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Gastroenteritis Flashcards

1
Q

What is Gastroentertitis?

A

It is the inflammation of the stomach and intestine
Most common cause of acute GI infection

caused by viral,bacterial and parasitic infection

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2
Q

What are the main symptoms of Gastroenteritis?

A

Diarrhoea (+/-) vomiting ( main)

abdominal pain and fever

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3
Q

What is acute diarrhea?

A

more than 3 or more episodes of unformed stools a day for less than 2 weeks

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4
Q

What is dysentery?

A

Infectious gastroenteritis with blood/mucus diarrhoea

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5
Q

What is traveller’s diarrhoea?

A

passage of three or more unformed stools per day during ,or shortly after foreign travel

Mainly occurs in young people and from those in developed countries travelling in developing countries

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6
Q

What’s the difference between type 1 and type 7 stools on the bristol stool chart?

A

Type 1 - separate hard lumps

Type 7- watery no solid pieces

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7
Q

Large volume of diarrhea suggest?

A

its origin is from small bowel

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8
Q

What is persistent diarrhoea?

A

acutely started diarrhoea lasting more than 2 weeks

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9
Q

What are 2 common bacteria which cause gastroenteritis and have short incubation periods?

ii. what type of bacteria are they?

A

Bacillus cereus- gram positive

Staphylococcus aureus- gram positive

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10
Q

What is the most common cause of gastroenteritis?

A

Viral infection

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11
Q

Give examples of Infective causes of gastroenteritis?

diarrhoea without blood

A

main viruses

Norovirus

Rotavirus

Main Bacteria

Bacillus cereus

staphylococcus aureus

cholera

Enterotoxigenic/enteropathogenic E coli

Clostridium perfringens

Main parasites

Giardia

cryptospordium

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12
Q

What are the main infective causes of dysentery?

A

common Virus

CMV

common bacteria

Shigella

salmonella

campylobacter

E coli O 157 (EHEC)

costridium difficile

common parasites

Whipworm ( trichuriasis)

amoeba
Entamoebic histolytica ( amoebic dysentery)
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13
Q

What type of virus is Norovirus?

A

single stranded RNA virus

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14
Q

How does norovirus transmitt?

A

Faecal oral transmission

aerosol transmission

transmission allows for people to people

common sources: food,water and fomites (objects- little kids put them in there mouth)

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15
Q

What are the signs and symptoms of norovirus?

A

Vomiting ( explosive and sudden! may be only symptom)

watery diarrhoea ( explosive and sudden!)

abdominal cramps

Nausea

headaches

short incubation ( less than 24 hours)

Vomiting more prevalent in children

diarrhoea more prevalent in adults

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16
Q

You can shed norovirus even if asymptomatic true or false?

A

true

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17
Q

How do you diagnose norovirus?

A

Stool sample or vomit swab for reverse transcriptase PCR

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18
Q

How do you treat Norovirus?

A

Usually is self limiting 2-4 days

oral rehydration solution

prevention: good hygiene and food preparation

Isolation may be required

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19
Q

What type of virus is rotavirus?

A

Double stranded RNA virus

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20
Q

Which age group does it mainly affect?

A

kids under age of 5 - most common cause in the world for gastroenteritis in this age group

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21
Q

What are the signs and symptoms of Rotavirus?

A

Watery diarrhoea

vomiting

fever

abdominal pain

symptoms are usually mild or absent in adults

bottle fed babies more likely to be symptomatic than breast fed

severe in immunocompromised children

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22
Q

How does rotavirus transmitt?

A

person-person

faecal oral

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23
Q

How do you diagnose rotavirus?

A

ELISA/PCR for stool antigens and vomit swab

histology

jejunal mucosa in children shows shortening of the villi with crypt hyperplasia

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24
Q

How do you manage rotavirus?

A

usually self limiting - 1 week

Oral rehydration therapy and sometimes IV fluid

Vaccines are now used - both are live vaccines ( Rotarix and rotateq) routine rotarvirus vaccination

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25
Q

What time of year does it mainly become effective?

A

winter months in non tropical areas

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26
Q

What are the main risk factors for 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
immunosuppression
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27
Q

What are the three main forms of mechanisms for bacteria to cause diarrhoea?

