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Gastrointestinal RT > Gastroenteritis > Flashcards

Gastroenteritis Flashcards

1
Q

what are the main GI symptoms of gastroenteritis?

A

fever, diarrhoea, abdominal pain, vomiting

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2
Q

what can pathogenic bacteria in the gut do?

A
  1. invasion of tissue

2. toxin production

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3
Q

what is the commonest bacteria that causes food poisoning?

A

campylobacter

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4
Q

what is the species of E coli which is pathogenic and causes food poisoning outbreaks?

A

E coli 0157

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5
Q

what 2 common causative pathogens of infective gastroenteritis have short incubation periods of 1-6 hours?

A

staph aureus

bacillus cereus

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6
Q

what 2 common causative pathogens of infective gastroenteritis have medium incubation periods of 12-48 hours?

A

salmonella

c. perfringens

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7
Q

what 2 common causative pathogens of infective gastroenteritis have long incubation periods of 2-14 days?

A

campylobacter

E coli 0157

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8
Q

out of staph aures, bacillus cerueus, salmonella, clostridium perfringens, campylobacter and E coli 0157, which are the bacteria which cause bloody stools?

A

salmonella
c perfringens
campylobacter
E. coli 0157

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9
Q

on average, how long does it take to culture bacteria in the lab?

A

48 hours

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10
Q

what type of food can campylobacter be found in?

A

poultry

raw milk

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11
Q

what type of food can salmonella be found in?

A

poultry, meat, raw egg

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12
Q

what are the antigens on the body of a bacteria called?

A

O antigens

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13
Q

what are the antigens on the flagella of a bacteria called?

A

H antigens

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14
Q

what toxin does E coli 0157 produce?

A

verotoxin

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15
Q

what fatal condition can the verotoxin of E coli 0157 cause if it gets in the blood stream?

A

haemolytic uraemic syndrome

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16
Q

what is the presentation of haemolytic uraemic syndrome?

A 
abdominal pain
fever
pallor
oliguria
petechiae (purple spots)
blood diarrhoea
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17
Q

what is petechiae caused by?

A

small haemorrhages of the blood cessels

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18
Q

if a patient has bloody faeces what must you do?

A

send a stool culture sapmle

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19
Q

what 3 drugs must be avoided in haemolytic uraemic syndrome and so must be avoided?

A

antibiotics
anti-motility agents
NSAIDs

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20
Q

who does rotavirus affect?

A

children less than 3 years old

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21
Q

how is rotavirus spread?

A

faecal-oral

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22
Q

what are the symptoms of rotavirus?

A

moderate fever
vomiting
diarrhoea (not bloody)

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23
Q

how do you treat rotavirus?

A

self-limiting, lasts a week

hydration

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24
Q

what type of vaccine is the rotavirus vaccine?

A

oral vaccine, live attenuated

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25
Q

when are the rotavirus vaccines given?

A

2 doses at 2/3 months old

no dose given to babies over 24 weeks old

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26
Q

who does noravirus affect?

A

all ages

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27
Q

how does noravirus spread?

A

faecal-oral

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28
Q

how do you diagnose norovirus?

A

PCR on stool

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29
Q

what is the incubation period for norovirus?

A

2-4 days

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30
Q

how do you treat nora virus?

A

self limiting

hydration

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31
Q

what is C dif the result of?

A

disruption of normal flora

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32
Q

when requesting a stool culture what do all stools automatically get tested for?

A 
salmonella
shigella
campylobacter
E coli 0157
cryptosporidium
C dif (if over 15 y/o)
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33
Q

how is C dif spread?

A

faecal-oral

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34
Q

what is gastroenteritis?

A

inflammation of stomach or intestines

infective or non-infective cause

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35
Q

why does gastroenteritis cause diarrhoea?

A

inhibitis nutrient absorption and excessive water and electrolye loss

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36
Q

compare the toxic production of staph aureus/ clostrium perfringens/ bacillius cereus to E coli toxic production?

