Diarrhoea & Gastro-enteritis Flashcards
What is the definition of diarrhoea?
Increased fluidity and frequency of stool
What is the definition of gastro-enteritis?
Inflammation of the stomach and intestines
many things come under it
What are the 2 main signs of dysentery?
Large bowel inflammation and bloody stools
On the Bristol stool chart, what types are associated with gastro-enteritis?
Types 6 and 7
What are the 3 types of diarrhoea illness?
Secretory (e.g. cholera)
Inflammatory (e.g. dysentery)
Mixed (e.g. C.diff infection)
What is the main treatment for all types of diarrhoea illness?
Rehydration and fluids
What is the difference between secretory and inflammatory diarrhoea illness?
Secretory -> no abdominal pain or fever
Inflammatory -> abdominal pain and fever
What other treatments can be used for inflammatory diarrhoea illness?
Antibiotics
What type of hypertension is associated with hydration?
Postural hypertension
What are the signs of Systemic Inflammatory Response Syndrome (SIRS)?
Fever
Tachycardia
Increased WCC
In diarrhoea, is it only water that is lost?
No, Na and K are also lost which means you are at risk of hyponatraemia and hypokalaemia
What is the main type of virus that causes diarrhoea in children (under 5)?
Rotavirus
What type of virus commonly causes diarrhoea in hospitals, schools, care homes etc?
Norovirus
very infectious
How is norovirus diagnosed?
PCR
What are the S & S of gastro-enteritis?
Diarrhoea (main) Vomiting Abdominal pain Dehydration Hyponatraemia Hypokalaemia Fever
What investigations can be undergone for gastro-enteritis?
Bristol Stool Chart Stool culture Blood culture Molecular/antigen detection RFTs Bloods Abdominal X-rays/CT PCR
How does the Bristol Stool Chart describe stool?
With increasing fluidity i.e. Type 1 is constipation, whilst Type 7 is diarrhoea
What are the treatments for gastroenteritis?
Rehydration (salt/sugar solution) IV saline Antibiotics Stool transplants Oral vancomycin Metronidazole
What are the risk factors for gastroenteritis?
Over-seas travel Deprived areas Poor hygiene Antacids Antibiotics Immunosuppressants Poor diet
What is involved in the differential diagnosis with gastroenteritis?
IBD
Spurious diarrhoea (secondary to constipation)
Carcinomas
What are some of the causes of gastroenteritis?
Viruses (main) Food poisoning Bacteria Parasites Immunosuppression Sepsis
Give examples of types of bacteria that can cause gastroenteritis.
Campylobacter (main) Salmonella E. coli O157 Shigella C. diff
Give examples of ways in which food poisoning can occur.
Poor farming
Poor storage (not chilled)
Poor cooking
Why do antacids increases your susceptibility for gastroenteritis?
As stomach acid usually digests most bacteria, but if this acid is limited then bacteria can assert its affects more easily
Why do antibiotics increases your risk of enteric infections?
As they affect normal gut flora
If symptoms last for more than 2 weeks, is it likely to be gastroenteritis?
No, as it is unlikely to be an infection
What type of diarrhoea occurs as a result of gastroenteritis?
Inflammatory
What presents along with dehydration?
Hyponatraemia
Hypokalaemia
Why should an abdominal X-ray or CT be undergone for abdominal pain or tenderness?
To check for potential perforation or acute appendicitis
What type of diarrhoea is secondary to constipation?
Spurious
Why is glucose provided along with fluids?
As glucose has a co-transporter with Na
Why is it difficult to find the causative bacteria in a stool sample?
As there is a vast number of both non-pathogenic and pathogenic bacteria
What investigations are used alongside stools cultures?
Antigen detection
Molecular detection
What is the difference between O and H antigens?
O: occur on the body of the bacteria
H: occur on the flagella of the bacteria
What is the most common causative bacteria for gastroenteritis?
Campylobacter
What condition can campylobacter gastroenteritis occur after?
Gullian-Barre Syndrome
What is a classic symptom of campylobacter gastroenteritis?
Sever abdominal pain
so it can be confused with acute appendicitis and perforation
What are the 2 main species of campylobacter?
C. jejuni and C. coli
C= campylobacter
What bacteria is the most common cause of food poisoning?
Campylobacter
Where can campylobacter be found?
Contaminated chicken and milk
What is the difference between salmonella gastroenteritis and campylobacter gastro-enteritis?
Salmonella -> presents quicker, more likely to spread into blood (but still not common)
Campylobacter -> presents slower, less likely to spread into blood
What are the 2 main species of salmonella?
S. enterica and S. bongori
(S= salmonella)
What are the most common infection types of salmonella?
S. enteritidis and S. typhimurium
What is the difference between E.coli O157 and salmonella?
E.coli O157 -> ferments lactose
Salmonella -> does not ferment lactose
What is the difference between E.coli O157 and other types of E.coli?
E.coli O157 doesn’t spread into blood
Where can you get E.coli O157?
Contaminated meat
What is the main symptom of E.coli O157 gastroenteritis?
Frequent bloody stools
What type of bacterium is E.coli O157?
A toxin-mediated bacterium, so the bacterium itself stays in the gut but the toxins it produces can spread into blood
What is the name of the toxins produced by E.coli O157?
Shiga
What can the Shiga toxins produced by E.coli O157 cause?
Haemolytic-Uremic Syndrome
What are the S&S of Haemolytic-Uremic Syndrome?
Renal failure
Haemolytic anaemia
Low platelet count
Why are antibiotics not used to treat E.coli O157 gastro-enteritis?
As antibiotics break down the bacteria, which would result in more toxins being produced and Haemolytic-Uremic Syndrome occurring
Where is Shigella common?
In children nurseries
When treating gastroenteritis, when are antibiotics indicated and contraindicated?
Indicated: immunocompromised, severe sepsis and chronic illnesses (e.g. cancer)
Contraindicated: healthy patients with a non-invasive infection
What is the likely cause of gastroenteritis if the patient has previously undergone antibiotic treatment of the 4 C’s?(cephalosporins, co-amoxiclav, clindamycin and ciprofloxacin )
C. diff
What type of toxins does C. diff produce?
Type A -> enterotoxin
Type B -> cytotoxin
What drugs can be used to treat C. diff gastroenteritis?
Metronidazole
Vancomycin (oral)
Give examples of viruses that can cause gastro-enteritis?
Rotavirus (common in children)
Norovirus (common in community areas)
How is norovirus usually diagnosed?
PCR