A

mucosal adherence- sometimes is a prelude only to the other two forms
( watery diarrhoea)
enteropathogenic/aggregative E.coli

diffusely adhering E.coli

mucosal invasion- penetration of the intestinal mucosa invasins disrupt host cell cytoskeleton.

Shigella
campylobacter

(dysentery)

toxin production:

Enterotoxins: induce excessive fluid secretion into bowel lumen.
(watery diarrhoea)

salmonella

campylobacter

Bacillus cereus

cholera

cytotoxins- damage intestinal mucosa

(dysentery)

E coli O157

salmonella

campylobacter

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28
Q

What should all bacteria stools check for?

A

Shigella.
E Coli 0157.
Campylobacter
Cryptosporidium

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29
Q

How does B cereus transmitt?

A

mainly through spores which germinate in semi cooked rice which is stored in warm temperatures before eaten

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30
Q

What are the symptoms of B cereus?

A

vomiting diarrhoea

nausea

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31
Q

Where does staphylococcus aureus originate from?

A

uncooked food

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32
Q

What are the symptoms of staphylococcus aureus?

A

violent vomiting (main)

profuse watery diarrhoea

rapid symptoms 2-4 hours

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33
Q

What type of bacteria is Enterotoxigenic E coli

A

gram negative anaerobic bacteria

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34
Q

what is the pathophysiology

A

Has heat labile and heat stable enterotoxins which stimulate secretion of fluid into the intestinal lumen

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35
Q

What types of diarrhoea does it cause?

A

Major cause of travellers’ diarrhoea

also causes infective diarrhoea

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36
Q

What are the signs and symptoms of enterotoxigenic E.coli

A

watery diarrhoea

cramps and nausea

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37
Q

How does enterotoxigenic E.coli transmit?

A

Person to person via contaminated food and water

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38
Q

How do you diagnose Enterotoxigenic E.coli?

A

stool culture for PCR

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39
Q

How do you manage Enterotoxigenic E.coli?

A

self limiting- 1-4 days

oral rehydration therapy

antimotility agents (Loperamide)- avoid if severe pain or bloody diarrhoea as may indicate invasive colitis

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40
Q

What type of bacteria is cholera?

A

gram negative aerobic bacteria

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41
Q

How does cholera transmit?

A

faecal oral route

faecal contaminated water main factor

found in asia

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42
Q

What are the signs and symptoms of cholera?

A

watery diarrhoea (rice-water stool)

vomiting

dehydration ( sunken eyes, hollow cheeks and a diminished urine output)

metabolic acidosis

circulatory collapse

Hypovolaemic shock

most are mild symptoms

can be asymptomatic

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43
Q

How do you diagnose cholera

A

stool culture ( serovars 01 or 139 will be present)

rapid dipstick test

death due to dehydration from watery diarrhoea and under the age of 5

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44
Q

How do you manage cholera?

A

Oral rehydration therapy ( salts)

IV therapy if severe

Antibiotics: doxycycline or tetracycline to decrease diarrhoea or ciprofloxacin

prevention: mainly clean water

good hygiene

oral cholera vaccines

zinc shortens illness in children

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45
Q

What type of bacteria is shigella?

A

Gram negative anaerobic bacteria

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46
Q

How does shigella transmit?

A

poor hygiene

person to person

more common in developing world and in children

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47
Q

What are the signs and symptoms of shigella?

A

occur after 1-2 days since infection
Dysentery

Pain

tenesmus

fever

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48
Q

what are the species responsible for shigella?

A

S. dysenteriae

s. flexneri
s. boydii
s. sonnei

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49
Q

How do you diagnose shigella

A

stool culture

PCR/enzyme immunoassay

50
Q

How do you manage shigella?

A

Usually self limiting

ORS

Antibiotics used only if systemically unwell or immunosuppressed due to resistance

Ciprofloxacin 500 mg twice daily or ampicillin and azithromycin

Nutrition:

Green bananas- increase short-chain fatty acids in colon

vitamin A

zinc if younger than 6

Avoid antidiarrheal agents- increase risk of toxic dilation

51
Q

What are the complications of shigella?

