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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
What does inflammatory cause
Mucosal damage Abdominal pain Bloody stools Systemic upset
26
What requires further investigation
Bloody diarrhoea
27
What is important in Dx history
``` GI Sx Food Hx Travel Hx Sexual history Contact history Vaccine Recent Ax use ```
28
How do you get Shigella
Childhood | Travel
29
What are the symptoms and incubation
``` Inc = 1-7 days Bloody diarrhoea Abdominal pain Vomiting Fever ```
30
How do you Dx Shigella
Stool MC+S
31
How do you treat
Rehydration | Ciprofloxacin
32
What are the complications
HUS due to producing SLT | Seizures
33
How do you get Salmonella
Poultry Eggs Meat
34
What are types of Salmonella and what does it cause
Salmonella Enteritidis - gastroenteritis | S.typhi and paratyphi - typhoid (enteric)
35
What are the symptoms of Salmonella
``` 48h after exposure Diarrhoea <10 days Vomiting Fever Abdo pain ```
36
How do you Dx salmonella
Need special agar as non-lactose fermenter | Blood and stool culture unlikely to be +Ve
37
How do you treat Salmonella
Rehydration | Cipro or ceftriaxone
38
What are the complications of Salmonella
Post infectious IBS | Gall stones
39
What causes Cambylobacter
C. jejuni Chickens Contaminated milk
40
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 ```
41
How do you Dx campylobacter
Stool MC+S - do 3 | Blood culture rare as need special conditions
42
How do you Dx
Ax not advised | Cipro
43
What are the complications
Guilian Barre | Reactive arthritis
44
How do you treat arthritis
NSAID
45
What is E.coli 0157
Gram -ve rod Produce shiga like toxin (SLT) Released into blood
46
How does E.coli spread
Cattle | Person to. person
47
How does E.coli 0157 present
Frequent bloody small volume watery stool Abdo pain Vomiting Similar to shigella
48
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
49
When is HUS more common
Very young children <5 | Elderly
50
How do you Dx E.coli 0157
Stool MC+S
51
What do you do if HUS develops
Stool culture FBC + film U+E
52
How do you treat E.coli 0157
No Rx
53
How do you treat HUS
``` Supportive Fluid + careful fluid balance Blood transfusion Possible dialysis if necessary Plasma exchange ```
54
What do you not give
NO AX as makes worse | No anti-motility e.g. loperamide as increases risk
55
When do you do plasma exchange
If HUS not related to diarrhoea illness | Malignancy ?
56
What are other forms of E>coli
Enterotoigenic Interoinvasive Only 0157 can be distinguished
57
What are complications
Fluid and electrolyte loss | Hyponatraemia
58
What is E.coli
A common gut commensal
59
What can E.coli cause
Diarrhoea UTI Neonatal meningitis
60
What is Travellers diarrhoea
``` Any diarrhoea that disrupts travel <1 week E.coli = most common Cambylobacter = common cause Salmonella Shigella Chorea Giardia = prolonged ```
61
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 ```
62
How do you Dx
Clinical
63
How do you treat
Rehydration = supportive | Antibiotics if severe
64
How is Cholera spread
Faecal oral
65
How does cholera present
``` Rice water stools Dehydration Shock Weight loss Hypoglycaemia Acidosis Renal failure ```
66
How do you Dx
Stool MC+S
67
How do you treat
Oral rehydration Ciprofloxacin or doxycycline ZN supplement Cooked rice powder
68
How does toxin cause dehydration
Release toxin which increases cAMP
69
What is antibiotic associated diarrhoea
C.diff - gram +Ve | Imbalance in gut flora
70
How is it transferred
Faecal oral
71
What does Clostridium tetani cause
Spastic paralysis
72
What does C.botilium cause
Flaccid paralysis
73
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 ```
74
What are the complications
``` Toxin megacolon Pseudomembranous colitis Perforation - guarding Renal Urgent surgical review ```
75
What are the RF
``` Age Antibiotics PPI H.pylori Serious underlying disease Prolonged hospital Poor hygiene ```
76
How do you Dx
CDT ELISA - toxin in stool | Need +Ve toxin + SYMPTOMS
77
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 ```
78
How do you prevent
``` Avoid 4C's Cephalosporin Quinolone - Ciprofloxacin Co-amoxiclav Clindamycin Clarithryomcin ```
79
What are common causes of acute food poisoning
S.aureus Bacillus cereus Clostridium perfrinigens
80
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 ```
81
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 ```
82
How do you get it
Refried rice
83
What can immunocompromised people get
Bacteraemia Endocarditis MSK CNS
84
What do you do if needs Rx
Vancomycin but most don't need
85
How does Clostridium Perfrinogens
8-24 hours after
86
How do you get
Toxin in reheated meat
87
How do you Dx and treat C.perfrinogens
Stool MC+S Benzypenicillin Metronidazole
88
What can C.perfrinogens
Muscle necrosis Haemorrhage blebs + bullae Crepitations on palpation Haemolysis
89
What parasites cause diarrhoea
``` Protozoa Helminths Cryptosporidium Giardia Lamblia Entamoeba Histolytic ```
90
What is the most common parasitic cause
Cryptosporidium Parvum Water borne Cattle reservoir 4-12 inc
91
What are the symptoms
Severe watery diarrhoea Abdominal cramp Fever Can get into pancreatic / bile / resp tracts - sclerosis cholangitis / pancreatitis
92
How does Giardia Lamblia present
``` Lethargy Blaoting Fever N+V Abdominal cramps Explosive diarrhoea - non bloody ```
93
What are long term complications
Malabsorption so can cause steathrorheoa Chronic diarrhoea Lactose intolerance
94
How do you Dx
3 stool culture | Send with PCO
95
How do you Rx
Metronidazole
96
How does Entamoeba Histolytic present
``` 1-4 week inc Mimic UC Dysnetery Gradual onset bloody diarrhoea Weight loss ```
97
What can Entamoeba Histolytic lead too
``` Can go to brain / liver / lungs Hepatomegaly Weight loss Diarrhoea Liver abscess - pus / fever / RUQ pain ```
98
How do you treat
Metronidazole | Fuamide for cyst carriage
99
What has shot incubation
Staph aureus | Bacillus
100
What has middle
Salmonella | Cambylobacter
101
What has long incubation
Parasite
102
What are viral causes of diarrhoea
Rotavirus Adenovirus Norovirus
103
How does rotavirus present
Common in children - faecal oral 1-7 day inc Severe diarrhoea and vomiting
104
How does norovirus present
72 hours inc Diarrhoea Projectile vomit Fever
105
Where is norovirus common
Outbeaks in hospital / cruise ship | Faecal-oral
106
How do you Dx viral
PCR
107
How do you treat
``` Hand hygiene Alcohol gel not sufficient PPE Isolation Exclude 48-72 hours ```
108
When would you do colonoscopy
Persistent diarrhoea despite Rx
109
When do you investigate diarrhoea further and how
If >14 days or dysentery FBC, U+E, LFT Inflammatory markers Stool microscopy for PCO
110
What should you not forget as causes of chronic diarrhoea
Malaria | HIV
111
How long do you exclude for
48 hours after symptoms resolved

Infection (14 decks)

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