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Gastroenterology > Gastroenteritis > Flashcards

Gastroenteritis Flashcards

1
Q

Define Gastroenteritis

A

Gastroenteritis is the term used to describe a condition in which there is diarrhoea +/- vomiting from an infectious origin

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2
Q

Give some common viral causes of gastroenteritis

A

Norovirus, Rotavirus and Adenovirus

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3
Q

Give some bacterial causes of gastroenteritis

A

Campylobacter, E.coli, Salmonella and Shigella

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4
Q

Give some parasitic causes of gastroenteritis

A

Cryptosporidium, Entamoeba and Giardia

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5
Q

How do you assess patients with gastroenteritis?

A

A to E assessment
Stabilise before any further assessment

Treat dehydration early

Rule out any severe abdominal pathology

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6
Q

Give the organism:
Bloody diarrhoea with fever and cramps
Incubation period = 8-24 hours

A

Salmonella

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7
Q

Give the organism:
Predominantly vomiting, with watery diarrhoea
Incubation period 12-48 hours

A

Norovirus

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8
Q

Give the organism:
Diarrhoea in young children
Incubation period = 1-7 days

A

Rotavirus

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9
Q

Give the organism:
Profuse watery bloody diarrhoea with fever and cramps
Incubation period = 2-5 days

A

Campylobacter

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10
Q

Give the organism:
Usually mild self-limiting diarrhoea for less than 72 hours
Incubation period = 12-72 hours

A

E. Coli

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11
Q

Give the organism:
Acute watery diarrhoea that may be accompanied by mucus, pus or blood. Fever and abdominal pain.
Incubation period = 2-3 days

A

Shigella

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12
Q

Give the organism:
Diarrhoea following antibiotics
Incubation period = 1-7 days

A

C. difficile

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13
Q

Give the organism:
Profuse watery diarrhoea without abdominal pain or fever
Incubation period = 2-5 days

A

Cholera

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14
Q

Give the organism:
HIV/ immunocompromised, prolonged diarrhoea
Incubation period = 4-12 days

A

Cryptosporidium

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15
Q

Give the organism:
Prolonged diarrhoea
Incubation period = 1-4 weeks

A

Giardia

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16
Q

What is the important condition associated with VTEC E.Coli? (and explain the features of the condition)

A

Haemolytic uraemic syndrome

Characterised by AKI, haemolytic anaemia and thrombocytopaenia

17
Q

How should a patient be managed with infective diarrhoea that has no systemic signs, is not immunocompromised and has not had any recent travel?

A

The patient should receive symptomatic treatment

A stool culture is not needed

18
Q

How should a patient be managed with infective diarrhoea that is systemically unwell?

A

Hospital admission

IV fluids and empirical Abx (ciprofloxacin) should be given

Stool culture is required

19
Q

What is routinely looked for on a stool culture?

A

Campylobacter, E.Coli, Salmonella, Shigella and Cryptosporidium

If another organism is suspected it must be requested

20
Q

If polymorphs are seen on direct faecal smear what does this indicate?

A

Shigella, Campylobacter or E.coli

21
Q

If no polymorphs are seen on direct faecal smear what does this indicate?

A

Salmonella, E.coli or C.difficile

22
Q

If the patient has severe diarrhoea and dehydration what blood tests should be performed?

A

FBC, U&Es, CRP/ESR, LFTs

If very severe = ABG

23
Q

If there is evidence of electrolyte imbalance what should be done?

A

An ECG

24
Q

How should patients with diarrhoea be managed?

A
  • Isolated in a side room
  • Consultant of infectious diseases notified
  • Barrier nursing
  • Hydration with oral/ IV fluids

If severe Sxs:
- Prochlorperazine or loperamide or codeine phosphate

In some cases of infectious diarrhoea:
- Abx

25
Q

Why is symptomatic management not recommended in all cases?

A

It slows the clearance of the pathogen

26
Q

What can be given for symptomatic relief of diarrhoea?

A
  • Prochlorperazine 12.5mg QDS PRN
  • Loperamide 2mg after each loose stool (max 16mg/ 24hr)
  • Codeine phosphate 30mg TDS
27
Q

What is given in traveller’s diarrhoea?

A

Ciprofloxacin 500mg BD for 3/7
or Azithromycin 500mg BD for 3/7

These can also be used for prophylaxis

28
Q

In parasitic infections what antibiotic is most effective?

A

Metronidazole

29
Q

When are antibiotics given?

A
  • Immunocompromised

- Severe/ prolonged infection

30
Q

What type of organism is C. difficile?

A

Gram positive rod

31
Q

Who commonly gets C.diff infections?

A

In patients treated with broad spectrum Abx

32
Q

Give some common antibiotics that lead to C.diff infections

A

Clindamycin and Meropenem

33
Q

How is C.diff identified?

A

C.diff toxin (A+B toxins) are identified on stool analysis

34
Q

How should a patient with a C.diff infection be managed?

A
  • Isolate the patient in a side room and introduce barrier nursing

Moderate disease:
- Metronidazole PO 500mg TDS for 10/7

Severe disease:
- Vancomycin PO 125mg QDS for 10/7

35
Q

What can be considered if antibiotic therapy is ineffective?

A

Foecal transplantation

36
Q

What is a potential complication of C.diff? and what can it lead to?

A

Pseudomembranous colitis

If severe can cause toxic megacolon and bowel perforation

37
Q

How can pseudomembranous colitis be identified?

A

Flexi sig would show yellow adherent plaques on an inflamed mucosa

38
Q

What should be done if patients with C.diff develop abdo distension?

A

ABG (to check lactate)
and AXR

Urgent colectomy may be required

Gastroenterology (5 decks)

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