeal illness
Inflammatory toxin damage and mucosal destruction
91
Treatment of inflammatory diarrhoeal illness
Antimicrobials may be appropriate but rehydration alone is often sufficient
92
Over how many days of the history does it mean it is unlikely to be gastroenteritis?
> 14 days
93
Things to ask in the history of diarrhoeal illness
Dietary Contact Travel
94
Features of dehydration and inflammation in babies/children
``` fever raised WCC sunken eyes and cheeks few/no tears Decreased skin turgor sunken fontanelle Sunken abdomen Dry mouth/tongue ```
95
Investigations of diarrhoeal illness
``` Stool culture (3) Blood culture (invasive or not) Renal function Blood count (neutrophilia, haemolysis) Abdominal X ray if distended or tender ```
96
Secretory diarrhoea fluid and electrolyte loss
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
In E. Coli 0157, what does O stand for?
Somatic antigen
98
How to catch E. coli 0157
Contaminated meat Person-to-person spread (low inoculum) Can be imported Strong link to cattle and slurry
99
Presentation of E. coli 0157 infection
Frequent bloody stools
100
Pathogenesis of E. Coli 0157
Produces (verocyto-) toxin Stays in gut but toxin gets into the blood Toxin can cause haemolytic uraemic syndrome (HUS)
101
What does haemolytic uraemic syndrome (HUS) consist of?
Renal failure Haemolytic anaemia Thrombocytopenia
102
Forms of E. Coli that cause diarrhoea
0157 Enteropathogenic Enterotoxic (travellers diarrhoea) Enteroinvasive
103
Diagnosis of E. coli strains
Routine diagnosis not possible | Only E. coli 0157 is easily distinguishable from "ordinary" E . coli
104
Treatment of E. coli infection
Supportive | Antibiotics NOT indicated
105
Pathology of haemolytic uraemic syndrome
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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