A

staph aureus/ C perfringens/ bacillus cereus- preformed toxin
E col- toxin produce in vivo

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37
Q

what are the symptoms of acute enteritis?

A

fever
diarrhoea
vomiting
abdominal pain

38
Q

what are the symptoms of acute colitis?

A

fever
abdominal pain
bloody diarrhoea

39
Q

what are the symptoms of enteric fever like illness?

A

fever
rigors
abdominal pain
only little diarrhoea and then constipation

40
Q

what are the 4 main causes of bloody diarrhoea?

A
  • infection (that’s caused colitis)
  • IBD
  • malignancy
  • ishaemia
41
Q

what is Guillain-Barre syndrome?

A

a rare but serious condition where the immune system attacks the peripheral nervous system
-can occur after viral/bacterial trigger

42
Q

what pathogenic bacteria, known to cause food-poisoning, is Guillain-Barre syndrome highly associated with?

A

campylobacter infection

43
Q

what is the main symptom of Guillain-Barre syndrome?

A

tingling of the feet leads to progressive paralysis of the arms, legs and rest of the body

44
Q

what does thumb printing show on an abdominal xray?

A

inflammatory/infective bowel condition

45
Q

what investigations can be done for suspected gastroenteritis?

A 
stool culture
stool toxin
stool PCR
stool microscopy
blood cultures
serology
FBC
U+Es
AXR
46
Q

what are the 4 severity markers of C. dif infection?

A

(1+ indicates severity)

  • temperature above 38.5
  • suspicion of pseudomembranous colitis or toxic megacolon or ileus or colonic dilation in AXR above 6cm
  • WCC above 15cells x 10^9
  • creatinine above1.5x baseline
47
Q

what are the 4 main intestinal complications of bacterial enteritis?

A

severe dehydration + renal failure
acute colitis, toxic dilation
post infective irritable bowel
transient secondary lactose intolerance

48
Q

what are the 6 main extra-intestinal complications of bacterial enteritis?

A 
septicaemia
metastatic infection
reactive arthritis
meningism
neurological problems (Guillian Barre extre)
HUS
49
Q

what is the treatment for acute gastroenteritis?

A

supportive:

oral rehydration and IV fluids

50
Q

what are the 3 classes of antidiarrhoeal agents?

A

antimotility agents
antisecretory agents
absorbents

51
Q

when should you avoid antimotility agents such as opiates and loperamide?

A 
dysenteric symptoms
(fever, bloody diarrhoea, abdominal pain)
52
Q

what is the empirical antibiotic treatment for gastroenteritis if the patient is high risk or has dysenteric symptoms?

A

ciprofloxacin 500mg BD for 3-5 days

after you have done a stool sample for culture

53
Q

what patients are high risk in terms of gastroenteritis complications?

A

immunocompromised
hypochlorhydria
IBD
prosthetic intravascular device

54
Q

what is hypochlorhdyria?

A

a condition where the stomach isn’t able to produce enough HCl

55
Q

what are the main risk factors for C. dif? (apart from antibiotics)

A 
PPI
H2-receptor antagonists
65 years old+
chemotherapy
chronic renal disease
IBD
56
Q

what antibiotics do you give to a patient with pseudomembranous colitis? (C. dif tested positive)

A

oral metronidazole (if non-severe)

oral vancomycin (if sever or failure of metronidazole)

57
Q

what can you give for traveller’s diarrhoea?

A

early symptomatic treatment:

single dose ciprofloxacin + short term anti-diarrhoeals

58
Q

what type of infection is amoebiasis?

A

a protozoal infection

59
Q

how is amoebiasis spread?

A

faecal-oral route

60
Q

what antibiotic is used in the treatment of amoebiasis?

A

metronidazole

61
Q

how is giardiasis spread?

A

cysts n normal drinking water

62
Q

what is the treatment of cryptosporidiosis?

A

supportive

antimicrobials are ineffective

63
Q

how is intestinal amoebiasis diagnosed?

A

stool microscopy and culture

64
Q

how is extra-intestinal amoebiasis diagnosed?

