Gastro - Gastroenteritis Flashcards
What is the most common cause of gastroenteritis?
Viral cause
What initial management is there for gastroenteritis?
Treat dehydration- IV fluids
Consider anti-emetics e.g. ondansetron, can be given IV if bringing everything up
Very easily spread, so must be isolated
Antibiotics are not recommended
What are the differentials for diarrhoea in children?
Infection - gastroenteritis
IBD
IBS
Lactose intolerance
Coeliac disease
Cystic fibrosis
Toddler’s diarrhoea
Some antibiotics
What does steatorrhea indicate?
Greasy stool with excessive fat content
Problem with fat digestions e.g. due to pancreatic insufficiency
Cystic fibrosis
What are some common causes of viral gastroenteritis?
Rotavirus
Norovirus
Adenovirus- less common and more subacute
Why should antibiotics be avoided in gastroenteritis?
Escherichia coli 0157 produces Shiga toxin
Shiga toxin destroys RBCs and leads to haemolytic uraemic syndrome
Antibiotic risk increases risk of HUS
How is E.coli spread?
Feaco-oral route
Unwashed salads
Contaminated water
What are the signs and symptoms of E.coli infection?
Abdominal cramps
Bloody diarrhoea
Vomiting
What is the most common bacterial cause of gastroenteritis?
Campylobacter jejuni
Common cause of travellers diarrhoea
Gram negative with a spiral shape
How is Campylobacter Jejuni spread?
Raw or improperly cooked poultry
Untreated water
Unpasteurised milk
How long is the incubation period in C.jejuni?
2-5 days
What are the symptoms of C. jejuni and how long do they take to resolve?
Abdominal cramps
Diarrhoea, often with blood
Vomiting
Fever
3-6 days to resolve
When are antibiotics considered for campylobacter jejuni?
After isolating organism
Severe symptoms
HIV
Heart failure
What antibiotics are used for campylobacter jejuni?
Azithromycin
Ciprofloxacin
How is shigella spread?
Feaco-oral route
Contaminated drinking water
Swimming pools
Food
What is the incubation period of shigella and how does long does it take to resolve?
1-2 days incubation
Resolve within 1 week
What are the symptoms of shigella?
Bloody diarrhoea
Abdominal cramps
Fever
How is shigella treated?
No treatment needed unless severe
Can produce Shiga toxin and cause HUS
Azithromycin or ciprofloxacin
How is salmonella spread?
Raw eggs
Raw poultry
Food contaminated with infected faeces of small animals
What is the incubation period for salmonella and how long does it take to resolve?
12 hours to 3 days incubation period
Within 1 week
What are the symptoms of salmonella?
Watery diarrhoea associated with mucus or blood
Abdominal pain
Vomiting
How is salmonella treated?
Supportive
Antibiotics only in severe cases, guided by stool culture and sensitivities
What is bacillus cereus?
Gramp positive bacillus
What is a typical cause of bacillus cereus infection?
Food not refrigerated after cooking
Fried rice left out at room temperature
What toxin is produced in bacillus cereus?
Cereulide - while growing on food
What does cereulide toxin cause?
Abdominal cramping Vomiting
Within 5 hours of ingestion
When it arrives in the intestines, produces different toxins causing
Watery diarrhoea
More than 8 hours after ingestion
Typically resolves within 24 hours
What is the typical patient with bacillus cereus?
Eating leftover fried race left at room temperature
Recovery within 24 hours
Vomiting within 5 hours
Diarrhoea after 8 hours
What is yersinia enterocolitica?
Gram negative bacillus
What is a common source of yersinia enterocolitica?
PIGS
Raw or undercooked pork
Contamination with urine or faeces of other mammals e.g. rats and rabbits
What are the signs of yersinia enterococolitica infection?
Watery or bloody diarrhoea
Abdominal pain
Fever
Lymphadenopathy
How long is the incubation period of yersinia and how long do symptoms last?
4-7 days incubation period
Symptoms last 3 weeks or more
Why can yersinia infection be harder to diagnose in older children or adults?
Mesenteric lymphadenitis
Causing right sided abdominal pain
Appendicitis impression
When are antibiotics given for yersinia?
Severe cases
Guided by **stool culture **and sensitivities
What toxins does staph aureus produce?
Enterotoxins
When growing on food e.g. eggs, dairy and meat
What causes symptoms with staph aureus infection?
Toxin ingestion, causes intestine inflammation
Diarrhoea
Perfuse vomiting
Abdominal cramps
Fever
Starts within hours of ingestion, settles within 12-24 hours
The enterotoxin causes the symptoms not the bacteria
What is giardia lamblia?
Microscopic parasite
Lives in small intestines of mammals e.g. pets, farmyard animals or humans
How does giardia lamblia spread?
Faeco-oral transmission
Parasite releases cysts in stools of infected mammals
Cysts contaminate food or water, infecting new host
What does giardia lead to?
May not cause any symptoms
or
Chronic diarrhoea
How is giardia managed?
Stool microscopy
Treat with metronidazole
How do you prevent spread of gastroenteritis?
Good hygiene
Barrier nursing
Rigorous infection control to stop spread
Off school for 48 hours after symptoms resolve
What is fluid challenge used for?
Ensure patient can tolerate the fluids
If they can tolerate fluids and hydrated can be managed at home
What rehydration solutions can be used?
Dioralyte
If fluid challenge fails what must be done?
IV fluids
When are antidiarrhoeals particularly avoided?
Escherichia coli 0157
Shigella infections
Bloody diarrhoea or high fever
What are some possible post gastroenteritis complications?
Lactose intolerance
IBS
Reactive arthritis
Guillain-Barré syndrome
