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Gastro > Gastroenteritis > Flashcards

Gastroenteritis Flashcards

1
Q

What is gastroenteritis?

A

Inflammation of the stomach or intestines

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2
Q

What does gastroenteritis do?

A

inhibits nutrient absorption and excessive H2O and electrolyte loss

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3
Q

What are the 4 causes of gastroenteritis

A

Bacterial
Viral
Parasitic
Poisoning by microbial toxins

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4
Q

What makes you feel worse - bacterial or viral?

A

Bacterial

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5
Q

What is the most common cause of gastroenteritis

A

Infection mostly caused by a virus, bacteria or parasite

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6
Q

Why is there a lower incidence of Gastroenteritis in Dundee than there is in London

A

The number of parasites increases with the population of a city

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7
Q

What are the main common presentations of gastroenteritis

A

Fever
Abdo pain
Diarrhoea
Sometime blood PR

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8
Q

Why is there only sometimes blood PR

A

Certain pathogens cause blood- some are more likely than others

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9
Q

What is an example of a pathogen likely to cause blood

A

Campylobacter

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10
Q

When is the onset for toxin mediated food poisoning

A

1-6 hours after exposure

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11
Q

Why is foodborne illness a rapidly emerging crisis in industrialised countries

A 
Poor sanitation and hygiene 
Change in eating habits 
Importation of food 
Increase in day care centre attendance 
Increase in elderly care 
institutes 
Increased travel 
Pets carry many pathogens
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12
Q

What do poultry and eggs carry? How could we get this?

A

Campylobacter - if we do not cook the meat well enough

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13
Q

What are some non-infectious diarrhoea examples

A 
GI bleed
Ischaemic gut 
Diverticulitis
Endocirne disorders
Numerous drugs
Fish toxins 
Withdrawl
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14
Q

How do we approach any clinical infection syndrome

A

Find what the key clinical symptoms and signs are that suggest infection
Differential diagnosis
Severity of infection
Site and microbiological diagnosis and investigations
Antibiotic and supportive management
Infection control
Public health

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15
Q

How does the norovirus spread

A

As a spray in vomit

Faecal/ oral

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16
Q

How long does it take for the norovirus to resolve

A

24-48 hours

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17
Q

What are the common symptoms of norovirus

A

Abrupt nausea, vomiting, diarrhoea, cramps, myalgias

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18
Q

Who is most likely to get the norovirus

A

Older children and adults - not children

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19
Q

What are the 3 common presentations of food poisoning

A

Acute enteritis: fever, D&V, abdo pain
Acute colitis: fever, pain, bloody diarrhoea
Enteric fever like illness: fever, rigors, pain, but little diarrhoea by the time the present

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20
Q

What does blood diarrhoea usually indicate

A

Infection
IBD
Malignancy
Iscahemia

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21
Q

What is a complication of campylobacter

A

Guillain Barre

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22
Q

How long does Campylobacter affect us for

A

5-14 days

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23
Q

What do indentations on an AXR indicate

A

Inflammation

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24
Q

What are the common symptoms of enteric fever like illness

Give an example of enteric fever

A

Fever
Systemically unwell
Abdo pain
Constipation but possibly short history if diarrhoea

Typhoid is an example

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25
Q

What is typhoid?

A

A type of salmonella

26
Q

In what countries is typhoid present?

A 
India 
SE Asia
Far East, 
Middle East
Africa
Central America 
South America
27
Q

How is typhoid carried?

A

In food and water

28
Q

What are the symptoms of typhoidW

A

Usually asymptomatic,
mild,
bacteriaemia,
enterocolitis

29
Q

Define enterocolitis

A

inflammation of the small intestine and the colon

30
Q

How can we diagnose typhoid

A

Blood, Stool and urine cultures

31
Q

How can we treat typhoid?

A

Chloramphenicol and ciprofloxacin

32
Q

What antibiotics are used in India, China or Middle east and why are they different?

