Gastroenteritis Flashcards
Name some bacterial that cause dysentery:
Shigella Dysenteriae
Campylobacter Jejuni
Hemorrhagic E.Coli
Yersina Enterocolitia
How is norovirus diagnosed?
PCR of stool
- reverse transcriptase
What is an important factor of norovirus with regard to further transmission/ being infective?
Even once the patient is asymptomatic, they still shed the virus in the stool.
What diet is often recommended for people with gastroenteritis?
BRAT
- Banna
- Rice
- Applejuice
- Toast
Name three main ways a person can get Salmonella poisoning? Name some complications of salmonella poisoning:
Undercooked Chicken or eggs (salmonella is heat sensitive)
Faecal oral transmission
Animals - reptiles
Complications:
- bacteraemia
- osteomyelitis
- septic arthritis
List some risk factors for C.Diff infection:
Recent hospital admission
Recent use of antibiotics
>65 years
Immunosuppressed
Cephalosporins
Clindamycin
Ciprofloxacin
Co-amoxiclav
What investigations should be done in suspected C. Diff?
Stool culture
Immunoassay for Glutamate dehydrogenase which is a common antigen seen on all strains of C.Diff.
Toxin immunoassay
What is the management for C.Diff?
Isolation
Hygiene practice
Protective clothing
Moderate: Metronidazole PO
Severe: Vancomycin PO
Non responders: HIgh dose vancomycin + metronidazole IV.
Recurrence: Vancomycin + faecal transplant`
If someone has an infectious cause of diarrhea that is persistent and non bloody - what are possible organisms? and how would you test for them?
Giardia
Cryptosporidium
Ova samples over 3 separate days
If someone has an infectious cause of diarrhea that is persistent and bloody - what are possible organisms? and how would you test for them?
Entamoeba Histolytica
- severe abdominal pain
- fever
Ova Samples over 3 separate days
What bacterial infection can mimic the symptoms of appendicitis, inducing mesenteric lymphadenopathy?
Yersinia Enterocolitica
Symptoms can last up to 3 weeks
How is campylobacter and Shigella infections treated if severe?
ciprofloxacin
How does bacillus cereus present symptomatically?
produces a toxin called cereulide;
within 5 hours of ingestion it produces:
- cramping abdominal pain + profuse vomiting
~8 hours later as it reaches intestines it produces severe diarrhoea.
symptoms usually resolve after 24 hours.
How is Giardiasis treated?
Metronidazole
When should anti - diarrhoea medication be avoided?
In bloody diarrhoea and fever
What are some differentials for chronic diarrhea?
Giardia
UC
Crohn’s
Celiac disease
IBS
laxative use
Hyperthyroidism
What are some non-infective causes of diarrhoea?
IBD
Bowel cancer
Thyrotoxicosis
Laxative use
Chronic pancreatitis
Celiac disease
Ischemic bowel
What are the symptom of enteric fever?
Systemic upset
Relative Bradycardia
Abdominal pain
Constipation** characteristic finding
Rose spots
What are some complications of enteric fever?
Osteomyelitis
G.I perforation
Meningitis
What investigations should be done into diarrhoea?
Bloods:
- FBC
- U&Es
- CRP
- LFTs
- tTG/ Anti -EMAs/ Anti DGP
Orifices:
- Stool cultures
- C.Diff toxin
- faecal elastase
- Ova/ cysts
- calprotectin
Xray:
- AXR
E
S:
- flexible sigmoidoscope
- colonoscopy
What are some Different pathogens for watery diarrhea?
Toxigenic E.Coli
Cholera Vibrio
Clostridium perfringens
Bacillus Cereus
Garidais infection
Norovirus
Rotavirus
What are some differentials for watery diarrhea?
Gastroenteritis infection
Coeliac disease
IBS
Crohn’s
Laxative use
Serotonin Syndrome
Over flow diarrhea
- constipation
How is cholera tested for?
Dipstick testing - picks up serovars 0139 in stool
Darkfield microscopy of stool
What fluids should be given to patients with Cholera and Why?
additionally, what substance can be given to children which can shorten duration?
WHO Hypo-osmolar formulation
- contains 75Na and 20 K+ (high amount)
Added with water.
If IV is needed:
Hartman’s/ Ringer’s lactate
- because patient’s have usually lost a lot of K+
Zinc lessens severity and time
What is a potentially fatal type of Clostridium perfringens?
Beta toxin from C. Perfringens Type C
Causes:
Clostridium Necrolysis enterocolitis
If antibiotics are to be given for Cholera what should be used?
Ciprofloxacin
What are the symptoms of enteric fever/ typhoid fever?
Fever headache Myalgia Relative Bradycardia Constipation Diarrhoea (in children)
Rose spots
Splenomegaly
Cough
Epistaxis
What are some of the complications of Enteric fever?
Septic shock
Bowel perforation
Meningitis
Cholecystitis
What is the management for Enteric fever?
Antipyretics
IV fluids
Ciprofloxacin + Ceftriaxone
if non responding:
- Azithromycin
How is enteric fever investigated?
Blood cultures
Stool samples
Bloods:
- leucopenia
- Dehydration
- deranged LFTs
What are the signs of peritonism?
Involuntary guarding
Rigid abdomen
Fever
Tachycardia
Ileus
Which of the gastroenteritis diseases is most associated with guillain barre syndrome?
Campylobacter jejuni
Why should antimotility drugs not be given to Shigella infections?
Risk of toxic megacolon
What investigations should be done into C.Diff?
Bloods:
- FBC
- CRP
- U&Es
- Blood cultures
Orifices:
- Stool cultures
- Immunoassay for C.Diff toxin A and B
- Immunoassay for glutamate dehydrogenase
X-rays:
- ABX - toxic megacolon
What are the complications of C.Diff?
Ileus
Toxic Megacolon
Perforation
Pseudomembranous
What are the diarrhoeas associated with traveling?
E.Coli - Enterotoxigenic Salmonella typhi/ paratyphi Entamoeba HIstolytica Giardia Lamblia Strongyloides Stercoralis
How does Entamoeba histolytica present?
1-4 weeks intubation
Dysentery Excessive wind Tenemus RUQ pain Swinging fevers
*treat with metronidazole
Which two infections are likely to early onset vomiting, followed by diarrhoea?
Staph Aureus
Bacillus Cereus
What infection is associated with soft cheese and refridged items?
Listeria monocytogenes
How does yersinia Enterocolitica present?
Fever
Diarrhoea
Mesenteric adenitis
Erythema nodosum
Which Gastroenteritis infections present with fever?
One’s that are invasive as they stimulate the innate immune system
- part from E.Coli 0157
Contrast Invasive and non-invasive gastroenteritis?
Non- invasive
- No fever
- Toxin mediated
- No leukocyte in stool
- Confined to lumen
How does the Shiga toxin cause its pathology?
Binds to 60S ribosomes inducing cellular death
What severe infection can cause paralysis?
Clostridium Botulism
causes D&V
this is followed by:
- cranial nerve palsies
- ascending weakness
Needs ventilator support and anti-toxins
High mortality
Which invasive gastroenteritis does not cause a fever?
E.Coli 0157
Complication of dysentery?
Sepsis
Severe dehydration
- AKI
Electrolyte abnormalities
- hypokalemia
- Metabolic acidosis
What are the symptoms of HUS following Ecoli 0157 infection?
Pallor - anaemia
Jaundice
Septic picture
