Gastritis

Question 1

What is C.diff?

Answer 1

C. difficile can exist in normal gut flora and acts as an opportunistic pathogen that is able to reproduce and become the dominant species in the gut of someone who has had disruption of their gut flora

Question 2

What can a C.diff infection result in?

Answer 2

pseudomembranous colitis which can lead to toxic megacolon and colonic perforation

Question 3

How do you manage C.diff?

Answer 3

• ORAL vancomycin, metronidazole or fidaoxmicin

- Stop diuretics and ACEi (reduced rx of dehydration and AKI)

Question 4

How do you test for C.diff?

Answer 4

• Stool sample - testing for C. diff toxin

* FBC and serum creatinine

Question 5

What is the main management for diarrhoea?

Answer 5

• Oral rehydration (dioralyte) or ORS.

- Give IV fluids if vomiting.

Question 6

What indicates that a patient needs a stool culture after >3 days hospitalisation?

Answer 6

• > 65yrs
• Comorbid disease
• Neutropenia
• HIV infection

Question 7

What is he most common cause of diarrhoea?

Answer 7

Campylobacter

Question 8

What are the signs of Campylobacter infection?

Answer 8

Abdominal pain, diarrhoea (may be bloody), malaise, vomiting

Question 9

How do you treat campylobacter?

Answer 9

Supportive

- Clarithromycin if severe

Question 10

Who are STEC and VTEC most common in?

Answer 10

Children <5yrs

Question 11

What can STEC cause?

Answer 11

HUS and TTP

Question 12

What does salmonella cause?

Answer 12

• Watery and sometimes bloody diarrhoea
• Abdominal pain
• Headache
• Nausea
• Vomiting
• Fever

Question 13

What is enteric fever?

Answer 13

Salmonella typhi/parathyphi

Question 14

What are the key points about enteric fever?

Answer 14

• Fever and abdominal pain

- Constipation more common that diarrhoea

Question 15

What can shigella cause?

Answer 15

• Bloody diarrhoea

- Fever

Question 16

What can cause chronic diarrhoea?

Answer 16

• Giardia lamblia
• Ameobiasis
• Schistosomiasis

Question 17

What tests would you do for chronic diarrhoea?

Answer 17

> 4 weeks 
•	FBC, U+Es, LFTs, TFTs
•	Blood cultures
•	Malaria films
•	HIV test
•	Stool culture and microscopy including acid fast staining
•	Flexible sigmoidoscopy with biopsies

Question 18

What are the features of giardia?

Answer 18

• Present in upper small bowel
• Lethargy, bloating, abdominal pain
• Non-bloody diarrhoea
• Malabsorption
• Empiric trial of therapy may be indicated with metronidazole/tinidazole

Question 19

What are the features of amoebiasis?

Answer 19

• Bloody diarrhoea, abscesses, amoebomas
• Stool microscopy: hot stool and antigen test
• Amoebic serology
• Treatment = metronidazole and luminal cysticide
• Abscesses may require drainage

Question 20

What are the features of schistosomiasis?

Answer 20

Severe disease follows years of mildly symptomatic infections

Question 21

What are the two types of dysentery?

Answer 21

• Shigella dysentery

- Amoebic dysentery

Question 22

When to norovirus symptoms begin and how long do they last?

Answer 22

• Symptoms begin 24-48hrs after infection

- Can last for 12-60hrs