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Diseases > Diarrhoea Notes > Flashcards

Diarrhoea Notes Flashcards

1
Q

Give the definition of diarrhoea:

A

Inc. frequency + fluidity of stools (subjective)

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2
Q

Give the definition of Gastro-enteritis:

A

3 or more loose stools a day + accompanying features

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3
Q

Give definition of dysentery:

A

Large bowel inflammation –> bloody stools

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4
Q

What chart is used to look at stools?

A

Bristol Stool Chart

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5
Q

How many types does the bristol stool chart have?

A

Type 1 to Type 7

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6
Q

Gastro-Enteritis (GE): What are the sources of GE?

A 
food contamination 
Storage of produce 
Travel related infections 
Isolated campylobacter cases 
Person to person spread
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7
Q

how is contamination of food a source of GE?

A

Due to increased intensity of farming

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8
Q

how is storage of food a source of GE?

A

due to increased bacterial proliferation at room temp

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9
Q

what is a travel related infection that causes GE?

A

Salmonella

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10
Q

what is the name of the person to spread virus that causes GE?

A

norovirus

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11
Q

What are some defence mechanisms against Enteric infections?

A

1) hygiene
2) stomach acidity: inc. susceptible when using PPIs/ antacids
3) Normal flora: when there is dec. flora then there is inc. C.diff
4) Immunity–> HIV –> Salmonella

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12
Q

What are the 2 types of diarrhoea?

A

1) Non-inflammatory/ Secretory- Cholera

2) Inflammatory

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13
Q

Describe Non-inflammatory/ Secretory- Cholera diarrhoea:

A

Secretory toxin mediated;
Cholera causes inc. cAMP levels + Cl (Chloride) secretion
Enterotoxigenic E.coli
Frequent watery stools with little abdominal pain

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14
Q

What is the treatment of Non-inflammatory/ Secretory- Cholera diarrhoea?

A

Rehydration

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15
Q

Describe inflammatory diarrhoea:

A

Inflammatory toxin damage + mucosal destruction = Pain + fever
Bacterial infection/ amoebic dysentery
Bloody + mucous diarrhoea

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16
Q

What is the treatment of inflammatory diarrhoea?

A

Treatment = rehydration

+ Antibiotics when appropriate

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17
Q

When assessing a patient with suspected Gastro-enteritis, what are you looking for?

A

1) Symptoms + duration; longer than 2 weeks–> unlikely to be GE
2) Risk of food poisoning
3) Hydration- how to check: postural BP/ skin turgor/ Pulse
4) Sepsis: Fever/ raised WCC

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18
Q

What investigations are used in Gastro-enteritis?

A

1) stool culture
2) blood culture
3) renal function
4) blood count: neutrophilia/ haemolysis
5) abdominal xray- toxic dilatation of colon

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19
Q

What are the differential diagnosis of someone with Gastro-enteritis?

A

1) Inflammatory bowel disease
2) Spurious diarrhoea- secondary to constipation
3) Carcinoma
4) Diarrhoea + fever can occur with sepsis outside gut ; lack of abdo pain/ tenderness, no blood/ mucous in stools

20
Q

What is the general treatment of Gastro-enteritis?

A

1) Rehydration: IV/ Oral
2) Antimicrobials: Not routinely given
3) Treatment of complications

21
Q

Name the 3 most common Gastro-enteritis pathogens:

A

1) Campylobacter Gastroenteritis
2) Salmonella Gastroenteritis
3) E.coli O157

22
Q

Name some other bacteria that cause Gastro-enteritis:

A 
shigella 
other forms of E.coli 
Staph aureus (toxin) 
Bacillus cereus (re-fried rice)
Clostridium perfringens (toxin)
23
Q

When do you give antibiotics with Gastro-enteritis?

