Gastro-Enteritis and Diarrhoea Flashcards
Most common causes of food poisoning / diarrhoea
Cambylobacter
What is most common cause of hospital admission with gastroenteritis
Salmonella
What is gastroenteritis
Inflammation of stomach lining and intestines
What can cause gastroenteritis
Virus
Bacteria
Parasite
Toxin
How does gastroenteritis spread
Faecal oral Person-person spread Contamination of food Poor storage Travel related - think vaccine
What suggests gastro-enteritis
3 stools in 24 hours + Fever Vomiting Abdominal pain Blood / mucous
What is suggestive of gastro
Waking through the night
When is gastro unlikely
Unlikely if >2 weeks
What are the RF for gastroenteritis / ask in Hx of D+V
Diet / food Contact Travel Vaccinations Anti-microbial use Sexual
How do you Dx gastroenteritis
Stool culture Blood culture Bloods Imaging Serology
What bloods are important
FBC - neutrophil / haemolytic / platelet
U+E - dehydration / renal function
What imaging
X-Ray
Sigmoidoscopy
What is important to do
Assess hydration
Look for signs of SEPSIS - fever / low urine / raised WCC
How do you treat gastroenteritis
Isolate and barrier nurse
Rehydration - oral if can tolerate, diorite or IV
Anti-motility agents but avoid if severe pain or bloody
Stay of work for 48 hours after symptoms resolved
Ax only if high risk
When are Ax indicated
Immunocompromised Severe sepsis Invasive organism outwit the gut Valvular heart disease Chronic illness DM
What is the differential of gastroenteritis
IBD - UC / Chron’s
Spurious 2 to constipation
Cancer
Obstruction
What does lack of pain or presence of blood suggest
Not gastroenteritis
What are complications of gastroenteritis
Sepsis Hyponatraemia due to sodium loss Reactive arthritis Dehydration Electrolyte imbalances
What is diarrhoea
3+ loose stools in 24 hours
What is dysentery
More obvious large bowel inflammation
Bloody stools
What are non inflammatory (secretory) toxin mediated causes of gastroenteritis
Cholera
Enterotoxigenic E.coli
E.coli 0.157
Viral
What are inflammatory causes of gastroenteritis
Shigella
Campylobacter
Salmonella
What causes mixed
C.difficile
Increased secretion and inflammation
How does non-inflammatory causes present
Watery stool
Dehydration
Little pain
Low fever
What does inflammatory cause
Mucosal damage
Abdominal pain
Bloody stools
Systemic upset
What requires further investigation
Bloody diarrhoea
What is important in Dx history
GI Sx Food Hx Travel Hx Sexual history Contact history Vaccine Recent Ax use
How do you get Shigella
Childhood
Travel
What are the symptoms and incubation
Inc = 1-7 days Bloody diarrhoea Abdominal pain Vomiting Fever
How do you Dx Shigella
Stool MC+S
How do you treat
Rehydration
Ciprofloxacin
What are the complications
HUS due to producing SLT
Seizures
How do you get Salmonella
Poultry
Eggs
Meat
What are types of Salmonella and what does it cause
Salmonella Enteritidis - gastroenteritis
S.typhi and paratyphi - typhoid (enteric)
What are the symptoms of Salmonella
48h after exposure Diarrhoea <10 days Vomiting Fever Abdo pain
How do you Dx salmonella
Need special agar as non-lactose fermenter
Blood and stool culture unlikely to be +Ve
How do you treat Salmonella
Rehydration
Cipro or ceftriaxone
What are the complications of Salmonella
Post infectious IBS
Gall stones
What causes Cambylobacter
C. jejuni
Chickens
Contaminated milk
What are the symptoms of Cambylobacter
Inc up to 7 days Flu predrome Severe abdominal pain - RUQ Bloody diarrhoea Fever Often present surgically like appendicitis
How do you Dx campylobacter
Stool MC+S - do 3
Blood culture rare as need special conditions
How do you Dx
Ax not advised
Cipro
What are the complications
Guilian Barre
Reactive arthritis
How do you treat arthritis
NSAID
What is E.coli 0157
Gram -ve rod
Produce shiga like toxin (SLT)
Released into blood
How does E.coli spread
Cattle
Person to. person
How does E.coli 0157 present
Frequent bloody small volume watery stool
Abdo pain
Vomiting
Similar to shigella
What do you get if SLT gets into blood and how does it present
HUS 5-9 days later
- Haemolysis - haemolytic anaemia
- Renal failure - uraemia (AKI)
- Thrombocytopenia
Presentation
- Abdo pain
- Reduce U/O
- Haematuria
- Confusion
- Oedema
- Hypertension
- Seizures
When is HUS more common
Very young children <5
Elderly
How do you Dx E.coli 0157
Stool MC+S
What do you do if HUS develops
Stool culture
FBC + film
U+E
How do you treat E.coli 0157
No Rx
How do you treat HUS
Supportive Fluid + careful fluid balance Blood transfusion Possible dialysis if necessary Plasma exchange
What do you not give
NO AX as makes worse
No anti-motility e.g. loperamide as increases risk
When do you do plasma exchange
If HUS not related to diarrhoea illness
Malignancy ?
