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General practice > Gastroenteritis > Flashcards

Gastroenteritis Flashcards

1
Q

Most common cause of acute diarrhea

A

Viral gastroenteritis

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2
Q

Vomiting is feature in which GE

A

Viral

Toxin mediated

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3
Q

Viral causes (4)

A

Rotavirua
Norovirus
Enteric adenovirus
Astrovirus

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4
Q

Symptoms suggestive of norovirus

A

Prominent vomiting, cramping, abdominal pain.

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5
Q

What increases liklihood of bacterial

A

Systemic- fever

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6
Q

What should be investigation for if recent antibiotic use/hospitalisation

A

C difficile

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7
Q

If used, what is the role of antibiotics

A

Reduce time and severity
Prevent extra-intestinal complications
Reduce spread

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8
Q

Characteristics of toxin mediated

A

Abrupt onset
Closely clustered contacts
NV, abdominal pain prominent symptoms
Diarrhea occur late if present

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9
Q

Antibiotics most commonly used in bacterial (if used)

A

Azithromycin
Ciprofloxacin
Doxycyclin for cholera

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10
Q

Definition

A

Inflammation (infectious) of stomach and small intestine leading to NVD

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11
Q

Bacterial causes food borne illness

A 
Bacillus cereus
Campylobacter jejuni
E. coli
Salmonella
Shigella
Yersinia enterocolitica
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12
Q

Risk factors

A 
Young
Day care
Exposure to sick contacts
Travelling
Immunocompromised
Sick contact
Antibiotic use
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13
Q

History

A

NVD, abdominal pain, volume depletion, fever
Hx of travel, contact with contaminated food, consumption of unprocessed meat/milk/cheese
Contact with infected person

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14
Q

Hydration status examination

A

General: stable, breathless, fever, evidence of infection
Input/output: IV fluids, catheter, NG tube, bowels
Chart: obs, fluid balance, drug chart
Hands: Temp, pulse volume and rate, collapsing, BP sitting and standing
HN: sunken eyes, dry mucous membrane, depressed/elevated JVP,
carotid pulse/volume
Chest: cap refill, skin turgor, apex beat, 3rd heart sound in overload + pulmonary edema.
Abdomen: ascites
Legs: peripheral edema
To complete my examination i would take further history, look at UEC, obs and fluid balance chart.
Serial weights, catheterise, UEC, ABG, serum lactate

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15
Q

Investigations

A 
Generally not required in young children
Stool culture X3 for MCS and C diff toxins, Campylobacter, Salmonella, Shigella
FBC- +WCC
Renal function- +U:Cr, hypokalemia
Glucose, ABG, lactate
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16
Q

Management

A

Rehydration

Nutrition

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17
Q

Important differentials for VD in children

A 
Appendicitis
UTI
Sepsis
Intusussception, enterocolitis, malrotation, Hirschsprung
HUS
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18
Q

Presentation in children

A 
Poor feeding
Vomiting
Fever
Diarrhea
Watery and frequent stools
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19
Q

Best indication of fluid depletion in children

A

Recent change in body weight

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20
Q

Signs to discriminate dehydration and hydration

A

-ve skin turgor
-ve peripheral perfusion
deep acidotic breathing

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21
Q

Mild dehydration classifcation, signs and management

A
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22
Q

Moderate dehydration classifcation and signs

A

5-9%
Same as mild + rapid pulse, -ve peripheral perfusion, sunken eyes and fontanelle, deep acidotic breathing, slow skin retraction

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23
Q

Management of moderate dehydration in children

A

Rehydration ?NGT
Reassess at 6 hours
If fluid replete, maintenance fluids then used
Weigh every 6 hours for first 24 hours of admission
Introduce food after hydration

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24
Q

Severe dehydration classification and signs

A

> 9% weight loss
All same signs +
in infants->drowsy, limp, cold, sweaty cyanosed, altered MS
In children->apprehension, cold, sweaty, cyanosed, feeble resp effort, hypotensive