A 
GE WITH: 
-Immunocompromised
-Severe sepsis/ invasive infection 
-Valvular heart disease 
-Chronic illness/ diabetes 
NOT IN HEALTHY PATIENTS WITH NON-INVASIVE INFECTIONS
24
Q

The GE pathogen: Campylobacter Gastroenteritis: Describe it:

A
  • Up to 7 days’ incubation
  • Stools negative within 6 weeks
  • Abdominal pain (can be severe)
  • <1% invasive
  • Commonest cause of bacterial food poisoning in UK
  • Specialised culture conditions
  • Isolated cases rather than outbreaks
25
Q

What pathogen is responsible for being the most common cause of bacterial food poisoning in the UK?

A

campylobacter gastroenteritis

26
Q

The GE pathogen: Salmonella Gastroenteritis: Describe it:

A

• Symptom onset <48 hours after exposure
• Diarrhoea lasts <10 days
• <5% positive blood cultures
• 20% patients have positive stools after 20 weeks
o Prolonged carriage may be associated with gallstones
• Post infectious irritable bowel is common
• Screened out as lactose non-fermenters antigen + biochemical tests
• Most common – Salmonella enteritidis + typhimurium

27
Q

The GE pathogen: E.coli O157: Describe it:

A

• Infection from – Contaminated meat / person to person spread
• Typical illness characterised by frequent bloody stools
• Produced verocytotoxin that can get into blood (but E.coli itself stays in gut)
• Toxin can cause haemolytic-uraemic syndrome (HUS)
o Stimulates platelet activation clump and block capillaries
o RBCs cannot pass so break down (haemolysis)
o Occurs in mesangial cells renal failure + urea

28
Q

When a patient presents with Clostridium Difficile diarrhoea , what do they usually have a history of?

A

previous antibiotic treatment

wide spectrum- wipes out normal flora

29
Q

What are the treatment options for c.difficile diarrhoea?

A
  • metronidazole
  • oral vancomycin
  • surgery
30
Q

What are some preventative measures (prevention) for c.difficile diarrhoea?

A
  • Reduction in prescribing of broad spectrum antibiotics
  • Antibiotic management team
  • Isolate symptomatic patients
  • Wash hands between patients
31
Q

what is the management of c.difficile diarrhoea?

A
  • stop prescribing antibiotic

- metronidazole/ oral vancomycin

32
Q

Parasites: Give 2 classes of parasites that can cause disease in humans?

A

Protozoa + helminths

33
Q

How are parasitic infections diagnosed?

A

diagnosed by microscopy

34
Q

Name 2 UK parasites:

A

Giardia lamblia & Cryptosporiduium parvum

35
Q

Describe giardia lamblia:

A

o Contaminated water
o Diarrhoea / malabsorption / failure to thrive
o Cysts on stool microscopy
o Treatment – Metronidazole

36
Q

What is the treatment of giardia lamblia?

A

metronidazole

37
Q

Describe Cryptosporiduium parvum:

A

o Contaminated water (animal faeces)
o Cysts on microscopy
o No treatment

38
Q

Name an imported parasite:

A

Entamoeba histolytica

39
Q

What does Entamoeba histolytica cause?

A

amoebic dysentery

40
Q

What is amoebic dysentery?

A

Amoebic dysentery is an infection of the intestines by a parasite causing diarrhoea that contains blood or mucus. Amoebic dysentery, also called amoebiasis, is caused by a single-celled parasite called Entamoeba histolytica. (from google so probs not important)

41
Q

Describe Entamoeba histolytica – Amoebic dysentery:

A

o Vegetative form in symptomatic patient
o Cysts in asymptomatic patient
o Amoebic liver abscess – long term

42
Q

What is the treatment for entamoeba histlytica- amoebic dysentery:

A

metronidazole

43
Q

What is viral diarrhoea in children under 5 called?

A

Rotavirus in children under 5

44
Q

What is viral diarrhoea called in people over 5?

A

Norovirus

45
Q

Describe rotavirus:

A

o Common in winter
o Diagnosis by antigen detection
o Vaccine available

46
Q

Describe Norovirus:

A

o Diagnosis by PCR
o Very infectious
o Strict infection control measures needed

Diseases (9 decks)

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