A

Ceftriaxone or axithromycin

Resistance - the antibiotics were over used there

33
Q

How can we prevent Typhoid?

How effective is this method?

A

VI or oral vaccine

70% effective

34
Q

What does the thyphoid vaccine not protect against?

A

Paratyphoid

35
Q

What are the 3 main investigations for determining the pathogen of gastroenteritis

A

Stool microscopy
Stool culture
Stool toxin

36
Q

What investigation should be done for salmonella, campylobacter and shigella

A

Stool culture

37
Q

What investigation should be done for a history of travel for giardia, amoeba etc

A

Stool microscopy

38
Q

What investigation should be done for C difficile, cytotoxin for E coli 0157

A

Stool toxin

39
Q

What would PCR detect?

A

Norovirus

40
Q

How can you assess the severity of gastroenteritis?

A 
Underlying medical condition
Presence or absence of fever 
Rigors
Shock (hypotension / tachycardia)
Blood in stools
Abdo pain
Number of stools in 24 hours 
Colonic dilation
WCC, U&Es
41
Q

What determines how severe CDI is?

A

Suspicion of psudomembranous colitis (PMC) or toxic megacolon or ileus or colonic dilation in CT / AXR >6cm
WCC >15cells / mm3
Creatinine >1.5 x baseline

42
Q

Name 4 complications of Bacterial Enteritis within the small bowel

A

Severe dehydration and renal failure
Acute colitis, toxic dilation
Post infective irritable bowel
Transient secondary lactase intolerance

43
Q

Name 6 complications of bacterial enteritis outside of the bowel

A 
Septicaemia 
Metastatic infection: meingitis , aortitis, endocarditis
Reactive arthritis
Guillian Barre syndrome 
Haemolytic uraemic syndrome
44
Q

What supportive treatment is given>

A 
Oral rehydration
IV fluids (saline!!)
45
Q

What are specific treatments which can be used

A

Anti-spasmodics
Anti-motility
Antibiotics - only in specific regions

46
Q

What is bad about long term antimotility drugs

A

They stop the normal peristaltic movements and prevent the body naturally clearing toxins

47
Q

What 3 drugs are used as antidiarrhoeal agents

A

Antimotility agents
Antisecretory agents
Absorbents

48
Q

Name 4 indications for antibiotic treatment

A

Enteric fever (tyohoid)
Shigellosis
Cholea
C difficile diarrhoea

49
Q

What are the 3 main aims of antibiotic treatment

A

To prevent and treat invasive disease especially in immunocompromised patients
To reduce the severity and duration of symptoms
To eradicate faecal excretion in order to reduce environmental contamination and to limit the spread of infection to the community

50
Q

What type of organism is clostridium difficile

A

Anaerobic, gram positive spore forming bacillus

51
Q

What is the major cause of diarrhoea and colitis in patients exposed to antibiotics

A

C diff

52
Q

How can we minimise the spread of CDI

A

Patients positive in a private room where possible
Full barrier praucations
Soap and water and not gel!

53
Q

How do we treat c diff

A

Treeat according tot he severity
Reduce the acute complitions
Reduce the likelihood of recurrence
Treat recurrence

54
Q

What are 3 pathogens found in travel related diarrhoea

A

Amoebiasis
Giardiasis
Cryptosporidiosis

55
Q

What is the most common cause of traveller’s diarrhoea

A

ETEC

56
Q

How long does traveller’s diarrhoea last

A

Around 4 days

57
Q

What is amoebiasis

A

A protozoal infection which is spread by faeco-oral route or by an ill or asymptomatic carrier

58
Q

Where is there a high prevelance of amoebiasis

A

In areas of poor sanitation

59
Q

What is Giardiasis

A

Protozoon Giardia lambia trophoxoites colonises the small bowel mucosa to produce diarrhoea and malabstoptions

60
Q

How is Giardiasis spread

A

Cysts found in the normal drinking water

61
Q

How can we treat giardiasis

A

Metronidazole

Gastro (67 decks)

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