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Phase 4 - Infectious Diseases > Gastroenteritis > Flashcards

Gastroenteritis Flashcards

1
Q

What id the definition of Travellers’ diarrhoea and the most common cause?

A
  • Defined as at least 3 loose to watery stools in 24 hours +/- abdominal cramps, fever, nausea, vomiting or blood.
  • The most common cause is E.coli
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2
Q

Describe acute food poisoning and its most common causes

A
  • It is the sudden onset of nausea, vomiting and diarrhoea after the ingestion of a toxin.
  • Common causes are S. aureus, Bacillus cereus and clostridium perfringes
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3
Q

What are the bacterial causes of gastroenteritis?

A
  • Staphylococcus aureus,
  • Bacillus cerus (reheated rice)
  • Clostridium perfringes (reheated meat)
  • Campylobacter
  • E.coli (inc. E.coli 0157)
  • Salmonella
  • Shigella
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4
Q

What are the viral causes of gastroenteritis?

A
  • Rotovirus (mainly in children)
  • Norovirus (across all ages)
  • Adenovirus (often causes resp illnesses)
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5
Q

What are the parasitic causes of gastroenteritis?

A
  • Giardia intestinalis,
  • Cryptosporidium
  • Schistosoma
  • Entamoeba
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6
Q

What are the investigations for gastroenteritis?

A
  • History and examination
  • Bloods (FBC, UEs - look for dehydration, LFTs, CRP, pregnancy test) and blood film,
  • Sigmoidoscopy
  • Abdominal x-ray
  • Stool cultures x3
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7
Q

Describe features of Salmonella infections and its presentation

A
  • Acquired via contaminated food. Incubation is 12-72 hours
  • It presents with watery orbloody diarrhoea, vomiting and fever. Can last up to 1 week
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8
Q

What is the treatment for salmonella infections

A
  • Fluid replacement is sufficient for most cases
  • Antibiotics, first line is ciprofloxacin, are for severe infections or bacteraemia.
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9
Q

What are the features and presentation of Campylobacter

A
  • Commonest foodborne bacterial infection in UK. Especially chicken. Incubation is 2-5 days.
  • Presents with bloody diarrhoea, cramping abdominal pain and fever. NOT vomiting. Can last up to 10 days.
  • Can mimic appendicitis
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10
Q

What is the treatment for campylobacter gastroenteritis

A
  • Fluid replacement is normally sufficient
  • In severe cases or immunocompromised patients; Clarithromycin is first line. (macrolides)
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11
Q

What is a complication of Campylobacter?

A

Guillian Barre Syndrome

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12
Q

What are the features of enteropathogenic and enterotoxigenic E.coli

A
  • Enteropathogenic causes attaching and effacing lesions mediated by intimin and Tir, causing microvili disrtuption. Incubation is 1-2 days
  • Enterotoxigenic releases heat labile and heat stable toxins. Incubation is 1-7 days
  • Both present with watery diarrhoea, abdominal pain and vomiting
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13
Q

Describe features of enterohaemorrhagic E.coli

A
  • E.coli 0157. It produces shiga like toxins. Incubation is 1-7 days.
  • It presents with bloody diarrhoea, abdominal pain and vomiting.
  • May cause haemolytic uraemic syndrome 5 days after diarrhoeal infection (in 5-10% of cases)
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14
Q

What is the treatment for enterohaemorrhagic e.coli?

A

Supportive management only as antiboitcs increases the risk of developing HUS.

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15
Q

What is the presentation of haemolytic uraemic syndrome?

A

Intravascular blood clots cause this triad of symptoms:
- Acute kidney injury,
- Microangiopathic haemolytic anaemia
- Thombocytopenia
This presents as low urine output, haematuria, abdo pain, confusion, hypertension and bruising.

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16
Q

What are the investigations for haemolytic uraemic syndrome?

A
  • FBC: Microangiopathic haemolytic anaemia is a Hb < 80 with a negative coomb’s test. It will also show thrombocytopenae
  • Blood film: Schistocytes and helmet cells
  • U&E’s - AKI
  • Stool culture: PCR for shiga toxin.
17
Q

What is the treatment of haemolytic uraemic syndrome?

A
  • Supportive: fluids, blood and dialysis if needed. NO ABx or loperamide
  • Plasma exchange for severe cases not associated with diarrhoea. With C5 monoclonal antibody
18
Q

What is a direct and indirect coombs test?

A

Direct - Detects if there are antibodies on the surface of RBCs. When mixed with coombs reagent it will cause a thrombus.
Indirect - Patient’s plasma (which contains any potential antibodies) is mixed with donor blood.

19
Q

When do you use the Direct coombs test and the indirect coombs test?

A

Direct - Autoimmune haemolytic anaemia, HUS, haemolytic disease of the newborn.
Indirect - Pre-transfusion testing ot pre-natal antibody screen

20
Q

Describe features of Shigella

A
  • It causes bloody diarrhoea, abdominal cramps and fever.
  • Incubation is 12hr-3 days
  • Produces shiga toxic so can cause HUS
  • Severe cases can be treated with azithromycin
21
Q

Describe features of bacillus Cereus

A
  • Grows on rice. Reheating can kill the bacteria but not toxin.
  • Cereulide toxin causes abdompinal cramping and vomiting within 5 hours of ingestion and diarrhoea within 8 hours of ingestion. Resolution in 24 hours.
22
Q

Describe features of Yersinia Enterocolitica

A
  • Pigs are key carriers. Incubation is 4-7 days. Typically affects kids
  • It causes watery/bloody diarrhoea, abdominal pain and fever.
  • In older children and adults it can cause right sided abdo pain due to mesenteric lymphadenitis which can mimic appendicitis
23
Q

What are the incubation periods for the following infections:
- S.Aureus,
- Salmonella,
- Shigella,
- Amoebiasis,
- Bacillus cereus,
- E.coli,
- Campylobactoor
- Giardiasis

A

1-6 hrs: Staphylococcus aureus, Bacillus cereus
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis

24
Q

Describe featurs of the norovirus

A

Symptoms occur 24-48 hours after innoculation. Usually self limiting vomiting bug but can cause AKIs in the elderly population.

25
Q

Describe features of Giardiasis

A
  • Parasitic infection which is transmitted via the faecal-oral route.
  • Can cause chronic diarrhoea, steatorrhoea, flactulence, malabsorption, bloating and abdominal pain
  • Investigated via stool sampling (NAAT)
  • Treated with tinidazole or metronidazole
26
Q

What are the general principles of managing gastroenteritis?

A
  • Send faeces sample for microscopy, culture and sensitivities.
  • Ensure hydration via oral rehydration salts or IV fluids
  • Antidiarrhoeal drugs (loperamide) and anti-emetics are generally avoided as they may worsen infection.
  • Antibiotics are only used in systemically unwell, elderly and immunosuppressed patients
27
Q

What are possible complications following gastroenteritis

A
  • Lactose intolerance,
  • IBS
  • Reactive arthritis
  • Guillian-Barre syndrome
  • HUS

Phase 4 - Infectious Diseases (23 decks)

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