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25
Q

Management of severe dehydrationq

A 
Get senior medical help
Shocked->20ml/kg IV NS
IV/IO access
Measure UEC, glucose, VBG
May require NGTR
If NGTR not successful IV fluids
Treat hypoglycemia w/ 5ml/kg 10% dextrose
Septic workup
ORS start after initial resus->frequent small amounts 10-20ml/kg over 1 hour
Give over 6 hours
Admit
Re-evaluate
Ongoing fluids: 5% dextrose + NS, 20mmol/L if K
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26
Q

What mechanism used in ORS

A

Glucose facilitated sodium transport in small intestine

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27
Q

Current ORS available

A

Gastrolyte Na 60 K 20 Cl 60 Citrate 10 Glucose 90
Replayte
Hydralyte

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28
Q

Suitable fluids for non dehydrated

A

Sugar water (1 teaspoon in 200ml)
Fruit juice 1 in 6 with water
Cordial 1 in 16
Lemonade 1 in 6

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29
Q

Why is early refeeding following rehydration important

A

Enhances mucosal recovery

Reduces duration of diarrhea

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30
Q

What can children have after rehydration

A

Complex carbohydrates, yoghurt, fruits, vegetables

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31
Q

One possibility if persistent diarrhea following recommencement of feeding

A

Transient lactose intolerance

32
Q

Indication for admission to hospital

A 
Moderate to severe dehydration
High risk for dehydration
High risk infants
When patient/carers thought not to be able to manage
If diagnosis is in doubt
33
Q

High risk for dehydration

A

4/24 hours

Observe for 4-6 hours to ensure maintenance of hydrations

34
Q

High risk infants for dehydration

A

Ileostomy, short gut, CHD, chronic renal disease, metabolic disorders, malnutirtions

35
Q

When would biochemistry tests be required in children

A

History of prolonged diarrhea with severe dehydration
Altered conscious state
Convulsions
Short bowel syndrome, ileostomy, Cardiac/renal, metabolic disorders
Infants

36
Q

Complications in children

A

Hypernatremic dehydration

Hyponatremic dehydration

37
Q

How much should sodium levels fall by

A

No more than 0.5mmol/L per hour

38
Q

General Advice to parents treating mil/moderate at home

A

Give small amounts of fluid often
Start solids after 24 hours
Continue breastfeeding or start bottles after 24 hours
Provide maintenance fluids and fluid loss

39
Q

Advice to parents for mild/moderate dehydration on Day 1, 2 and 3, day 4

A

Day 1: General 50ml/15 mins. 200ml for every watery stool
Ideal is gastrolyte, hydralyte or home made solutions
Day 2 and 3: reintroduce babys formula/milk, dilute to half strength (equal milk to water)
Day 4: increase milk to normal strength, gradually reintroduce normal diet
Aim to give more fluid in first 6 hours

40
Q

Maintenance for 1-3 months, 4-12months, 12 months >

A

1-3 month 120ml/kg/hr
4-12 month 100ml
>12 month 80ml

41
Q

Calculating total

A

Maintenance + fluid loss

42
Q

Calculate fluid loss

A

%body weight loss X body weight X 10

43
Q

Daily maintenance IV fluid based on weight

3-10kg, 10-20kg, >20kg

A

3-10= 100ml/kg/day
10-20- 1000ml + 50ml/kg for each kg >10kg
>20- 1500ml + 20ml/kg for each kg >20kg

44
Q

Types of E. Coli

A 
Enterohemorrhagic
Enteroinvasive
Enteropathogenic
Enteroaggregative
Enterotoxigenic
45
Q

Most important type of E. coli

A

EHEC

46
Q

Toxin produced by EHEC

A

Verotoxin
O157
Identical to Shiga toxin

47
Q

What does the Shiga toxin do

A

Attaching effacing mechanism
Hemorrhagic colitis
HUS

48
Q

Food borne illnesses associated with preformed toxins

A

S aureus

B cereus

49
Q

Presentation of salmonella typhi

A

Rose spots
Abdominal pain
Fever
Malaise

50
Q

Complications of S typhi

A 
Hemorrhagic ulcerations of GIT
Myocarditis
Hepatic/bone marrow toxicity
Meningitis
Osteomyelitis
51
Q

Pathogenesis of typhoid

A

Ingested->penetrate mucus via PP in jejunum/ileum->intestinal LN->multiply in macrophages->mesenteric LN->thoraci duct->blood->organs->intestine= ++iflammation in PP, ulceration, intestinal perforation

