Gastroenteritis Flashcards
What is gastroenteritis?
This is inflammation of the stomach or intestines which inhibits nutrient absorption and excessive water and electrolyte loss
What can gastroenteritis be caused by?
Bacteria, virus, parasites or poisoning by microbial toxins
What is the most common cause of gastroenteritis?
Infection
How do patients present with food poisoning?
Fever
Abdominal pain
Diarrhoea
PR bleeding in some cases
what can cause toxin mediated food poisoning?
staph. aureus, bacillus cereus or enterotoxigenic E. Coli
Is there blood or pus in the faeces of a patient with toxin mediated food poisoning?
No - usually not
What can Arizonan turtles cause?
Salmonella
Give examples of resivoirs for salmonella
reptiles, eggs and undercooked poultry
What are the causes of non-infectious diarrhoea?
Fish toxins Endocrine disorders Withdrawl Diverticulitis Ischemic gut Numerous drugs GI bleed
What symptoms are caused by the norovirus?
Abrupt nausea, vomiting, diarrhoea, cramps, myalgia
what is myalgia?
Pain in a muscle or a group of muscles
What are the presenting complains in a patient with acute enteritis?
fever, diarrhoea, vomiting and abdominal pain
What are the presenting complains in a patient with acute colitis?
fever, pain, bloody diarrhoea
What are the presenting complains in a patient with enteric fever?
fever, rigors and pain - perhaps a little diarrhoea
what does bloody diarrhoea suggest?
Infection - usually colonic inflammation
what kind of bacteria can cause bloody diarrhoea?
Campylobacter, shigella spp or E. coli
what can campylobacter mimic?
appendicitis
name an important complication to remember of campylobacter
Guillain-Barre syndrome
what can be used to treat campylobacter?
if severe treat with clarithromycin and azithromycin
what is Guillain-Barre syndrome?
Autoimmune response - leads to tingling of the feet and progressive paralysis of the legs, arms then rest of the body
what are the symptoms of enteric fever like illness?
fever, systemic illness, abdominal pain and constipation - may have short history of diarrhoea
Give an example of an enteric fever?
typhoid fever
how does typhoid fever present?
Asymptomatic, mild, bacteraemia, enterocolitis
How is typhoid fever diagnosed?
blood, stool and urine cultures
What is used to treat typhoid fever?
Usually azithromycin - in Asia there is a resistance to chloramphenicol and ciprofloxacin
what is important when taking a drug history?
To find out if they have been on recent antibiotics or PPIs
what investigations can be ordered for gastroenteritis?
Stool microscopy Stool culture Stool toxin - for C diff Blood cultures - Salmonella PCR FBC AXR
what are the severity markers for CDI?
Suspicion of pseudomembranous colitis/toxic megacolon/colonic dilatation
increased WCC
Increased Creatinine
CDI symptoms despite 2 treatments
What are the complications of bacterial enteritis intestinal?
Severe dehydration and renal failure
Acute colitis, toxic dilatation
Post infective irritable bowel
Transient secondary lactase intolerance
What are the complications of bacterial enteritis extra-intestinal?
Bacteriaemia leading to sepsis metastatic infection: meningitis, aortitis, Ostyeomyelitis, endocarditis Reactive arthritis Meningism Neurological Haemolytic uraemic syndrome
what are the objectives of antibiotic treatment?
treat invasive disease
reduce severity of symptoms
eradicate faecal excretion
what is the treatment for gastroenteritis?
Oral rehydration - IV fluids
Anti-spasmodics
Anti-motility (short term)
what are risk factors for gastroenteritis?
age
immunosuppression
PPI use
Hospitalisation
Key factors to the treatment of C. Difficile?
treat according to severity
reduce acute complications
reduce likelihood of recurrence
which patients are more at risk of C. Diff?
Elderly Antibiotic treatment Prolonged hospitalisation Defective immune response to toxin A Gastric acid suppression
what are the drivers for C. Difficile infections?
Broad spectrum antibiotic therapy certain antibiotic types long duration of therapy total amount of antibiotic use vulnerable groups
How should patients with vomiting and diarrhoea be managed?
oral rehydration
what should be avoided in patients with vomiting and diarrhoea?
anti-motility agents
what can cause travel related diarrhoea?
amoebiasis
giardiasis
cryptosporidiosis
how should traveller’s diarrhoea be treated?
treat symptomatically
ciprofloxacin
short term anti-diarrhoeals
what is amoebiasis?
Protozoal infection spread by faeco-oral route or by an ill or asymptomatic carrier
how can amoebiasis be diagnosed?
examination of hot stool for ova and cycsts
Amoebic serology
what may occur during amoebiasis?
an amoebic liver abscess may form
how does giardiasis spread?
by cysts found in normal drinking water
how is giardiasis diagnosed?
examination of stools for ova and cysts
duodenal aspiration
How is giardiasis treated?
Metronidazole
how is Cryptosporidiosis
transmitted?
water, food, contact with animals - highly infectious
how is Cryptosporidiosis
diagnosed?
duodenal aspirate
How is Cryptosporidiosis
treated?
supportive - nitizoxamide can be used
