Gastro-enteritis

Question 1

What is THE most common causative organism of diarrhoea in out country?

Answer 1

Campylobacter

Question 2

What are the 2nd and third most common causes of gastroenteritis?

Answer 2

Salmonella

E.coli 0157

Question 3

What is the most common cause of travel-related gastroenteritis?

Answer 3

E.coli 0157

Question 4

How is campylobacter transmitted?

Answer 4

Contaminated food

Question 5

How salmonella most commonly acquired?

Answer 5

Contaminated food in foreign countries

Question 6

How is norovirus transmitted?

Answer 6

Person to person spread

Question 7

What are the 4 factors that provide the host with defences?

Answer 7

Hygiene
Stomach acidity
Normal flora
Immunity

Question 8

What are the 3 types of diarrhoea?

Answer 8

Non-inflammatory = secretory toxin causing frequent watery stool and abdominal pain
Inflammatory - toxin damage and mucosal destruction causing pain and fever
Mixed picture eg C.diif

Question 9

What is cholera’s mode of action of causing diarrhoea?

Answer 9

Increases cAMP levels and Cl- secretion and therefore pulls the water into the lumen

Question 10

Which bacteria causes an inflammatory response?

Answer 10

Shigella

Question 11

What are the 3 mechanisms of diarrhoea?

Answer 11

Toxin-mediated
Invasion
Attachment

Question 12

What are 3 parasites that can cause diarrhoea?

Answer 12

Cryptosporidium parvum

Giardia Intestinalis

Question 13

What are the clinical features of a Salmonella infection?

Answer 13

48hr post-exposure
Lasts for 10 days
Don’t give antibiotics

Question 14

What are the clinical features of a campylobacter infection?

Answer 14

Incubation up to 7 days
Clears within 3 weeks
Severe abdominal pain

Question 15

What are the clinical features of a E.coli infection?

Answer 15

Increasing incidence
Excretion >3wks post symtoms
5-9 days later can develop HUS because it produces a toxin which can enter the bloodstream

Question 16

What organism is involved in antibiotic related diarrhoea?

Answer 16

C.difficile

Question 17

what 4 C antibiotics are associated with C.Diff?

Answer 17

Clarithromycin,
Co-amoxiclav
Clindamycin
Cephalosporin

Question 18

What is the diagnostic criteria of gastroenteritis?

Answer 18

Three or more loose stools a day for less than 2 weeks with the following accompanying features:
Pain
Fever
Blood or mucus in the stool
Vomiting

Question 19

What are your key investigations?

Answer 19

Stool culture 
Blood culture - salmonella 
U&E
FBC: neutrophilic, haemolysis 
Sigmoiscopy

Question 20

What things are you looking for on your examination

Answer 20

BP and postural hypotension
Skin turgor
Pulse
Inflammation markers - fever 
Mainly fluid hydration status

Question 21

If you suspect a parasite then what investigations are you going to do?

Answer 21

Microscopy

Question 22

If it is confirmed as non-inflammatory diarrhoea then what is your management?

Answer 22

Rehydration with either oral salt and sugar solution

IV saline

Question 23

What are the indicators for use of antibiotic in diarrhoea?

Answer 23

Traveller's diarrhoea
Immunocompromised
Severe sepsis 
Chronic illness
DM 
Valvular hear disease

Question 24

How can you treat a C.diff diarrhoea?

Answer 24

STOP the causative antibiotics

Oral metronidazole instead and if segvere then Vancomycin

Question 25

Give34 differential of Gastro-enteritis

Answer 25

IBD - over 2 weeks
Overflow diarrhoea - contipated
Sepsis outside the GI tract - they have no blood/mucus

Question 26

What is haemolytic uraemia syndrome?

Answer 26

Microangiopathic Haemolytic Anaemia
Thrombocytopenia
AKI
Result of E.coli infection