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1. GI > Gastroenteritis > Flashcards

Gastroenteritis Flashcards

1
Q

What is the most common bacteria to cause Gastroenteritis?

A

Campylobacter

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2
Q

What is the most common bacteria to cause outbreaks of Gastroenteritis?

A

Salmonella

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3
Q

What is a rare cause of outbreaks of Gastroenteritis but one that can cause high morbitity?

A

E coli 0157

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4
Q

What is the most common management of Gastroenteritis?

A

supportive

no antibiotics

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5
Q

How is Gastroenteritis spread?

A

Faecal-oral transmission

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6
Q

What are the global causes of Gastroenteritis?

A 
Poor sanitation & hygiene
Commercialisation of food production
Import of food from other countries
Increase in day care/care home
International Travel
Acid suppression
Healthcare associated infections of GI tract
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7
Q

What can make a patient more susceptible to Gastroenteritis?

A

Malnutrition (micronutrient) deficiency
Closed/ semi-closed communities – cruises etc
Exposure to contaminated food/water /travel
Winter congregating/ summer floods
Age <5, not breastfeeding
Older age

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8
Q

What bacteria are people with acid supression more likely to contract?

A

C.diff

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9
Q

Describe how the bacteria acts in gastroenteritis?

A

adherence/attachment to the gastrointestinal mucosa
cellular invasion
production of exotoxins
changes in epithelial cell physiology
loss of brush border digestive enzymes, and/or cell death
increased intestinal motility, net fluid secretion, influx of inflammatory cells, and/or intestinal hemorrhage

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10
Q

What defines diarrhoea?

A

> 3 unformed stools/day

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11
Q

What is Dysentry gastroenteritis?

A

inflammation of the intestine, particularly the colon, causing diarrhea associated with blood and mucus

Caused by: Shigella, Campylobacter
generally associated with fever, abdominal pain, and rectal tenesmus (sense of incomplete defaecation)

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12
Q

How long does acute gastroenteritis last for?

A

under 2 weeks

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13
Q

What kitchen related things can cause gastroenteritis?

A 
cross contamination of raw &amp; cooked food
preparation food too far in advance
inadequate heating &amp; cooling
contaminated environment &amp; equipment
poor personal hygiene
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14
Q

What does cholera cause?

A

large volume diarrhoea

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15
Q

What bacteria require short incubation times? (1-6hrs)

A 
Staphylococcus aureus
- preformed toxin in food
Gram positive coccus
- Foods left at room temperature
Bacillus cereus
- Starchy foods
- Heat resistant spores (reheated rice)
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16
Q

What is the incubation period for E.coli?

A

3 - 8 days

uncooked beef, water, person to person contact, raw milk

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17
Q

Where is shigella bacteria often found?

A

Refugees
institutionalisation
military

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18
Q

What does shigella produce?

A

Shiga toxin

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19
Q

What does the shiga toxin do?

A

Binds to receptors found on renal cells, RBC & others

Inhibit protein synthesis

Causes cell death

20
Q

Which type of shiga toxin is more potent?

A

Type 2

21
Q

What is the development of Hematuria and renal failure (HUS) associated with?

A

primarily with serotypes that produce Shiga toxin 2

22
Q

What can shiga toxin produce?

A

E. coli O157

23
Q

What is the signs of E. coli O157 and what can cause it?

A

bloody diarrhoea (90%) /blood per rectum

very low infectious dose
food: beef (raw milk/water) but wide range
also person to person direct/indirect (11% of cases)
animal contact – petting zoos

24
Q

What can E. coli O157 also be called?

A

EHEC

25
Q

Describe EHEC?

A

incubation 1-14 days (7)
produces verotoxin (VTEC)
mild - severe (death)

bloody diarrhoea
haemorrhagic colitis

26
Q

Describe HUS?

A 
Abdo pain, fever, pallor, petechiae, oliguria (low urine output)
bloody diarrhoea in 90% of cases 
85% of HUS cases are under 16 years old
High white cells
Low platelets
Low HB
Red cell fragments
LDH>1.5 x normal
May develop after diarrhoea stopped
27
Q

What are the investigations for HUS?

A

Send stool culture samples: all patients with bloody faeces

Send U&E, FBC, film, LFT, clotting, urine, (dipstick/micro), lactate dehydrogenase

28
Q

What should be avoided in a pateint with suspected HUS?

A

NO antibiotics: may precipitate HUS
NO anti-motility agents
NO NSAIDS

29
Q

Name 4 other E. coli pathotypes?

A

enteroToxigenic(ETEC)
enteroPathogenic (EPEC)
enteroInvasive (EIEC)
enteroAggregative (EAIC)

30
Q

Describe enteroToxigenic(ETEC)?

A

Produces heat labile and heat stable toxin
Heat stable toxin similar to cholera and Yersinia toxins
Travel related

31
Q

Describe enteroPathogenic (EPEC)?

A

Attaching and effacing lesions. No toxin, not invasive
Synthesises, secretes and inserts its own receptor into cell membranes
Non breastfed children
Can be asymptomatic

32
Q

Describe enteroInvasive (EIEC)?

A

Watery diarrhoea, rare dysentery
Demonstrates invasion
Sereny test

33
Q

Describe enteroAggregative (EAIC)?

A

Travellers diarrhoea
New kid on the block
Cytogenic, secretogenic, proinflammatory

34
Q

What is the incubation time for Campylobactor?

A

16- 48 hrs incubation

35
Q

What is a possible treatment for Campylobactor?

A

macrolide - clarithromycin

36
Q

What is the most common Campylobactor pathogenic strain?

A

C jejunisubspeciesjejuni

37
Q

Why should HIV patients not keep reptiles?

A

they are full of salmonella – can end up with a bacteriemia

38
Q

Describe the incubation time, clinical signs and source of Salmonella?

A 
12-48 hr incubation 
D&amp;V, blood, fever
Food: poultry, meat, raw egg
animal gut, multiplies in food
toxin and invasion
39
Q

Where can Listeria monocytogenes come from?

A

delicatessens

Unpasteurised milk products

40
Q

What is the danger with Listeria monocytogenes?

A

Can cause child mortality if passed on from mother to child in utero

41
Q

What are the clinical signs of Listeria monocytogenes?

A

Fever
muscle aches
diarrhoea

42
Q

What is the treatment for Rotavirus and Norovirus?

A

supportive treatment

43
Q

What is the investigation done to diagnose Rotavirus and Norovirus?

A

PCR
Rota - on feaces
Noro - on vomit

44
Q

What are the features of Rotavirus?

A 
Commonest cause in kids <3 yrs 
~ all kids get it before 5
person-person Faecal oral
Direct &amp; indirect
usually in the winter
Subclinical or mild in adults
Immunocompromised? can be severe
May have moderate fever first, vomiting then diarrhoea
Lasts a week
45
Q

What does the rotavirus affect?

A

absorption & secretion in bowel

46
Q

What are the features of Norovirus?

A

‘Winter Vomiting Disease’- lately all year round!
affect all ages: HIGHLY infectious
5 billion viruses per gram of faeces
faecal-oral/droplet routes of spread
person to person (or on contaminated food/water)

47
Q

What is the key management for Noro and Rota viruses?

A

hydration

1. GI (61 decks)

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