A

bacteraemia

reactive arthritis

HUS

52
Q

What type of bacteria is Shiga Toxin producing E.coli (STEC)

A

Gram negative anaerobe

53
Q

give an example of STEC?

A

E.coli O157

54
Q

What is the pathophysiology of E.coli O157?

A

produces verotoxins which are shigella which affects endothelial cells in the gut and kidney. Irreversibly inhibit protein synthesis

55
Q

What age group is mainly affected by E coli O157?

A

children and elderly

and immunocompromised

56
Q

How does E coli O157 transmit?

A

contaminated food and livestock

57
Q

What are the signs and symptoms of E coli 0157

A

Diarrhoea ( bloody)

Hemorrhagic colitis

Abdominal pain

Nausea

HUS ( haemolytic uraemic syndrome)

thrombotic thrombocytopenic

58
Q

How do you diagnose E coli O157

A

stool culture

PCR

59
Q

How do you treat E coli O157

A

Supportive ( ORS and potentially IV fluid balance)

don’t give antibiotics, NSAIDs or antimotility agents as increase risk of HUS

60
Q

How do you diagnose Staphylococcus aureus?

A

Culture of organism in vomit or remaining food

61
Q

How long does it take to recover from staphylococcus aureus?

A

less than 24 hours

62
Q

How do you diagnose Bacillus cereus?

A

Culture of organism in faeces and food

Reheated rice!!!

63
Q

How long does it take to recover from Bacillus cereus?

A

6-24 hours

can die from fulminant hepatic failure

64
Q

What type of bacteria is salmonella enteritidis?

A

Bacillus gram negative anaerobe

65
Q

How does salmonella transmit?

A

contaminated foodstuffs ( poultry,meat,raw eggs) and water

66
Q

What are the signs and symptoms of salmonella?

A

diarrhoea (bloody)
Vomiting
fever
cramps

usually between 12-36 hours after

invasive infections of salmonella can cause:
sepsis
meningitis
osteomyelitis

children and elderly risk of dehydration

67
Q

What are the antigens found on the lipopolysaccharide /body( LPS) of a bacteria?

A

O antigens

68
Q

What are the antigens found on the flagellum of the bacteria?

A

H antigens

69
Q

How do you diagnose salmonella?

A

Stool culture - can serogroup salmonella based on O antigens

PCR

70
Q

How do you manage salmonella?

A

Supportive care

usually self limits after 3-6 days

may have stool issues for several weeks though

71
Q

What type of bacteria is campylobacter

A

gram negative spiral shaped rod

72
Q

What part of the body can salmonella and campylobacter both effect?

A

small and large bowel

73
Q

salmonella is the most common cause of gastroenteritis true or false?

A

false- its campylobacter

74
Q

How does campylobacter transmit?

A

comes from undercooked meat ( especially beef burgers and chicken)

contaminated milk and water

less likely to spread human to human

75
Q

What are the signs and symptoms of campylobacter?

A

incubation 2-5 days

Bloody or watery diarrhoea

pain fever

headache

severe abdominal cramps

76
Q

what diseases are associated with campylobacter?

A

Guillain Barre syndrome

Bacteraemia

hepatitis

pancreatitis

77
Q

How do you diagnose campylobacter?

A

Stool culture

PCR/enzyme immunoassay

78
Q

what is the main symptom of Guillain-Barre syndrome?

A

tingling of the feet leads to progressive paralysis of the arms, legs and rest of the body

79
Q

How do you manage campylobacter jejuni?

A

self limiting 3-5 days

supportive care mainly

can give antibiotics (azithromycin)- if symptoms severe

80
Q

what is clostridium difficile

A

Gram positive bacillus anaerobic

81
Q

Where can clostridium difficile be found?

A

part of colonic flora

82
Q

What is the pathophysiology of clostridium difficile?

A

Production of enterotoxins A and B cause symptoms

antibiotic exposure inhibits colonic flora allowing for it to grow rapidly

faecal oral spread

83
Q

What are the signs and symptoms of clostridium difficile

A

watery diarrhoea

abdominal pain

mild to fulminant colitis ( pseudomembranous colitis)

ileus - lack of motility

toxic megacolon

84
Q

What are the risk factors of clostridium difficile

A

Age

surgery

prolonged stay at hospital- considered hospital superbug

Drugs: mainly antibiotics- clindamycin, co amoxiclav and quinolones ( ciprofloxacin )

85
Q

How do you diagnose c.difficile?

