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