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General surgery + HPB - YR3 > Gastroenteritis > Flashcards

Gastroenteritis Flashcards

1
Q

What is gastrotenteritis?

A
  • Inflammation of GI tract
  • Considered infective in origin usually (but can be non-infective)
  • Usually transient and associated with diarrhoea, vomitting and abdominal pain
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2
Q

Most common cause of gastroenteritis

A

Viral

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3
Q

Length of time between ingestion of food and development of symptoms - organism cause?

A
  • Hours = bacterial toxins
  • Days = viruses
  • Weeks = bacteria
  • Months = parasites
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4
Q

Define diarrhoea

A

3 or more loose stools or stools with increased liquid per day

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5
Q

Acute vs chronic diarrhoea

A

Chronic lasts more than 14 days

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6
Q

What is dysentery?

A
  • Gastroenteritis characterised by loose stools with blood and mucus
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7
Q

What is travellers diarrhoea?

A
  • More than 3 loose stools commencing within 24hrs of foreign travel
  • With or without cramps, nausea, fever or vomiting
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8
Q

RF for gastroenteritis

A
  • Poor food preparation - esp in handling and cooking
  • Immmunocompromised
  • Poor personal hygiene
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9
Q

Symptoms of gastroenteritis

A
  • Cramp like abdominal pain
  • Diarrhoea +/- mucus or blood
  • Vomitting
  • Night sweats
  • Weight loss
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10
Q

Examination of patient with gastroenteritis

A

Dehydrated and pyrexial

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11
Q

Features from history to ask about re infective gastroenteritis

A
  • Bowel movements - blood? watery?
  • Affected family or friends?
  • Recent travel abroad
  • Recent use of abx within last 4 weeks - c.diff?
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12
Q

Complications that can present from gastroenteritis

A
  • Guillain Barre syndrome
  • Reactive arthiritis
  • Haemolytic ureamic syndrome
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13
Q

Investigations for gastroenteritis presentation

A
  • None usually needed as self limiting
  • Stool culture if blood/mucus, immunocompromised or if severe/persistent
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14
Q

Management - general gastroenteritis

A
  • Rehydrate - encourage oral fluid intake, if severe and cannot tolerate oral fluids - admit for IV maybe
  • Education to prevent further episodes
  • Exclusion from work - 48hrs from last episode of vomitting or diarrhoea
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15
Q

Notifiable disease - when?

A
  • Food poisoning
  • Infectious bloody diarrhoea

Diagnosing doctor has DUTY to inform

  • Campylobacter and Salmonella also are but the lab inform public health about this
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16
Q

Viral causes of gastroenteritis

A
  • Norovirus
  • Rotavirus
  • Adenovirus
17
Q

Noravirus presentation

A
  • Most common in adults - single stranded RNA virus
  • Abdominal cramps, watery diarrhoea, vomitting
  • Lasting 1-3 days
18
Q

Rotavirus - presentation

A
  • Double stranded RNA virus
  • Severe diarrhoea in infants and young children
  • Generally self resolves in less than 1 week
19
Q

Adenovirus presentation

A
  • Double stranded DNA virus
  • Common cause of diarrhoea in children
20
Q

Bacterial causes of gastroenteritis

A
  • Campylobacter
  • E-coli
  • Salmonella
  • Shigella
21
Q

Campylobacter presentation

A
  • Most common cause food poisoning - typically chicken, eggs or milk (gram -ve bacilli)
  • Prodrome of fatigue, fever or myalgia, then nausea abdominal cramps and diarrhoea
22
Q

What complications can Campylobacter cause?

A
  • Guillan Barre syndrome
  • HUS
  • Thrombotic thrombocytopaenic purpura
23
Q

E-coli presentation

A
  • Transmitted through contaminated food usually (but can be from animals to human and person to person)
  • Several forms exist - enterotoxigenic e-coli is most common cause travellers diarrhoea
24
Q

Which form of e-coli can cause HUS?

A
  • Serotype 0157:H7
25
Q

Salmonella presentation

A
  • Undercooked poultry or raw eggs
  • Fever, vomitting abdominal cramps and bloody diarrhoea
26
Q

Shigella presentation

A
  • Contaminated dairy products and water
  • Fever, abdominal pain, bloody diarrhoea
27
Q

Bacterial toxin causes of gastroenteritis

A
  • Staphylococcus aureus - meat and dairy exotoxin not destroyed by heat
  • Bacillus cereus - reheated rice
  • Clostridium perfringens - reheating meat
  • Vibrio cholera - contaminated water, oral vaccine available
28
Q

Parasite causes of gastroenteritis

A
  • Cryptosporidium
  • Entamoeba histolytica
  • Giardia intestinalis
  • Schistosoma
29
Q

Cryptosporidium presentation

A
  • Self limiting watery diarrhoea and abdominal cramps
  • Diagnosis made by stool culture for ova, cysts and parasites
30
Q

Entamoeba histolytica

A
  • Ingestion of food/water contaminated with faeces
  • Bloody diarrhoea, abdominal pain and fever
  • Can also cause lliver absces
  • Stool culture for ova, cysts and parasites needed for diagnosis - treat with Metronidazole
31
Q

Giardia intestinalis

A
  • Direct contact or faeco-oral route
  • Acute disease - diarrhoea, fever, fatigue, nausea and bloating OR
  • Chronic disease - steatorrhoea, malabsorption, weight loss
  • Stool culture for ova, cysts and parasites for diagnosis - Metronidazole treats
32
Q

Schistosoma presentation

A
  • Contaminated water
  • Acute develops a month after initial infection = fever, malaise, abdominal pain, bloody diarrhoea
  • Severe causes –> chronic liver disease
  • Eosinophilia on FBC sometimes
  • Stool culture for ova, cysts and parasites needed - treat with Praziquantel
33
Q

Hospital acquied gastroenteritis - main pathogens

A
  • C.diff - then produces large amounts of exotoxins A&B
  • Gram +ve organism
  • Develops post use of broad spec abx distrupting normal microbiota of bowel
34
Q

What do the c.diff exotoxins do to the bowel?

A
  • Trigger large immune response
  • = inflammatory exudate on colonic mucosa
  • This presents clinically with severe bloody diarrhoea and has potential to develop into toxic megacolon - bowel becomes severely dilated and high risk of perf if untreated
35
Q

Investigations for ?c.diff

A
  • Stool culture
  • C.difficile toxin testing (CDT)
36
Q

Non-infective causes of gastroenteritis

A
  • Radiation colitits
  • Inflammatory bowel disease
  • Microscopic colitis - macroscopically normal on endoscopy but biopsy shows increase in inflammatory cells
  • Chronic ischaemic colitis - usually splenic flexure watershed area, endoscopy may show blue swollen mucosa
37
Q
A

General surgery + HPB - YR3 (38 decks)

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