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CLINICAL PATHOLOGY > Gastroenteritis > Flashcards

Gastroenteritis Flashcards

1
Q

Is gastroenteritis only caused by infection?

A

No, can have many different causes, not just infective

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2
Q

The faecal flora is estimated to have a metabolic capacity equal to what organ?

A

The liver

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3
Q

What are the 3 main beneficial affects of the commensal flora of the gut?

A

1) Metabolism
2) Colonisation resistance
3) Antibody induction

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4
Q

What is thought to have a profound effect on the composition of gut flora?

A

Diet

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5
Q

Which 2 vitamins are secreted by enteric bacteria?

A

Vitamins K and B12

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6
Q

We are born sterile, what is the difference in the flora of bottle fed babies compared to breast fed babies?

A

Bottle fed - adult microflora

Breast fed - bifidobacteria

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7
Q

Are the bacteria in the gut mainly anaerobes or aerobes?

A

Obligate anaerobes (cant survive in presence of oxygen)

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8
Q

What are facultatively anaerobic bacteria?

A

Can survive in presence or absence of oxygen

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9
Q

What are the 4 most common commensal flora of the gut, what kind of bacteria are they?

A

1) Bacteroides (anaerobic GNB)
2) Clostridium perfringens (anaerobic GPB)
3) Escherichia coli (Facultative GNB)
4) Enterococcus faecalis (Facultative GPC)

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10
Q

Globally there are roughly how many cases of diarrhoeal disease every year?

A

1.7 billion

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11
Q

What is the leading cause of malnutrition in children under 5 years old?

A

Diarrhoea

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12
Q

What are the 8 common bacterial causes of gastroenteritis?

A

1) Salmonella
2) Shigella
3) E coli
4) Campylobacter
5) Vibrio cholera
6) Clostridium difficile
7) Staph aureus
8) Bacillus cereus

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13
Q

What are the 3 common parasitic causes of gastroenteritis?

A

1) Entamoeba hist.
2) Giardia lamblia
3) Cryptosporidium

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14
Q

Have outbreaks of foodbourne diseases in England and wales increased or decreased?

A

Decreased - mainly due to salmonella - more education and better food standards

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15
Q

Have outbreaks of non-foodborne diseases increased or decreased?

A

Increased - often related to recreational water or animal contact

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16
Q

What are the 5 main presenting complaints for gastroenteritis?

A

1) Acute onset
2) Vomiting
3) Diarrhoea - frequency, mucous, blood
4) Abdominal pain
5) Systemic effects - fever etc.

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17
Q

What are the 6 complications of gastroenteritis?

A

1) Dehydration
2) Renal failure
3) HUS - haemolytic urea syndrome
4) Toxic megacolon
5) Guillan barre syndrome
6) Dissemination of salmonella

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18
Q

What are the 3 main investigations in gastroenteritis?

A

1) Bloods - FBC, U&E, CRP, blood cultures
2) Abdo XR if severe
3) Stool analysis

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19
Q

What 4 tests may be used to analyse a stool in gastroenteritis?

A

1) Ova, parasites and cysts ‘OCP’
2) Microscopy, culture and sensitivity ‘MC&S’
3) Clostridium difficile toxin ‘CDT’
4) Viral PCR

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20
Q

Name one common viral gastroenteritis?

A

Norovirus

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21
Q

Norovirus incidence is higher in which season?

A

Winter

22
Q

What are the 2 main symptoms of norovirus?

A

1) Diarrhoea

2) Projectile vomiting

23
Q

How long does norovirus tend to last, is it dangerous?

A

24-48 hours, not dangerous

24
Q

How is norovirus spread?

A

Via aerosols which come off the vomit of infected people

25
Q

How is norovirus managed?

A

Manage dehydration and let illness take its course, stay away from others and diligent hand washing to prevent transmission

26
Q

What are the 3 main causes of parasitic gastroenteritis?

A

1) Cryptosporidium
2) Giardia
3) Entamoeba

27
Q

Cryptosporidium is transmitted how?

