Gastroenteritis

Question 1

What is acute gastritis

Answer 1

inflammation of the stomach and presents with nausea and vomiting

Question 2

What is gastroenteritis

Answer 2

inflammation all the way from the stomach to the intestines and presents with nausea, vomiting and diarrhoea.

Question 3

What is the most common cause of gastroenteritis

Answer 3

viral:

• Rotavirus
• Norovirus
• Adenovirus is a less common cause and presents with a more subacute diarrhoea

Question 4

What is E. Coli

Answer 4

• Not all strains cause gastroenteritis (some normal gut)

- spread through contact with infected faeces, unwashed salads or water

Question 5

Which strain of E.coli is dangerous

Answer 5

• E. coli 0157 produces the Shiga toxin
• abdominal cramps, bloody diarrhoea and vomiting
• Shiga toxin destroys blood cells and leads to haemolytic uraemic syndrome (HUS).

Question 6

Why do we avoid antibiotics in gastroenteritis, especially when e.coli suspected

Answer 6

antibiotics increases the risk of haemolytic uraemic syndrome

Question 7

What is Campylobacter Jejuni

Answer 7

• common cause of travellers diarrhoea
• most common bacterial cause of gastroenteritis worldwide
• a gram negative bacteria that is curved or spiral shaped.
• Incubation 2-5 days

Question 8

How is Campylobacter Jejuni spread

Answer 8

Raw or improperly cooked poultry
Untreated water
Unpasteurised milk

Question 9

What are the symptoms of Campylobacter Jejuni

Answer 9

Abdominal cramps
Diarrhoea often with blood
Vomiting
Fever

Question 10

When should you considered antibiotics in patients with campylobacter

Answer 10

• after isolating the organism where patients have severe symptoms or other risk factors such as HIV or heart failure.
• Popular antibiotic choices are azithromycin or ciprofloxacin.

Question 11

What is Shigella

Answer 11

• spread by faeces contaminating drinking water, swimming pools and food.
• incubation period is 1-2 days
• symptoms usually resolve within 1 week without treatment.

Question 12

Symptoms of Shigella

Answer 12

• bloody diarrhoea
• abdominal cramps
• fever
• can produce the Shiga toxin and cause haemolytic uraemic syndrome

Question 13

What is the treatment of Shigella

Answer 13

• Nil if not severe

- If severe, azithromycin or ciprofloxacin.

Question 14

What is Salmonella

Answer 14

• spread by eating raw eggs or poultry and food contaminated with infected faeces of small animals
• Incubation 12 hours - 3 days
• symptoms usually resolve within 1 week

Question 15

What are the symptoms of salmonella

Answer 15

• watery diarrhoea

- can be associated with mucus or blood, abdominal pain and vomiting.

Question 16

What is the management of salmonella

Answer 16

• Antibiotics are only necessary in severe cases and guided by stool culture and sensitivities.

Question 17

possible post-gastroenteritis complications

Answer 17

Lactose intolerance
Irritable bowel syndrome
Reactive arthritis
Guillain–Barré syndrome

Question 18

What is Bacillus Cereus

Answer 18

• gram positive rod that is spread through inadequately cooked food (fried rice) (occasionally IVDU)
• Whilst growing on the food it produces a toxin called cereulide

Question 19

Symptoms of Bacillis Cereus

Answer 19

• abdominal cramping and vomiting (5 hours)
• watery diarrhoea (>8 hours after ingestion.)
• All of the symptoms usually resolves within 24 hours.

Question 20

What is Yersinia Enterocolitica

Answer 20

• gram negative bacillus
• Incubation is 4-7 days
• symptoms lasting 3 weeks or more

Question 21

Causes of Yersinia Enterocolitica

Answer 21

• Pigs are key carriers of Yersinia (raw or undercooked pork)
• also spread through contamination with the urine or faeces of other mammal such as rat and rabbits.

Question 22

Symptoms of Yersinia Enterocolitica

Answer 22

• Children: watery or bloody diarrhoea, abdominal pain, fever and lymphadenopathy
• Adults: right sided abdominal pain due mesenteric lymphadenitis (inflammation in the intestinal lymph nodes) and fever which can give the impression of appendicitis.

Question 23

What is Staphylococcus Aureus Toxin

Answer 23

• The bacteria doesn’t cause the enteritis but the staphylococcus enterotoxin which causes the symptoms
• symptoms start within hours of ingestion and settle within 12-24 hours

Question 24

What are the symptoms of Staphylococcus Aureus Toxin

Answer 24

• diarrhoea
• perfuse vomiting
• abdominal cramps
• fever

Question 25

What is Giardiasis

Answer 25

• microscopic parasite: lives in the small intestines of mammals.
• may be pets, farmyard animals or humans
• releases cysts in the stools of infected mammals
• cysts then contaminate food or water and are eaten to infect a new host

Question 26

What is the presentation and management of giardiasus

Answer 26

• may not cause any symptoms or it may cause chronic diarrhoea.
• Diagnosis is made by stool microscopy
• Treatment is with metronidazole.

Question 27

Mangement of gastroenteritis

Answer 27

• Fluid challenge, if tolerate, consider outpatient mangement: Diarolylite vs iv fluids
• microscopy, culture and sensitivities
• Off school and work until symptoms resolved for 48 hrs
• Anti-diarrhoeal medications
• Anti-emetics

Question 28

When should you avoid anti-diarrhoeal medications

Answer 28

• e. coli 0157
• shigella infections
• bloody diarrhoea
• high fever.