Gastroenteritis

Question 1

Can cause family/community outbreaks, cruise ships

Answer 1

Norovirus

Question 2

Who does norovirus tend to affect?

Answer 2

Older children, adults

Question 3

Faecal/oral, waterborne, shellfish

Answer 3

Norovirus

Question 4

Abrupt nausea, vomitting, diarrhoea, cramps, myalgia

24-48 hour incubation

Answer 4

Norovirus

Question 5

When will norovirus resolve?

Answer 5

24-48 hours

Question 6

Onset 1-6 hours after exposure
Diarrhoea, abdominal pain, afebrile
No blood or pus in faeces

Answer 6

Toxin mediated food poisoning (e.g. staph aureus, clostridium perfringens, bacillus cereus)

Question 7

Fever, D&V, abdominal pain

Answer 7

Acute enteritis

Question 8

Fever, pain, bloody diarrhoea

Answer 8

Acute colitis

Question 9

Enteric fever like illness

Answer 9

Fever, rigors and pain but LITTLE diarrhoea

Question 10

Infections that cause bloody diarrhoea

Answer 10

Camplyobacter
Shigella
E.coli O157
Amoebiasis

Question 11

Food/water, poultry

Most common cause of bacterial infection

Answer 11

Camplyobacter

Question 12

2-5 day incubation

Illness lasts 5-14 days

Answer 12

Camplyobacter

Question 13

Associated with Guillain-Barre

Answer 13

Campylobacter

Question 14

How does camplyobacter present?

Answer 14

Colitic syndrome - fever, pain, bloody diarrhoea

May mimic appendicitis

Question 15

GI bleed

Answer 15

E. coli

CMV

Question 16

Malabsorptive diarrhoea with bloating

Answer 16

Microsporidium

Giardia lamblia

Question 17

Indian subcontinent, SE Asia, Far East, Middle East, Africa etc

Answer 17

Typhoid

Question 18

What is key to diagnosis of typhoid?

Answer 18

Blood cultures

Question 19

Test for salmonella

Answer 19

Stool culture

Question 20

Test for Campylobacter

Answer 20

Stool culture

Question 21

Test for Shigella

Answer 21

Stool culture

Question 22

Test for C. difficile

Answer 22

Stool toxin (culture not routinely done!!)

Question 23

Test for E. coli O157?

Answer 23

Cytotoxin

Question 24

Test for salmonella

Answer 24

Blood culture

Question 25

Test for Norovirus

Answer 25

PCR

Question 26

How to assess severity of CDI?

Answer 26

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

Question 27

Complications of bacterial enteritis?

Answer 27

Severe dehydration and renal failure Acute colitis, toxic dilatation Post infective irritable bowel (very common) Transient secondary lactose intolerance

Question 28

Antimotility agents

Answer 28

Opiates, loperamide | avoid if dysentery symptoms

Question 29

Anti-secretory agents

Answer 29

Chlropromazine | Bismuth subsalycilate

Question 30

Empirical therapy

Answer 30

Ciprofloxacin 500mg BD for 3-5 days

Question 31

Abx predisposing to C.diff infection

Answer 31

Cephalosproins Clindamycin Ciprofloxacin Clarithromycin

Question 32

Treatment for pseudomembranous colitis

Answer 32

Metronidazole (non-severe) Vancomycin (severe) Give both orally!! Give metronidazole --> should improve 3-5 days, if not then start metronidazole!

Question 33

Abx for shigellosis

Answer 33

Ciprofloxacin (quinolone)

Question 34

Abx for campylobacter

Answer 34

Macrolide (azithromycin etc)

Question 35

Community acquired/traveller's diarrhoea

Answer 35

``` Salmonella Shigella Campylobacter E. coli C. diff ```

Question 36

Nosocomial diarrhoea

Answer 36

C. diff

Question 37

Persistant diarrhoea > 7 days

Answer 37

Giardia | Cryptosporidium

Question 38

Treatment for traveller's diarrhoea?

Answer 38

Ciprofloxacin and anti-diarrhoeals

Question 39

Diagnosis of amoebiasis?

Answer 39

Examination of hot stool for ova and cysts

Question 40

Treatment of amoebiasis?

Answer 40

Metronidazole | -remove from lumen by using diloxanide furoate or paromomycin

Question 41

Associated with liver abscess?

Answer 41

Amoebiasis

Question 42

Diarrhoea and malabsorption, often explosive

Answer 42

Giardiasis

Question 43

Infection spread by cysts found in normal drinking water | Diagnosis= examination of hot stools for ova and cysts (more accurately by duodenal aspiration)

Answer 43

Giardiasis

Question 44

Treatment for giardiasis

Answer 44

Metronidazole

Question 45

How does amoebiasis present?

Answer 45

Acute bloody diarrhoea

Question 46

What do you HAVE to do if extra-intestinal amoebiasis?

Answer 46

SEROLGY

Question 47

Diagnosis of intestinal amoebiasis

Answer 47

Stool M&C

Question 48

Probable cause of protracted diarrhoeal symtpoms

Answer 48

Giardiasis

Question 49

Probable cause of protracted diarrhoeal symtpoms

Answer 49

Giardiasis

Question 50

Cryptosporidosis treatment

Answer 50

Usually supportive