A

serology

65
Q

what is the definition of acute travellers diarrhoea?

A

3 loose stools in 24 hours

66
Q

what is the most common cause of travellers diarrhoa?

A

E. coli

67
Q

what is the treatment for acute travellers diarrhoea?

A

supportive (fluid rehydration)
bloody diarrhoea with systemic upset may warrant treatment:
single dose ciprofloxacin

68
Q

what is enteric fever causes by?

A

salmonella typhi or paratyphi

69
Q

if a patient has sever sepsis with enteric fever what is the treatment?

A

IV ceftriaxone

ciproflacin is quicker at clearance but organisms are less likely to be sensitive

70
Q

what are the infective causes of pre-hepatic jaundice?

A

malaria

HUS (complication of diarrhoeal illness- E coli -157, shigella)

71
Q

what is the life cycle of intestinal nematodes? (round worms)

A
  1. egg ingested
  2. hatch in small intestine
  3. invade gut wall into venous system
  4. reach lungs and break into alveoli
  5. ascend tracheobronchial tree
  6. swallowed
  7. reach gut and develop into adult worms
72
Q

what is the length of presenting complaints for protozoan infections?

A

much longer than bacterial infection

73
Q

what are the 3 main local symptoms of inta-abdominal infection?

A

pain
tenderness
constipation or diarrhoea

74
Q

what are the 7 main systemic symptoms of intra-abdominal infection?

A 
fever
rigors/chills
nausea
vomiting
anorexia
malaise
lethargy
75
Q

what are the 5 major causes for SIRS? (systemic inflammatory response syndrome)

A 
infection
trauma
burns
pancreatitis
other inflammatory processes
76
Q

what is severe sepsis?

A

acute organ dysfunction secondary to sesis

77
Q

what is the sepsis 6 protocol?

A 
Take:
blood cultures
full blood count and lactate
measure urine output
Give:
fluids
antibiotics
oxygen
78
Q

what are the 3 main community acquired bacteraemia causes?

A

Escherichia coli (and other coliforms)
Stephylococcus aureus
Streptococcus pyogenes

79
Q

what are the 6 main hospital acquired bacteraemia causes?

A 
E coli (and other coliforms(
Staph. aureus
Coagulase negative Staph
Enterococcus spp
Pseudomonas aeurignosa
Candida spp
80
Q

what are coliforms?

A

large, aerobic, gram negative rods which inhabit the large bowel

81
Q

what is the normal flora of the mouth?

A 
strep viridans
neisseria sp
anaerobes
candida sp
staylococci
82
Q

what is the normal flora of the stomach/duodenum?

A

usually sterile

few candida and staphylocci

83
Q

what is the normal flora of the bile ducts?

A

usually sterile

84
Q

what is the normal flora of the jejunum?

A

small numbers of coliforms and anaerobes

85
Q

what is the normal flora of the colon? (‘faecal flora’)

A

large numbers of coliformes
anaerobes
enterococcus faecalis

86
Q

what antibiotics are used for an intra-abdominal infection?

if patient isnt allergic to penicillin

A

IV amoxicillin + metronidaxole + gentamicin
then step down to
PO co-trimoxazole + metronidazole
(7-10 days)

87
Q

what antibiotics are used for an intra-abdominal infection? (if patient is allergic to penicillin)

A

IV vancomycin + metronidazole + gentamicin
then step fown to
PO co-trimoxazole + metronidazole
(7-10 days)

88
Q

when giving amoxicillin for an intra-abdominal infection what organisms is this antibiotic targetting?

A

enterococci

89
Q

when giving gentamicin for an intra-abdominal infection what organisms is this antibiotic targetting?

A

coliforms

90
Q

when giving metronidazole for an intra-abdominal infection what organisms is this antibiotics targetting?

A

anaerobes

91
Q

what is septic shock?

A

severe sepsis with hypotension refractory to adequate volume resuscitation or requiring vasopressors or inotropes

Gastrointestinal RT (15 decks)

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