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LC Gastroenterology Week 5 > Gastroenteritis > Flashcards

Gastroenteritis Flashcards

1
Q

What is acute diarrhoea?

A

sudden onset and lasts less than 2 weeks
90% are infectious
10% are caused by medications, toxin ingestions and ischaemia

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2
Q

What is chronic diarrhoea?

A

Diarrhoea which lasts for more than 4 weeks

Most of the causes are non-infectious

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3
Q

What is persistent diarrhoea?

A

Diarrhoea lasting between 2-4 weeks

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4
Q

What might cause acute diarrhoea?

A 
Viral, bacterial, protozoa, medications
Laxatives or diuretic abuse 
Ingestion of environmental preferomed toxin such as seafood
Ischemic colitis
Graft verus host
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5
Q

What might cause chronic diarrhoea?

A 
IBS
Diverticular disease 
colorectal cancer 
Bowel resection 
Malabsorption 
IBD
Coeliac disease 
Carcinoid tumour
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6
Q

What is gastroenteritis?

A

Inflammation of the lining of the stomach, small and large intestine

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7
Q

What is acute gastroenteritis common in?

A

Young children and elderly, and those who are immunocompromised.

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8
Q

What are most causes of gastroenteritis?

A

Most are infectious (90%), some acute may follow ingestion of drugs and chemical toxins (10%)

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9
Q

What are the causative pathogens of gastroenteritis?

A

Bacteria
Viral
Protozoa

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10
Q

What specific viral organisms can cause gastroenteritis?

A

Rotovirus
Norovirus
Adenovirus

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11
Q

What specific protozoa can cause gastroenteritis?

A

Entamoeba histolytica
Cryptosporidium
Giardia intestinalis
Schistosomiasis

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12
Q

What specific bacterial organisms can cause gastroenteritis?

A 
Campylobacter jejunei**
Salmonella sp.
Shigella
Escherichia coli**
Clostridium difficile**
Staphylococcal enterocolitis
Bacillus cereus
Clostridium perfringens
Clostridium botulinum
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13
Q

What are the different mechanisms by which enteric pathogens can cause diarrhoea?

A
  1. stimulation of net fluid and electrolyte secretion
  2. Increased propulsive muscle contractions
  3. Mucosal destruction and increased permeability
  4. Nutrient alabsorption
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14
Q

What is enteric pathogen?

A

Pathogens of the intestine - may also refer to the gut flora

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15
Q

Describe toxin mediated food poisoning?

A 
Differentiation from acute toxin mediated 
Food poisoning 
Pre formed staph.A
Onset 1-6 hours after exposure 
Diarrhoea and adobe pain 
Resolves in 6-10 houes 
No blood or pus in faeces
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16
Q

What is the most common cause of travellers diarrhoea?

A

Enterotoxigenic E.Coli

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17
Q

what does enterotoxigenic E.coli produce?

A

Enterotoxins - increase intracellular levels of cAMP

Causes cell leakage

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18
Q

What is the major reservoir for human infection?

A

Cattle

(deer, sheep, goats, horses, dogs, birds, flies)

Bacterial can survive in manure and water troughs

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19
Q

What symptoms can E.Coli 015:H7 give you?

A

Adobe cramps

diarrhoea +/- blood

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20
Q

Where might you get E.Coli from?

A

Beef, raw milk

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21
Q

Where are you likely to get salmonella from?

A

Poultry, raw eggs, meat

22
Q

What is the most common cause of food poisoning?

A

Campylobacter

23
Q

Describe campylobacter in more detail?

A

Poultry, raw milk
Blood bowel movements, abdo pain
(can mimic appendicitis)

24
Q

How would you treat severe campylobacter?

A

Clarithromycin or azithromycin

25
Q

What might diarrhoea from the small bowel and colon present like?

A 
Large volume stool 
Moderate increase in number 
Minimal urgency 
No tenesmus 
Little mucus
26
Q

What might diarrhoea from the recto-sigmoid present like?

