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Infection > Gastro-Enteritis and Diarrhoea > Flashcards

Gastro-Enteritis and Diarrhoea Flashcards

1
Q

Most common causes of food poisoning / diarrhoea

A

Cambylobacter

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2
Q

What is most common cause of hospital admission with gastroenteritis

A

Salmonella

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3
Q

What is gastroenteritis

A

Inflammation of stomach lining and intestines

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4
Q

What can cause gastroenteritis

A

Virus
Bacteria
Parasite
Toxin

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5
Q

How does gastroenteritis spread

A 
Faecal oral 
Person-person spread 
Contamination of food
Poor storage
Travel related - think vaccine
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6
Q

What suggests gastro-enteritis

A 
3 stools in 24 hours + 
Fever
Vomiting
Abdominal pain
Blood / mucous
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7
Q

What is suggestive of gastro

A

Waking through the night

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8
Q

When is gastro unlikely

A

Unlikely if >2 weeks

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9
Q

What are the RF for gastroenteritis / ask in Hx of D+V

A 
Diet / food
Contact
Travel 
Vaccinations
Anti-microbial use
Sexual
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10
Q

How do you Dx gastroenteritis

A 
Stool culture 
Blood culture 
Bloods 
Imaging 
Serology
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11
Q

What bloods are important

A

FBC - neutrophil / haemolytic / platelet

U+E - dehydration / renal function

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12
Q

What imaging

A

X-Ray

Sigmoidoscopy

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13
Q

What is important to do

A

Assess hydration

Look for signs of SEPSIS - fever / low urine / raised WCC

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14
Q

How do you treat gastroenteritis

A

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

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15
Q

When are Ax indicated

A 
Immunocompromised
Severe sepsis
Invasive organism outwit the gut 
Valvular heart disease
Chronic illness
DM
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16
Q

What is the differential of gastroenteritis

A

IBD - UC / Chron’s
Spurious 2 to constipation
Cancer
Obstruction

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17
Q

What does lack of pain or presence of blood suggest

A

Not gastroenteritis

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18
Q

What are complications of gastroenteritis

A 
Sepsis 
Hyponatraemia due to sodium loss
Reactive arthritis 
Dehydration
Electrolyte imbalances
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19
Q

What is diarrhoea

A

3+ loose stools in 24 hours

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20
Q

What is dysentery

A

More obvious large bowel inflammation

Bloody stools

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21
Q

What are non inflammatory (secretory) toxin mediated causes of gastroenteritis

A

Cholera
Enterotoxigenic E.coli
E.coli 0.157
Viral

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22
Q

What are inflammatory causes of gastroenteritis

A

Shigella
Campylobacter
Salmonella

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23
Q

What causes mixed

A

C.difficile

Increased secretion and inflammation

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24
Q

How does non-inflammatory causes present

A

Watery stool
Dehydration
Little pain
Low fever

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25
Q

What does inflammatory cause

A

Mucosal damage
Abdominal pain
Bloody stools
Systemic upset

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26
Q

What requires further investigation

A

Bloody diarrhoea

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27
Q

What is important in Dx history

A 
GI Sx
Food Hx
Travel Hx
Sexual history
Contact history
Vaccine
Recent Ax use
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28
Q

How do you get Shigella

A

Childhood

Travel

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29
Q

What are the symptoms and incubation

A 
Inc = 1-7 days 
Bloody diarrhoea
Abdominal pain
Vomiting
Fever
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30
Q

How do you Dx Shigella

A

Stool MC+S

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31
Q

How do you treat

A

Rehydration

Ciprofloxacin

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32
Q

What are the complications

A

HUS due to producing SLT

Seizures

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33
Q

How do you get Salmonella

A

Poultry
Eggs
Meat

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34
Q

What are types of Salmonella and what does it cause

A

Salmonella Enteritidis - gastroenteritis

S.typhi and paratyphi - typhoid (enteric)

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35
Q

What are the symptoms of Salmonella

A 
48h after exposure 
Diarrhoea <10 days 
Vomiting
Fever
Abdo pain
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36
Q

