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Gastroenteritis Flashcards

1
Q

Toxin Mediated Food Poisoning

A

Onset 1-6 hours after exposure
Diarrhoea >few hours, ado pain and fever
Resolves in 6-10 hours
Can be a significant problem in the elderly with co-morbidities

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2
Q

Non-Infectious Causes of Diarrhoea

A 
GI bleed
Ischaemic gut 
Diverticulitis
Endocrine disorders 
Numerous drugs
Fish toxins
Withdrawal
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3
Q

Presenting Clinical Syndromes of Food Poisoning

A

Acute Enteritis = D&V, fever, abdominal pain
Acute Colitis = Bloody diarrhoea, fever, abdominal pain
Enteric Fever like Illness = Fever, rigors, abdominal pain, little diarrhoea

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4
Q

Most Common Causes of Bloody Diarrhoea

A

Infection - campylobacter, shigella, E.Coli O157, amoebiasis
IBD
Malignancy
Ischaemia

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5
Q

Guillain-Barre Syndrome

A

40% of cases preceded by campylobacter
Tingling feet, then progressive paralysis of legs, arms and body
Poss. associated with autoimmune response

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6
Q

Appearance on Abdominal X-Ray

A

Thumbprinting Colitis

Dilated Bowel

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7
Q

Typhoid Carrier

A

Imported
Food or water
Human carrier

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8
Q

Typhoid Presentation

A

Enteric Fever Like Illness:
Asymptomatic
Mild bacteraemia
Enterocolitis

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9
Q

Typhoid Diagnosis

A

BLOOD CULTURES

Stool and urine cultures

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10
Q

Typhoid Treatment

A

Ciprofloxacin or chloramphenicol (resistance)

Azithromycin or ceftriaxone

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11
Q

Key Features of History Taking

A

Diarrhoea = frequency, nocturnal diarrhoea, colour and consistency, blood
Associated Symptoms = abdo pain, vomiting, fever
Family members/colleagues with similar symptoms
Occupation
Pets and animal contact
Travel abroad
Medications = recent antibiotics, PPIs

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12
Q

Key Features of Examination

A 
Fever 
Skin rashes
Dehydration signs 
Abdominal tendernes, distension
RECTAL EXAM
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13
Q

Investigations

A 
Stool microscopy (parasites)
Stool culture (bacteria)
Stool toxin (C.diff)
Blood cultures (salmonella)
PCR (viral)
FBC (WCC for severity of CDI)
U&Es 
AXR
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14
Q

Assessing Severity

A 
Co-morbidities 
Fever 
Rigors 
Shock 
Blood in stools
Abdo pain
Number of stools/24 hours
Colonic dilatation
Lab results: WCC, renal function
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15
Q

Assessing Severity of C.diff Infection

A

Pseudomembranous colitis, toxic megacolon or ileus/colonic dilatation
WCC >15
Creatinine >1.5x baseline
Persisting symptomatic CDI despite two treatments

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16
Q

Complications of Bacterial Enteritis - Intestinal

A

Severe dehydration and renal failure
Acute colitis, toxic dilatation
Post infective irritable bowel (v common, lasts 4-6 weeks)
Transient secondary lactase intolerance

17
Q

Complications of Bacterial Enteritis - Extra Intestinal

A 
Bacteraemia leading to sepsis +/- metastatic infection 
Reactive arthritis 
Meningism 
Neurological (GB syndrome)
Haemolytic uraemic syndrome
18
Q

Treatment of Gastroenteritis

A 
Antibiotics are generally not indicated
Oral rehydration (or IV fluids if needed)
?Anti-spasmodics, Anti-motility drugs (avoid in elderly/young)
19
Q

Indications for Antibiotics

A 
Enteric fever (TYPHOID)
Shigellosis (non sonnei species)
Sometimes enterotoxigenic E.coli
Cholera
C.diff diarrhoea 
Giardiasis 
Ameobiasis 
Invasive salmonellosis
20
Q

C.diff - Pathogenesis

A

Broad spectrum antibiotics kill normal gut flora
C.diff forms spores which are resistant
Destruction of normal flora allows C.diff to dominate and multiply

21
Q

C.diff - Host Risk Factors

A 
Over 65
Immunosuppression
PPI use
Hospitalisation, long term care facilities 
Previous CDI
22
Q

C.diff - Prevention

A

Isolation and treatment of symptomatic patients
Reduction in use of broad spectrum, 4 C antibiotics
Treatment of asymptomatic carriers

23
Q

C.diff - At Risk Patients for Recurrence

A 
Elderly 
Antibiotics after initial CDI treatment
Prolonged hospitalisation of stay in LTCF
Defective immune response to toxin A
Gastric acid suppression
24
Q

C.diff - Drivers

A 
Broad spectrum antibiotic therapy
4 Cs 
Long duration of therapy
Vulnerable population
Route of therapy makes no difference
Total amount of antibiotic use 
Antibiotics in absence of infection
25
Q

Treatment of Traveler’s Diarrhoea

A

Grin and bear it
~93 hour illness
Early symptomatic treatment = single dose ciprofloxacin and anti-diarrhoeals

26
Q

Amoebiasis

A

Protozoal infection
May mimic acute colitis - acute bloody diarrhoea
Amoebic liver abscesses can occur if spread to bloodstream
Diagnosis = examination of hot stool, serology
Treatment = metronidazole

27
Q

Giardiasis

A

Protozoal infection
Symptoms = diarrhoea (often explosive and foul smelling) and malabsorption
Spread via cysts in water
Diagnosis = examination of stool, duodenal aspiration
Treatment = metronidazole

28
Q

Cryptosporidiosis

A 
Transmission = water, food, animal contact
Clinical = self limiting, more common in immunosuppressed 
Diagnosis = duodenal aspirate, examination of stool
Treatment = supportive

GI (24 decks)

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