A 
Small amount of stool
Frequency 
Urgency 
Tenesmus 
Mucus 
Blood
27
Q

Describe enteric fever like illness?

A

Fever
Systemically unwell
Abdo pain
Constipation but possibly short history of diarrhoea

28
Q

Describe typhoid?

A

Almost always imposed (far eat)

Food and water or carrier

29
Q

How does typhoid present?

A

Asymptomatic, mild, bacteramia, enterocolitis

30
Q

What would you do to diagnose typhoid?

A

Blood cultures

Stool and urine cultures

31
Q

What are the 3 different presenting clinical syndrome of food poisoning?

A

Acute enteritis : fever. D&V, abdominal pain

Acute colitis: fever, pain, bloody diarrhoea

Enteric fever like illness : fever, rigors, pain but little diarrhoea

32
Q

What are some complications of bacterial enteritis - intestinal?

A

Severe dehydration and renal failure
Acute colitis, toxic dilatation
Post infective irritable bowel (very common)
Transient secondary lactase intolerance

33
Q

What are some complications of bacterial enteritis - extra-intestinal?

A 
Bacteriaemia leading to sepsis +/_
metastatic infection: meningitis, aortitis. Ostyeomyelitis, endocarditis
Reactive arthritis
Meningism
Neurological [Guillian Barre syndrome] 
Haemolytic uraemic syndrome
Others
34
Q

What type of organism is C.diff?

A

Anaerobic gram positive spore forming bacillus

35
Q

What are the 4 antibiotic Cā€™s that should be reduced at all costs?

A

Cephalosporins
Clindamycin
Co-Amoxiclav
Cirpofloxacin

36
Q

What are the main drivers for CDI?

A

A. BROAD SPECTRUM ANTBIOTIC THERAPY

B. SPECIFIC ANTIBIOTIC TYPES E.G QUINOLONES, CEPHALOSPORINS

C. LONG DURATION OF THERAPY

VULENRABLE POPULATION E.G ELDERLY, NURSING HOME, CO-MORBIDITIES, HOSPITALISED

E. ROUTE OF THERAPY MAKES NO DIFFERENCE

F. TOTAL AMOUNT OF ANTIBIOTIC USE ā€“ number of exposures

G. GIVING ANTIBIOTIC IN THE ABSENCE OF INFECTION

37
Q

What are 4 different types of travel related diarrhoea?

A

ETEC (E.Coli)
AMOEBIASIS
GIARDIASIS
CRYPTOSPORIDIOSIS

38
Q

What is the average duration of travellers diarrhoea?

A

Around 4 days

39
Q

Describe what amoebiasis is?

A

It is a protozoal infection spread by the feacal-oral route or by an ill or asymptomatic carrier

It is common in areas of poor sanitation

40
Q

What symptoms might you get with amoebiasis?

A

Acute bloody diarrhoea

extra-intestinal spread can produce abscess

41
Q

What is the treatment of amoebiasis?

A

Metronidazole

42
Q

What is giardia lamblia?

A

Flagellated protozoan infection of the duodenum and proximal jejunum

Cysts found in water and food

43
Q

What is the spread of giardia lamblia?

A

Person to person infection

Intestinal parasite

44
Q

What are the symptoms of giardia lamblia?

A

Acute infectious diarrhoea, no mucus or blood

Malabsorption due to diarrhoea

45
Q

How might you diagnose giardia lamblia?

A

Stool analysis/duodenal aspirate

46
Q

How would you treat giardia lamblia?

A

Metronidazole

47
Q

What is Cryptosporidiosis?

A

Travel related diarrhoea

48
Q

How is Cryptosporidiosis spread?

A

Water food contract with animals

It is highly infectious

49
Q

What might be the symptoms of Cryptosporidiosis?

A

Diarrhoea

Self limiting

50
Q

How would you diagnose Cryptosporidiosis?

A

Duodenal aspirate/stool

51
Q

How would you treat Cryptosporidiosis?

A

Supportive

Antimicrobials are virtually ineffective

LC Gastroenterology Week 5 (10 decks)

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