Gastro

Question 1

What is the most common cause?

Answer 1

bacterial = 20%, parasitic = <6%

Question 2

What are the clinical features?

Answer 2

fever, abdominal pain, diarrhoea (sometimes with blood)

Question 3

Why is food poisoning and gastroenteritis so common?

Answer 3

poor sanitation/hygiene, commercialisation of food, importation of food, international travel, increase in day care and elderly care, nosocomial of healthcare acquired infections and animal contact.

Question 4

What do turtles carry?

Answer 4

Salmonella

Question 5

Approach?

Answer 5

differentials, severity, site and investigations, treatment, infection control and public health.

Question 6

describe Norovirus

Answer 6

Older children and adults, can cause massive outbreaks, fecal/oral, waterborne (shellfish), 24-48 hour incubation, abrupt nausea, vomiting, diarrhoea, cramps, myalgias and resolution in 24-48 hours.

Question 7

What are the 3 clinical syndromes?

Answer 7

Acute enteritis - fever, D&V, abdominal pain.
Acute colitis - fever, pain, bloody diarrhoea.
Enteric fever like illness - fever, rigors, pain but little diarrhoea.

Question 8

What organism usually causes bloody diarrhoea?

Answer 8

Campylobacter. spp, Shigella spp, E.coli or amoebiasis.

also could be due to IBD, malignancy or ischaemia.

Question 9

What is the incubation and duration of Campylobacter?

what antibiotic is used?

Answer 9

2-5 days, and 5-14 days.

Clarithromycin and azithromycin

Question 10

Guillain-Barre Syndrome?

Answer 10

Tingling in the feet leads to progressive paralysis in arms, legs and rest of body.
40% of cases due to Campylobacter, 80% recover completely, 5% mortality with treatment.

Question 11

Describe enteric-like illness

Answer 11

fever, systemically unwell, abdominal pain, constipation, possible short history of diarhhoea

Question 12

How is typhoid carried?

Answer 12

water and food

Question 13

Treatment of Typhoid?

Answer 13

chloramphenicol, Ciprofloxacin, azithromycin, ceftriaxone

Question 14

what drugs should you ask about in the history taking?

Answer 14

PPI’s and antibiotics

Question 15

Investigations

Answer 15

stool sample
stool toxin
stool PCR for norovirus
stool microscopy 
bloodculture (invasive salmonella)

Question 16

Main Factors of severity

Answer 16

Colonic dilatation and laboratory WWC and renal function tests

Question 17

Complications of bacterial enteritis intestinal?

Answer 17

severe dehydration, renal failure, acute colitis, toxic dilation, post infective irritable bowel (very common), transient secondary lactase intolerance.

Question 18

Treatment?

Answer 18

Supportive - oral rehydration, IV fluids (saline important)
Specific - anti-spasmodics, antibodies (in specific situations)
avoid anti-motility drugs as you are stopping peristalsis getting rid of the infection.

Question 19

Anti-motility agents

Answer 19

Opiates, loperamide (avoided if dysenteric symptoms)

Question 20

Anti-secretory drugs

Answer 20

Chlorpromazine, Bismuth subsalycilate

Question 21

Absorbents

Answer 21

Kaolin, charcoal

Question 22

Describe Clostridium difficile

Answer 22

Anaerobic gram-positive spore forming bacillus

Question 23

Risk factors for C diff

Answer 23

antibitoics (fluoroquinolones, cephalosporins, clindamycins, broad spectrum penicillins), PPI’s, Histamine-2 receptor blocker, chemotherapy, chronic renal disease and underlying IBD

Question 24

How many patients relapse with infection?

Answer 24

10-30%

Question 25

Average duration of untreated Traveller’s Diarrhoea?

Answer 25

~4 days

Question 26

Is prophylaxis recommended?

Answer 26

No

Question 27

What is Amoebiasis?

Answer 27

A protozoal infection spread by faecal-oral route or by an ill or asymptomatic carrier

Question 28

What is Giardiasis?

Answer 28

A protozoon Giardia lambia trophozoites colonizes the small bowel mucosa to produce diarrhoea and malabsorption, often explosive, protracted and foul smelling.

Question 29

How do you treat Amoebiasis and Giardiasis?

Answer 29

Metrinidazole