diarrhoeal diseases PH Flashcards
what is the definition of diarrhoea?
3 or more watery stools a day (but remember need to take into account what is the normal for the pt as well)
what is the bristol stool chart?
groups stools into seven types from type 1 to type 7
what is type 7 stool?
watery, no solid pieces, entirely liquid
what is type 1 stool?
separate hard lumps like nuts that are hard to pass
what type of stool is like a sausage or snake and is smooth and soft?
type 4
what are the non-infective causes of diarrhoea?
neoplasm hormonal inflammatory radiation irritable bowel chemical anatomical
give an example of an anatomical cause of diarrhoea?
short gut syndrome either from birth or due to surgery eg for mesenteric ischaemia
what are the hormones that can cause diarrhoea?
adrenaline
serotonin
thyroxine
why does radiation cause diarrhoea?
due to the inflammation of the bowel caused by the radiation
how can the infective causes of diarrhoea be classified?
bloody (dysentery)
non-bloody
what could be a reservoir of infection?
environment, human, animal
what are the 3 broad types of transmission of infection?
direct
indirect
airborne
what are the methods of transmission within the direct group?
direct contact eg for STIs
faeco-oral route
what are the methods of transmission within indirect transmission?
vehicle borne - ie needle or transfusion products
vector borne - eg malaria and Dengue fever
is legionella and airborne disease and can it be passed from human to human?
yes airborne
no - can’t be passed from human to human
what organisms could be causing frequent diarrhoea, flatulence, nausea and abdominal discomfort in a student returning from a backpacking holiday in south asia?
giardia - protozoa E. coli Enteric fever (Salmonella typhi and paratyphi) Cholera viral gastroenteritis eg norovirus and rotavirus Campylobacter Entamoeba histolytica Cryptosporidium hominis
which pathogen is common in nurseries?
rotavirus
which pathogens cause illness from petting zoos?
Campylobacter
Salmonella
E. coli O157
what bacterium is responsible for HUS
E. coli O157
What can the E. coli O157 toxin lead to?
acute kidney failure liver dysfunction haemolysis of blood cells bloody diarrhoea HUS
what pathogen is common in care homes?
norovirus
give the symptoms of norovirus
vomiting diarrhoea nausea cramps headache fever chills myalgia
how long do the symptoms in norovirus last?
1-3 days
where is norovirus found?
- Hospitals
- Care Homes
- Schools
- Cruise ships
- Families
what should you tell a food handler who has diarrhoea?
keep out of work for days, they need to come back to the doctor to assess their fitness to practice before going back to work
is food poisoning a notifiable disease?
yes - as this means that the source could be found and the infection and spread controlled
an elderly pt who has diarrhoea while recovering from surgery is likely to have what pathogen?
C. diff
what can low volume bloody stools be caused by?
Shigella
what are the characteristics of the bacterium C. diff?
produces spores - which are difficult to eradicate
people can carry C. diff
C. diff is an environmental pathogen eg found in soil
what causes psudomembranous colitis in C. diff infection?
the C. diff toxin
how is C. diff spread?
faeco-oral route
spores in the environment
what does the acronym SIGHT stand for?
Suspect C diff as a cause of diarrhoea Isolate the case Gloves and aprons must be worn Hand washing with soap and water Test stool for toxin - request this on the form as this test is not routinely done
How is C. diff managed?
infection control procedures
control antibiotic use especially the broad spectrum ones such as ampicillin, amoxicillin and cephalosporins
surveillance and case finding
any pt with diarrhoea should be isolated, enteric precautions taken, stool samples tested, environmental cleaning and treat C.diff with metronidazole or vancomycin
how is C. diff infection investigated?
test stool samples
culture stool samples to identify the strain
biopsies taken at sigmoidoscopy
Do you need to treat asymptomatic carriers of C. diff?
no
what may be causing altered bowel motions, increased frequency and mucous and symptoms for 6 months, weight loss and night sweats?
bowel cancer, most likely to be colorectal cancer
what is the second largest killer of children worldwide?
diarrhoea!
what is the first largest killer of children world-wide?
resp tract infections
what is the number 1 treatment for diarrhoea in developing countries?
rehydration
Which parts of the world have a high infant mortality for diarrhoeal diseases?
south asia
africa
Give examples of causative organisms for diarrhoea in children
E. coli Shigella Campylobacter Salmonella Cryptosporidium Rotavirus
How are diarrhoeal diseases prevented as part of the global WHO-UNICEF prevention package?
vaccinations breastfeeding vitamin A supplementation promote hand washing with soap improved water supply quantity and quality sanitation promotion in communities
How are diarrhoeal diseases treated as part of the global WHO-UNICEF treatment package?
Fluid Replacement to prevent dehydration
Zinc treatment
what are some control measures that can be taken to prevent spread of diarrhoea?
- Hand-washing with soap
- Ensure availability of safe drinking water
- Safe disposal of human waste
- Breastfeeding of infants & young children
- Safe handling and processing of food
- Control of flies/vectors
- Case management including exclusion
- Vaccination
who are the 4 at risk groups fro diarrhoea?
A – Persons of doubtful personal hygiene or with
unsatisfactory hygiene facilities at home, work or
school
B – Children who attend pre school or nursery
C – People whose work involves preparing or serving
unwrapped/uncooked food
D – HCW/Social care staff working with vulnerable
people
