Gastroenteritis Flashcards
Define Gastroenteritis
Gastroenteritis is the term used to describe a condition in which there is diarrhoea +/- vomiting from an infectious origin
Give some common viral causes of gastroenteritis
Norovirus, Rotavirus and Adenovirus
Give some bacterial causes of gastroenteritis
Campylobacter, E.coli, Salmonella and Shigella
Give some parasitic causes of gastroenteritis
Cryptosporidium, Entamoeba and Giardia
How do you assess patients with gastroenteritis?
A to E assessment
Stabilise before any further assessment
Treat dehydration early
Rule out any severe abdominal pathology
Give the organism:
Bloody diarrhoea with fever and cramps
Incubation period = 8-24 hours
Salmonella
Give the organism:
Predominantly vomiting, with watery diarrhoea
Incubation period 12-48 hours
Norovirus
Give the organism:
Diarrhoea in young children
Incubation period = 1-7 days
Rotavirus
Give the organism:
Profuse watery bloody diarrhoea with fever and cramps
Incubation period = 2-5 days
Campylobacter
Give the organism:
Usually mild self-limiting diarrhoea for less than 72 hours
Incubation period = 12-72 hours
E. Coli
Give the organism:
Acute watery diarrhoea that may be accompanied by mucus, pus or blood. Fever and abdominal pain.
Incubation period = 2-3 days
Shigella
Give the organism:
Diarrhoea following antibiotics
Incubation period = 1-7 days
C. difficile
Give the organism:
Profuse watery diarrhoea without abdominal pain or fever
Incubation period = 2-5 days
Cholera
Give the organism:
HIV/ immunocompromised, prolonged diarrhoea
Incubation period = 4-12 days
Cryptosporidium
Give the organism:
Prolonged diarrhoea
Incubation period = 1-4 weeks
Giardia
What is the important condition associated with VTEC E.Coli? (and explain the features of the condition)
Haemolytic uraemic syndrome
Characterised by AKI, haemolytic anaemia and thrombocytopaenia
How should a patient be managed with infective diarrhoea that has no systemic signs, is not immunocompromised and has not had any recent travel?
The patient should receive symptomatic treatment
A stool culture is not needed
How should a patient be managed with infective diarrhoea that is systemically unwell?
Hospital admission
IV fluids and empirical Abx (ciprofloxacin) should be given
Stool culture is required
What is routinely looked for on a stool culture?
Campylobacter, E.Coli, Salmonella, Shigella and Cryptosporidium
If another organism is suspected it must be requested
If polymorphs are seen on direct faecal smear what does this indicate?
Shigella, Campylobacter or E.coli
If no polymorphs are seen on direct faecal smear what does this indicate?
Salmonella, E.coli or C.difficile
If the patient has severe diarrhoea and dehydration what blood tests should be performed?
FBC, U&Es, CRP/ESR, LFTs
If very severe = ABG
If there is evidence of electrolyte imbalance what should be done?
An ECG
How should patients with diarrhoea be managed?
- 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
Why is symptomatic management not recommended in all cases?
It slows the clearance of the pathogen
What can be given for symptomatic relief of diarrhoea?
- Prochlorperazine 12.5mg QDS PRN
- Loperamide 2mg after each loose stool (max 16mg/ 24hr)
- Codeine phosphate 30mg TDS
What is given in traveller’s diarrhoea?
Ciprofloxacin 500mg BD for 3/7
or Azithromycin 500mg BD for 3/7
These can also be used for prophylaxis
In parasitic infections what antibiotic is most effective?
Metronidazole
When are antibiotics given?
- Immunocompromised
- Severe/ prolonged infection
What type of organism is C. difficile?
Gram positive rod
Who commonly gets C.diff infections?
In patients treated with broad spectrum Abx
Give some common antibiotics that lead to C.diff infections
Clindamycin and Meropenem
How is C.diff identified?
C.diff toxin (A+B toxins) are identified on stool analysis
How should a patient with a C.diff infection be managed?
- 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
What can be considered if antibiotic therapy is ineffective?
Foecal transplantation
What is a potential complication of C.diff? and what can it lead to?
Pseudomembranous colitis
If severe can cause toxic megacolon and bowel perforation
How can pseudomembranous colitis be identified?
Flexi sig would show yellow adherent plaques on an inflamed mucosa
What should be done if patients with C.diff develop abdo distension?
ABG (to check lactate)
and AXR
Urgent colectomy may be required