What are other forms of E>coli
Enterotoigenic
Interoinvasive
Only 0157 can be distinguished
What are complications
Fluid and electrolyte loss
Hyponatraemia
What is E.coli
A common gut commensal
What can E.coli cause
Diarrhoea
UTI
Neonatal meningitis
What is Travellers diarrhoea
Any diarrhoea that disrupts travel <1 week E.coli = most common Cambylobacter = common cause Salmonella Shigella Chorea Giardia = prolonged
How does it present
Frequent watery large volume stools At least 3x 24 hours due to cAMP Abdominal pain / cramps N+V Blood in stool
How do you Dx
Clinical
How do you treat
Rehydration = supportive
Antibiotics if severe
How is Cholera spread
Faecal oral
How does cholera present
Rice water stools Dehydration Shock Weight loss Hypoglycaemia Acidosis Renal failure
How do you Dx
Stool MC+S
How do you treat
Oral rehydration
Ciprofloxacin or doxycycline
ZN supplement
Cooked rice powder
How does toxin cause dehydration
Release toxin which increases cAMP
What is antibiotic associated diarrhoea
C.diff - gram +Ve
Imbalance in gut flora
How is it transferred
Faecal oral
What does Clostridium tetani cause
Spastic paralysis
What does C.botilium cause
Flaccid paralysis
What are the symptoms of C.diff and what suggests severe
Can range from mild-severe Bloody diarrhoea with foul odour Abdominal pain Fever Severe = ITU / shock / WCC >15/ rising creatinine / complications
What are the complications
Toxin megacolon Pseudomembranous colitis Perforation - guarding Renal Urgent surgical review
What are the RF
Age Antibiotics PPI H.pylori Serious underlying disease Prolonged hospital Poor hygiene
How do you Dx
CDT ELISA - toxin in stool
Need +Ve toxin + SYMPTOMS
How do you treat
DOn't treat unless symptoms Stop Ax Oral metronidazole = 1st line Oral Vance if recurrent or severe Withhold opioids / anti-motility agents Faecal transplant if refractory to Rx Surgery Isolate
How do you prevent
Avoid 4C's Cephalosporin Quinolone - Ciprofloxacin Co-amoxiclav Clindamycin Clarithryomcin
What are common causes of acute food poisoning
S.aureus
Bacillus cereus
Clostridium perfrinigens
How does S.Aureus present
1-6 hour after ingestion of toxin that is released by S.aureus Sudden onset and rapid recovery Severe vomiting D+V Pain - abdo cramps Hypotension
How does Bacillus cereus present
1-6 hour Again due to toxin Vomiting after 1-6 hours Watery diarrhoea 8-16 hours Abdominal cramps Resolves 24 hours
How do you get it
Refried rice
What can immunocompromised people get
Bacteraemia
Endocarditis
MSK
CNS
What do you do if needs Rx
Vancomycin but most don’t need
How does Clostridium Perfrinogens
8-24 hours after
How do you get
Toxin in reheated meat
How do you Dx and treat C.perfrinogens
Stool MC+S
Benzypenicillin
Metronidazole
What can C.perfrinogens
Muscle necrosis
Haemorrhage blebs + bullae
Crepitations on palpation
Haemolysis
What parasites cause diarrhoea
Protozoa Helminths Cryptosporidium Giardia Lamblia Entamoeba Histolytic
What is the most common parasitic cause
Cryptosporidium Parvum
Water borne
Cattle reservoir
4-12 inc
What are the symptoms
Severe watery diarrhoea
Abdominal cramp
Fever
Can get into pancreatic / bile / resp tracts - sclerosis cholangitis / pancreatitis
How does Giardia Lamblia present
Lethargy Blaoting Fever N+V Abdominal cramps Explosive diarrhoea - non bloody
What are long term complications
Malabsorption so can cause steathrorheoa
Chronic diarrhoea
Lactose intolerance
How do you Dx
3 stool culture
Send with PCO
How do you Rx
Metronidazole
How does Entamoeba Histolytic present
1-4 week inc Mimic UC Dysnetery Gradual onset bloody diarrhoea Weight loss
What can Entamoeba Histolytic lead too
Can go to brain / liver / lungs Hepatomegaly Weight loss Diarrhoea Liver abscess - pus / fever / RUQ pain
How do you treat
Metronidazole
Fuamide for cyst carriage
What has shot incubation
Staph aureus
Bacillus
What has middle
Salmonella
Cambylobacter
What has long incubation
Parasite
What are viral causes of diarrhoea
Rotavirus
Adenovirus
Norovirus
How does rotavirus present
Common in children - faecal oral
1-7 day inc
Severe diarrhoea and vomiting
How does norovirus present
72 hours inc
Diarrhoea
Projectile vomit
Fever
Where is norovirus common
Outbeaks in hospital / cruise ship
Faecal-oral
How do you Dx viral
PCR
How do you treat
Hand hygiene Alcohol gel not sufficient PPE Isolation Exclude 48-72 hours
When would you do colonoscopy
Persistent diarrhoea despite Rx
When do you investigate diarrhoea further and how
If >14 days or dysentery
FBC, U+E, LFT
Inflammatory markers
Stool microscopy for PCO
What should you not forget as causes of chronic diarrhoea
Malaria
HIV
How long do you exclude for
48 hours after symptoms resolved