A

Predominantly water borne disease which is spread via contaminated drinking water, swimming pools etc.

28
Q

Why is cryptosporidium commonly spread via swimming pools?

A

Oocytes are resistant to chlorine based disinfectants

29
Q

Is cryptosporidium infection more common in the first or second half of the year, why?

A

Second half - related to foreign travel and summer holidays

30
Q

Via which 2 mechanisms can bacteria cause gastroenteritis?

A

1) Enterotoxin production - toxin produced by bacteria attacks host enterocytes
2) Adherence or invasion of enterocytes by bacteria itself

31
Q

Other than gastroenteritis what other infection does E coli commonly cause?

A

UTI

32
Q

Via what mechanism does E coli cause gastroenteritis?

A

Enterotoxin production

33
Q

10-15% of patients with gastroenteritis caused by E coli also develop what complication and why?

A

Haemolytic urea syndrome

Toxin affects RBCs too

34
Q

How does E coli infection lead to inflamed and fluid filled bowel?

A

1) Toxin produced which is internalised by epithelial cells
2) Toxin affects small proteins so that Cl- moves out of the cell followed by Na+
3) High electrolyte content in the lumen also pulls water out in the lumen by osmosis - leading to a fluid filled lumen and dehydration

35
Q

What are the 4 main types of salmonella?

A

1) S. typhi
2) S. paratyphi
3) S. enteritidis
4) S. typhimurium

36
Q

What 3 conditions does salmonella cause?

A

1) Food poisoning
2) Typhoid
3) Paratyphoid

37
Q

What is the treatment for infective gastroenteritis?

A

Supportive management.
Generally avoid Abx as this may increase duration of salmonella carriage
Abx treatment may also worsen E coli HUS (Haemolytic urea syndrome)

38
Q

What is the difference between tyhpoidal salmonella and non-typhoidal salmonella?

A

Typhoidal salmonella can disseminate to other cells outside of the GIT and cause typhoidal fever

39
Q

Why does Abx associated diarrhoea occur?

A

Due to disruption of the gut microflora which leads to a change in metabolism (carbohydrates/bile acids) and overgrowth of pathogenic organisms

40
Q

What are the symptoms of Abx associated diarrhoea?

A

Range from mild diarrhoea to pseudomembranous colitis and can lead to conditions such as toxic megacolon, perforation and shock

41
Q

What is the most common cause of Abx associated diarrhoea?

A

C. diff - accounts for 10-25%

42
Q

Other than C diff what 5 organisms can cause Abx associated diarrhoea commonly?

A

1) C perfringens
2) S aureus
3) Candida spp
4) Klebsiella spp
5) Salmonella spp

43
Q

Risk of C diff infection increases massively with increasing…?

A

Age

44
Q

What strain of C diff is associated with a 2.5-3.5 fold increased death rate and deaths in younger people?

A

CD 027

45
Q

What 2 Abx are high risk for C diff infection?

A

1) Cephalosporins

2) Clindamycin

46
Q

What 4 Abx are medium risk for C diff infection?

A

1) Ampicillin/amoxicillin
2) Co-trimoxazole
3) Macrolides
4) Fluoroquinolones

47
Q

Which Abx is CD 027 resistant to and is therefore of particular importance?

A

Fluoroquinolones

48
Q

What are the 8 CD infection control measures?

A

1) Early warning system to identify changes in epidemiology
2) Reduce risk of transmission
3) Early isolation/cohorting of patients with diarrhoea
4) Environmental cleaning, chlorine
5) Hand hygiene soap & water
6) Examine/optimise/reduce overall Abx use
7) Limit high risk agents in high risk patients
8) Feedback CDI and Abx data on a regular basis

49
Q

What 2 Abx are the current therapy for CD infection and what is the new Abx?

A

Current: Oral metronidazole/ oral vancomycin
New: oral fidaxomicin

50
Q

Other than Abx what is the other treatment for C diff?

A

Faecal transplant

CLINICAL PATHOLOGY (56 decks)

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