GASTROENTERITIS

Question 0

Is food poisoning an infection?

Answer 0

No. It’s the ingestion of preformed toxin -> intoxication

Question 1

What is travellers diarrhoea?

Answer 1

When person from industrialized county travels to developing country with reduced levels of personal and good hygiene.

E.Coli 40%

Question 2

Risk factors for gastroenteritis?

Answer 2

No immunisation to rotavirus
Travelling to developing countries
Contact with sick
Foods ingested or contaminated water

Question 3

Symptoms of gastro? Feats of viral, bacterial, protozoal and enterotoxic?

Answer 3

Dehydration
Watery diarrhoea
Acute vomiting and diarrhoea (viral)
Blood in stools, also longer lasting (bacterial)
Diarrhoea > 2 weeks (Protozoa, lactase deficiency?)
Short incubation (enterotoxins - staph)

Question 4

Norovirus?

• age
• transmission
• incubation
• symptoms
• mechanism of diagnosis

Answer 4

All ages, commonly semi-closed environments e.g camps, hospitals, NH

Faecal-oral or aerosol vomitus

Incubation average 24hrs but 10-51hrs

Features - diarrhoea (watery), vomiting (dominant symptom > 50%), fever (LC mild)

RTPCR

Question 5

Rotavirus

• age
• transmission
• incubation
• symptoms
• Ix for diagnosis

Answer 5

<5 years dt vaccinations 
Faecal-oral route 
Incubation 1-3 days 
Explosive watery diarrhoea (5-10eps/day)
Vomiting
Fever frequent
Duration 2-8 days
Stool enzyme immunoassay (EIA)

Question 6

Giardia

• age
• transmission
• incubation
• symptoms
• diagnosis
• management

Answer 6

Small non invasive parasite
Faecal oral
Self limiting
Malaise, bloating, flatulence, malodorous stools, no dysentery
Diagnose with antigens in stool not microscopy

Metronidazole

Question 7

Complications?

Answer 7

DEHYDRATION 
Electrolyte disturbance
Sepsis
Shiga toxin E.coli -> haemolytic uraemic syndrome
Campylobacter -> GBS

Question 8

Ix?

Answer 8

CBE EUC LFT CRP BGL
STOOL MCS
- faecal leukocyte count and FOBT
PARASITE EXAM IF SUSPECTED?

Question 9

Management?

Answer 9

Fluid and electrolyte replacement mainstay

• IV/NGT/PO
• anti-emetics
• ABx
• anti-diarrhoeals not recommended

Question 10

How do you monitor hydration?

Answer 10

Pt weight
Clinical signs
Evidence of fluid overload - creps, oedema, JVP

Question 11

Indications for ABx?

Answer 11

Sepsis
Prolonged fever from inflammatory diarrhoea
Child <1 yr
If shigella, vibrio cholera, C. difficile, travellers diarrhoea, giardia

Question 12

Fluid requirements in children?

Answer 12

If hypotension or very dry-> fluid bolus 10-20ml/kg with .9%NaCl

Maintenance -> .45%NaCl + 5% glucose + 20mmolKCl (4-2-1)

Correct deficit -> estimate then % deficit * weight * 10) = bolus amount

Replace ongoing losses