How do you Dx salmonella

A

Need special agar as non-lactose fermenter

Blood and stool culture unlikely to be +Ve

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37
Q

How do you treat Salmonella

A

Rehydration

Cipro or ceftriaxone

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38
Q

What are the complications of Salmonella

A

Post infectious IBS

Gall stones

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39
Q

What causes Cambylobacter

A

C. jejuni
Chickens
Contaminated milk

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40
Q

What are the symptoms of Cambylobacter

A 
Inc up to 7 days
Flu predrome
Severe abdominal pain - RUQ
Bloody diarrhoea
Fever
Often present surgically like appendicitis
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41
Q

How do you Dx campylobacter

A

Stool MC+S - do 3

Blood culture rare as need special conditions

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42
Q

How do you Dx

A

Ax not advised

Cipro

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43
Q

What are the complications

A

Guilian Barre

Reactive arthritis

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44
Q

How do you treat arthritis

A

NSAID

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45
Q

What is E.coli 0157

A

Gram -ve rod
Produce shiga like toxin (SLT)
Released into blood

46
Q

How does E.coli spread

A

Cattle

Person to. person

47
Q

How does E.coli 0157 present

A

Frequent bloody small volume watery stool
Abdo pain
Vomiting
Similar to shigella

48
Q

What do you get if SLT gets into blood and how does it present

A

HUS 5-9 days later

  • Haemolysis - haemolytic anaemia
  • Renal failure - uraemia (AKI)
  • Thrombocytopenia

Presentation

  • Abdo pain
  • Reduce U/O
  • Haematuria
  • Confusion
  • Oedema
  • Hypertension
  • Seizures
49
Q

When is HUS more common

A

Very young children <5

Elderly

50
Q

How do you Dx E.coli 0157

A

Stool MC+S

51
Q

What do you do if HUS develops

A

Stool culture
FBC + film
U+E

52
Q

How do you treat E.coli 0157

53
Q

How do you treat HUS

A 
Supportive
Fluid + careful fluid balance 
Blood transfusion 
Possible dialysis if necessary 
Plasma exchange
54
Q

What do you not give

A

NO AX as makes worse

No anti-motility e.g. loperamide as increases risk

55
Q

When do you do plasma exchange

A

If HUS not related to diarrhoea illness

Malignancy ?

56
Q

What are other forms of E>coli

A

Enterotoigenic
Interoinvasive
Only 0157 can be distinguished

57
Q

What are complications

A

Fluid and electrolyte loss

Hyponatraemia

58
Q

What is E.coli

A

A common gut commensal

59
Q

What can E.coli cause

A

Diarrhoea
UTI
Neonatal meningitis

60
Q

What is Travellers diarrhoea

A 
Any diarrhoea that disrupts travel 
<1 week
E.coli = most common
Cambylobacter = common cause
Salmonella
Shigella
Chorea 
Giardia = prolonged
61
Q

How does it present

A 
Frequent watery large volume stools
At least 3x 24 hours due to cAMP
Abdominal pain / cramps
N+V
Blood in stool
62
Q

How do you Dx

63
Q

How do you treat

A

Rehydration = supportive

Antibiotics if severe

64
Q

How is Cholera spread

A

Faecal oral

65
Q

How does cholera present

A 
Rice water stools
Dehydration
Shock
Weight loss 
Hypoglycaemia
Acidosis 
Renal failure
66
Q

How do you Dx

A

Stool MC+S

67
Q

How do you treat

A

Oral rehydration
Ciprofloxacin or doxycycline
ZN supplement
Cooked rice powder

68
Q

How does toxin cause dehydration

A

Release toxin which increases cAMP

69
Q

What is antibiotic associated diarrhoea

A

C.diff - gram +Ve

Imbalance in gut flora

70
Q

How is it transferred

A

Faecal oral

71
Q

What does Clostridium tetani cause

A

Spastic paralysis

72
Q

What does C.botilium cause

A

Flaccid paralysis

73
Q

What are the symptoms of C.diff and what suggests severe

A 
Can range from mild-severe
Bloody diarrhoea with foul odour 
Abdominal pain
Fever 
Severe = ITU / shock / WCC >15/ rising creatinine / complications
74
Q

What are the complications

A 
Toxin megacolon 
Pseudomembranous colitis
Perforation - guarding
Renal 
Urgent surgical review
75
Q

