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Infection > Diarrhoea > Flashcards

Diarrhoea Flashcards

1
Q

Define diarrhoea

A

fluidity and frequency

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2
Q

Define gastro-enteritis

A

Three or more loose stools/day

Accompanying features

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3
Q

Define dysentery

A

Large bowel inflam

Bloody stools

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4
Q

Bristol stool chart

A

Type 1; seperate hard pieces, hard to pass

Type 2; sausage shape, lumpy

Type 3; sausage, cracked surface

Type 4; sausage, soft and smooth

Type 5; soft blobs, clear-cut edges

Type 6; fluffy pieces with ragged edges, mushy

Type 7; watery, no solid pieces

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5
Q

Epidemiology of gastroenteritis

A

Contamination of foodstuff

Poor produce storage

Travel-related infections; salmonella

Person-to-person spread; norovirus

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6
Q

What is the most common cause of infectious intestinal disorder?

A

Viruses

Campylobacter most common bacterial pathogen

Salmonella causes the most hospital admissions

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7
Q

Defences against enteric infections

A

Hygiene
Stomach acidity
Normal gut flora
Immunity; HIV and salmonella

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8
Q

Clinical features of diarrhoeal illness

A

Non-inflammatory/secretory i.e. cholera

  • frequent watery stools, little abdo pain
  • rehydration mainstay of therapy

Inflammatory i.e. shigella dysentery

  • pain and fever
  • rehydration ± antimicrobials

Mixed picture i.e. C diff

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9
Q

Examination assessment of a patient with diarrhoeal illness

A

Symptoms and duration
- >2/52 unlikely infective gastroenteritis

Risk of food poisoning

Assess hydration

Features of inflammation
- fever, raised WCC

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10
Q

Describe fluid and electrolyte loss in diarrhoea

A

Can be severe

Hyponatraemia due to sodium loss with fluid replacement by hypotonic solutions

hypokalaemia due to K loss in stool

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11
Q

Investigations for a patient with diarrhoeal illness

A

Stool culture ± molecular or Ag testing

Blood culture

Renal function

Blood count; neutrophils, haemolysis

Abdo x-ray/CT if abdo distended/tender

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12
Q

Differential diagnoses in diarrhoeal illness

A

Inflammatory bowel disese
Spurious diarrhoea; secondary to constipation
Infectious
Carcinoma

Rare; sepsis outside gut

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13
Q

Treatment of gastroenteritis

A

Rehydration; IV or oral

  • oral with salt/sugar solution
  • IV saline
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14
Q

Describe post-infectious issues in campylobacter

A

Guillain-barre syndrome

Reactive arthritis

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15
Q

What two campylobacter species cause the most infections?

A

C. jejuni

C. coli

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16
Q

What are the commonest isolates of salmonella in UK?

A

S. enteritidis

S. typhimurium

17
Q

Describe E.coli O157

A

Typical illness = frequent bloody stools

Produces Shiga toxin

E.Coli stays in gut but toxin enters blood

Toxin can cause haemolytic anaemia and renal failure

18
Q

Describe haemolytic uraemic syndrome (HUS)

A

Renal failure
Haemolytic anaemia
Thrombocytopenia

Caused by toxin from E. Coli which stimulates platelet activation

19
Q

When should antibiotics be given in the case of diarrhoea?

A

Indicated in gastroenteritis for

  • immunocompromised
  • severe sepsis or invasive infection
  • chronic illness e.g. malignancy

Not indicated for healthy patient with non-invasive infection

20
Q

What are the common previous antibiotics in the history of a C.diff patient?

A

4 C’s

  • cephalosporins
  • co-amoxiclav
  • clindamycin
  • ciprofloxacin
21
Q

What does C.diff produce?

A

enterotoxin and cytotoxin

22
Q

How do we treat C.diff?

A
  • Metronidazole
  • oral vancomycin
  • fidaxomicin (new and expensive)
  • stool transplants
  • surgery may be required
23
Q

How do we prevent CDI?

A

Reduce broad spectrum AB prescribing

Avoid 4C’s

Antimicrobial management team and local antibiotic policy

Isolate symptomatic patients

WASH hands between patients - contact precautions

Cleaning environment

24
Q

Management of CDI

A

Stop precipitating AB if possible

Follow published treatment algorithm; oral metronidazole if no severity markers

Oral vancomycin is 2 or more severity markers

25
Q

C.diff severity markers

A
  • Temperature >38.5°C
  • WBC > 15 cells/mm3
  • Creatinine > 1.5 x
    baseline
  • Suspicion of PMC
  • Toxic megacolon
  • Ileus
  • CT evidence of severe disease
26
Q

How are parasites diagnosed?

A

Protozoa and helminths

Generally by microscopy

Send stool with request “parasites, cysts and ova please” or P, C and O

27
Q

Describe Giardia duodenalis

A

Protozoa in UK causing diarrhoea, gas, malabsorption, failure to thrive

Transmission by direct contact w/cattle, cats, dogs, other people or food/water contaminates w/faeces

Cysts on stool microscopy

Treat with metronidazole

28
Q

Describe Cryptosporidium parvum

A

Carried by >150 species of mammals

Diarrhoea, nausea, vomiting, abdo pain

Infected animals/faeces, contaminated water/food

Oocysts on microscopy

No specific treatment usually required

29
Q

Describe entamoeba histolytica

A

Amoebic dysentery
Invasive extraintestinal amoebiasis
Usually no bowel symptoms

Cysts seen formed in stool

Intestinal disease: metronidazole + luminal agent to clear colonization

Liver abscess (anchovy pus) = long term complication

30
Q

Describe viral diarrhoea

A

Rotavirus, norovirus, adenovirus

Rotavirus = children <5yoand diagnosed by antigen detection in stool

Noroviruses diagnosed by PCR (sometimes cruise ships)

Infection (15 decks)

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