52
Q

What food has HUS

A

Fast food burgers

53
Q

How does C jejuni present

A

Bloody diarrhea
fever
Abdominal cramps

54
Q

Reasons antibiotics are rarely indicated

A

Most commonly cause by viral
Can eradicate normal GIT flora->predisposing to C difficile
Prolong shedding of Salmonela and other bacterial diarrhea
EHEC w/ antibiotics may increase risk of HUS

55
Q

Causes of acute bloody diarrhea

A 
Campylobacter
EHEC
Entameoba histolytica
Salmonella
Shigella
56
Q

Indications to investigate

A 
fever, blood in stool
Severe abdominal pain, peritonism
Profuse diarrhea, signs of hypovolemia
Hospitalised, recent antibiotics
Age >65, comorbidities
Immunocompromised
Diarrhea >7 days
Exposure to suspicious food
Sexual contacts- MSM
57
Q

Indications to do stool OCP for Giardia, Cryptosporidium, E histolytica

A

Diarrhea >7 days
Exposure to untreated water
HIV
MSM

58
Q

Source and mode of transmission for 1. B cereus, 2. C jejuni, 3. C diff 4. EIEC 5. ETEC 6. EHEC 7. S typhi 8 S enteritis 9. Shigella 10. S aureus 11. Cholera 12. Yersinia

A
  1. rice, meats, vegetables, beans
  2. Uncooked meat
  3. Normal colon, antibiotics
    4/5. Contaminated water/food
  4. Hamburger, raw milk
  5. FO route, contaminated water, travel to endemic
  6. Contaminate food animal eggs, poultry, meat, milk
  7. FO, water
  8. Unrefrigerated meat, dairy, custard
  9. Water, shellfish
  10. Contaminated food, unpasteurised milk
59
Q

Which infections have short IP- within 24 hours

A

B cereus, C perfringens, S enteritis, S aureus

60
Q

Infections that present 1-3 days

A

EHEC, C jejuni, Shigella

61
Q

Presents at 5 days

A

Yersinia

62
Q

IP of 10-14 days

A

Salmonella typhi

63
Q

Which infection is associated with GBS

A

Campylobacter jejuni

64
Q

Complications of Shigella

A

Toxic megacolon

HUS

65
Q

What increases risk of toxic megacolon in Shigella

A

Antidiarrheals

66
Q

What can occur in Yersinia infection which may mimic appendicitis

A

Mesenteric adenitis and terminal ileus without diarrhea

67
Q

Parasites causing diarrhea

A

Cryptosporidium
Entamoeba histolytics
Giardia

68
Q

Risk factors for Giardia

A

Day care childre
Untreated water
MSM
Immunodeficiency

69
Q

What should be monitored with EHEC and why

A

Hb, platelet count, renal function as evidence of developing HUS

70
Q

Red flags in children which require SMO assessment

A

Short gut syndrome
Ileostomy
Complex/cyanotic heart disease
Renal transplant/insufficiency

71
Q

Monitoring rehydration

A 
Bare weight patient 6 hourly in moderate and severe, NGTR or IVF
Reassess early at 4-6 hours, then 8 hourly
Look for:
Weight change
Clinical signs of deH
Urine output
Ongoing losses
Signs of overload
Consider early feeding
72
Q

In what circumstances is medical review required before D/C

A

= 3 large stools during reH

Abdominal pain worsening

73
Q

Principles of early feeding

A

Stop any fortifications
Early feeding
If diarrhea ++ after initial refeeding consider hydrolysed formula temporarily

74
Q

Key points for parents

A
  1. Babies and young children w/ gastro can become deH very quickly, need small amounts of fluid regularly
  2. Babies 12-24 hours
  3. Give older children 1 cup of fluid for every big vomit/diarrhea
  4. Continue to give food to a hungry child, do not stop food for >24 hours
  5. Wash hands of child and family, was before and after nappy changes, feeding
  6. Keep away from child as much as possible until the diarrhea has settled
75
Q

Which antibiotic is typically associated with pseuomembranous colitis

A

Clindamycin

76
Q

If antibiotics indicated for diarrhea, most commonly used

A

Ciprofloxacin

General practice (26 decks)

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