What are the RF

A 
Age
Antibiotics
PPI
H.pylori 
Serious underlying disease
Prolonged hospital
Poor hygiene
76
Q

How do you Dx

A

CDT ELISA - toxin in stool

Need +Ve toxin + SYMPTOMS

77
Q

How do you treat

A 
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
78
Q

How do you prevent

A 
Avoid 4C's
Cephalosporin
Quinolone - Ciprofloxacin
Co-amoxiclav
Clindamycin
Clarithryomcin
79
Q

What are common causes of acute food poisoning

A

S.aureus
Bacillus cereus
Clostridium perfrinigens

80
Q

How does S.Aureus present

A 
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
81
Q

How does Bacillus cereus present

A 
1-6 hour 
Again due to toxin 
Vomiting after 1-6 hours
Watery diarrhoea 8-16 hours
Abdominal cramps
Resolves 24 hours
82
Q

How do you get it

A

Refried rice

83
Q

What can immunocompromised people get

A

Bacteraemia
Endocarditis
MSK
CNS

84
Q

What do you do if needs Rx

A

Vancomycin but most don’t need

85
Q

How does Clostridium Perfrinogens

A

8-24 hours after

86
Q

How do you get

A

Toxin in reheated meat

87
Q

How do you Dx and treat C.perfrinogens

A

Stool MC+S
Benzypenicillin
Metronidazole

88
Q

What can C.perfrinogens

A

Muscle necrosis
Haemorrhage blebs + bullae
Crepitations on palpation
Haemolysis

89
Q

What parasites cause diarrhoea

A 
Protozoa
Helminths
Cryptosporidium
Giardia Lamblia
Entamoeba Histolytic
90
Q

What is the most common parasitic cause

A

Cryptosporidium Parvum
Water borne
Cattle reservoir
4-12 inc

91
Q

What are the symptoms

A

Severe watery diarrhoea
Abdominal cramp
Fever
Can get into pancreatic / bile / resp tracts - sclerosis cholangitis / pancreatitis

92
Q

How does Giardia Lamblia present

A 
Lethargy
Blaoting
Fever
N+V
Abdominal cramps
Explosive diarrhoea - non bloody
93
Q

What are long term complications

A

Malabsorption so can cause steathrorheoa
Chronic diarrhoea
Lactose intolerance

94
Q

How do you Dx

A

3 stool culture

Send with PCO

95
Q

How do you Rx

A

Metronidazole

96
Q

How does Entamoeba Histolytic present

A 
1-4 week inc
Mimic UC
Dysnetery
Gradual onset bloody diarrhoea
Weight loss
97
Q

What can Entamoeba Histolytic lead too

A 
Can go to brain / liver / lungs
Hepatomegaly 
Weight loss
Diarrhoea
Liver abscess - pus / fever / RUQ pain
98
Q

How do you treat

A

Metronidazole

Fuamide for cyst carriage

99
Q

What has shot incubation

A

Staph aureus

Bacillus

100
Q

What has middle

A

Salmonella

Cambylobacter

101
Q

What has long incubation

102
Q

What are viral causes of diarrhoea

A

Rotavirus
Adenovirus
Norovirus

103
Q

How does rotavirus present

A

Common in children - faecal oral
1-7 day inc
Severe diarrhoea and vomiting

104
Q

How does norovirus present

A

72 hours inc
Diarrhoea
Projectile vomit
Fever

105
Q

Where is norovirus common

A

Outbeaks in hospital / cruise ship

Faecal-oral

106
Q

How do you Dx viral

107
Q

How do you treat

A 
Hand hygiene
Alcohol gel not sufficient 
PPE
Isolation
Exclude 48-72 hours
108
Q

When would you do colonoscopy

A

Persistent diarrhoea despite Rx

109
Q

When do you investigate diarrhoea further and how

A

If >14 days or dysentery
FBC, U+E, LFT
Inflammatory markers
Stool microscopy for PCO

110
Q

What should you not forget as causes of chronic diarrhoea

A

Malaria

HIV

111
Q

How long do you exclude for

A

48 hours after symptoms resolved

Infection (14 decks)

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