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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
Management of severe dehydrationq
``` 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 ```
26
What mechanism used in ORS
Glucose facilitated sodium transport in small intestine
27
Current ORS available
Gastrolyte Na 60 K 20 Cl 60 Citrate 10 Glucose 90 Replayte Hydralyte
28
Suitable fluids for non dehydrated
Sugar water (1 teaspoon in 200ml) Fruit juice 1 in 6 with water Cordial 1 in 16 Lemonade 1 in 6
29
Why is early refeeding following rehydration important
Enhances mucosal recovery | Reduces duration of diarrhea
30
What can children have after rehydration
Complex carbohydrates, yoghurt, fruits, vegetables
31
One possibility if persistent diarrhea following recommencement of feeding
Transient lactose intolerance
32
Indication for admission to hospital
``` 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
High risk for dehydration
4/24 hours | Observe for 4-6 hours to ensure maintenance of hydrations
34
High risk infants for dehydration
Ileostomy, short gut, CHD, chronic renal disease, metabolic disorders, malnutirtions
35
When would biochemistry tests be required in children
History of prolonged diarrhea with severe dehydration Altered conscious state Convulsions Short bowel syndrome, ileostomy, Cardiac/renal, metabolic disorders Infants
36
Complications in children
Hypernatremic dehydration | Hyponatremic dehydration
37
How much should sodium levels fall by
No more than 0.5mmol/L per hour
38
General Advice to parents treating mil/moderate at home
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
Advice to parents for mild/moderate dehydration on Day 1, 2 and 3, day 4
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
Maintenance for 1-3 months, 4-12months, 12 months >
1-3 month 120ml/kg/hr 4-12 month 100ml >12 month 80ml
41
Calculating total
Maintenance + fluid loss
42
Calculate fluid loss
%body weight loss X body weight X 10
43
Daily maintenance IV fluid based on weight | 3-10kg, 10-20kg, >20kg
3-10= 100ml/kg/day 10-20- 1000ml + 50ml/kg for each kg >10kg >20- 1500ml + 20ml/kg for each kg >20kg
44
Types of E. Coli
``` Enterohemorrhagic Enteroinvasive Enteropathogenic Enteroaggregative Enterotoxigenic ```
45
Most important type of E. coli
EHEC
46
Toxin produced by EHEC
Verotoxin O157 Identical to Shiga toxin
47
What does the Shiga toxin do
Attaching effacing mechanism Hemorrhagic colitis HUS
48
Food borne illnesses associated with preformed toxins
S aureus | B cereus
49
Presentation of salmonella typhi
Rose spots Abdominal pain Fever Malaise
50
Complications of S typhi
``` Hemorrhagic ulcerations of GIT Myocarditis Hepatic/bone marrow toxicity Meningitis Osteomyelitis ```
51
Pathogenesis of typhoid
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
What food has HUS
Fast food burgers
53
How does C jejuni present
Bloody diarrhea fever Abdominal cramps
54
Reasons antibiotics are rarely indicated
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
Causes of acute bloody diarrhea
``` Campylobacter EHEC Entameoba histolytica Salmonella Shigella ```
56
Indications to investigate
``` 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
Indications to do stool OCP for Giardia, Cryptosporidium, E histolytica
Diarrhea >7 days Exposure to untreated water HIV MSM
58
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
1. rice, meats, vegetables, beans 2. Uncooked meat 3. Normal colon, antibiotics 4/5. Contaminated water/food 6. Hamburger, raw milk 7. FO route, contaminated water, travel to endemic 8. Contaminate food animal eggs, poultry, meat, milk 9. FO, water 10. Unrefrigerated meat, dairy, custard 11. Water, shellfish 12. Contaminated food, unpasteurised milk
59
Which infections have short IP- within 24 hours
B cereus, C perfringens, S enteritis, S aureus
60
Infections that present 1-3 days
EHEC, C jejuni, Shigella
61
Presents at 5 days
Yersinia
62
IP of 10-14 days
Salmonella typhi
63
Which infection is associated with GBS
Campylobacter jejuni
64
Complications of Shigella
Toxic megacolon | HUS
65
What increases risk of toxic megacolon in Shigella
Antidiarrheals
66
What can occur in Yersinia infection which may mimic appendicitis
Mesenteric adenitis and terminal ileus without diarrhea
67
Parasites causing diarrhea
Cryptosporidium Entamoeba histolytics Giardia
68
Risk factors for Giardia
Day care childre Untreated water MSM Immunodeficiency
69
What should be monitored with EHEC and why
Hb, platelet count, renal function as evidence of developing HUS
70
Red flags in children which require SMO assessment
Short gut syndrome Ileostomy Complex/cyanotic heart disease Renal transplant/insufficiency
71
Monitoring rehydration
``` 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
In what circumstances is medical review required before D/C
= 3 large stools during reH | Abdominal pain worsening
73
Principles of early feeding
Stop any fortifications Early feeding If diarrhea ++ after initial refeeding consider hydrolysed formula temporarily
74
Key points for parents
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
Which antibiotic is typically associated with pseuomembranous colitis
Clindamycin
76
If antibiotics indicated for diarrhea, most commonly used
Ciprofloxacin

General practice (26 decks)

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