A

Markers of severity include:

Temperature higher than 38.5

raised white cell count >15x 10^9

raised serum creatine

raised serum lactate

severe abdominal pain

Detection of A or B toxins in stool culture with PCR

ELISA if stool antigen is positive

sigmoidoscopy for pseudomembranous colitis

Abdominal x ray for toxic megacolon

86
Q

How do you manage c.difficile?

A
  1. for mild or moderate disease: metronidazole 400 mg three times daily

for severe or relapsing cases: Oral vancomycin 125-500 mg four times daily or fidaxomicin

  1. in relapsing cases faecal transplant can restore normal bowel

Prevention

Think ‘SIGHT’

Suspect

Isolate within 2 hours

Gloves and aprons

Hygiene ( clean surfaces and wash hands etc)

Test immediately

87
Q

What are the signs and symptoms of HUS?

haemolytic uraemic syndrome

A

Microangiopathic haemolytic anaemia

Acute kidney injury- caused by thrombosis of glomerular capillaries from microangiopathy

Bloody diarrhoea

Abdominal pain

fever

pallor

petechiae (tiny red spots on skin look like bruises)

oliguria

88
Q

which age group is HUS mainly associated with?

A

children ( 85% of cases under age of 16)

89
Q

How do you diagnose HUS?

A

Increase in LDH

high WBC

detection of RBC fragments in blood film

decrease in Platelets

decrease in haemoglobin

evidence of E coli O157 (STEC)

signs of AKI - proteinuria

90
Q

How do you manage HUS

A

No NSAIDs, antibiotics or antimotility agents- all increase risk of precipitating HUS

mainly supportive care

91
Q

what does thumb printing show on an abdominal xray?

A

inflammatory/infective bowel condition

92
Q

what are the 3 classes of antidiarrhoeal agents?

A

antimotility agents
antisecretory agents
absorbents

93
Q

when should you avoid antimotility agents such as opiates and loperamide?

A 
dysenteric symptoms
(fever, bloody diarrhoea, abdominal pain)
94
Q

when giving metronidazole for an intra-abdominal infection what organisms is this antibiotics targetting?

A

anaerobes

95
Q

What is Giardis lamblia?

A

Flagellate protozoa which causes Giardiasis- a cause for parasitic Gastroenteritis in the small intestine

96
Q

How does Giardiasis spread?

ii how does it exist?

A

faecal oral route

infected drinking water/food and fomites

ii.exists as either cyst or a trophozoite ( cyst form is how it transmits)

person to person may occur in nurseries and residential institutions

97
Q

what are the signs and symptoms of giardisasis

A

mainly asymptomatic

symptoms form between 1-3 weeks after ingesting cysts

diarrhoea

malabsorption

Bloating

flatulence

abdominal discomfort

nausea

potentially weight loss

98
Q

What is Giardiasis mainly associated with?

A

travellers diarrhoea- most common parasitic cause in travellers returning to UK

99
Q

What can chronic giardiasis cause?

A

growth retardation in children- common in developing countries

100
Q

How do you diagnose giardiasis?

A

stool microscopy for cysts and trophozoites- need more than 3 samples due to intermittent shedding allowing to increase sensitivity

Endoscope for giardiasis which is found in duodenal aspirate

or duodenal aspirate fluid analysis

101
Q

How do you manage giardiasis?

A
  1. Hygiene to prevent transmission
  2. metronidazole- single dose on three successive days

or

tinidazole

or

albendazole– less side effects while also treating other parasites

102
Q

What is amoebiasis caused by?

A

entamoeba histolytica

103
Q

How does amoebiasis spread?

A

faecal oral pathway

source: water
form: cysts and trophozoites

104
Q

What are the signs and symptoms

A

asymptomatic in luminal amoebiasis (90%)

intestinal - dysentery ,headache, nausea,pain,colitis, appendicitis, toxic megacolon formation of ameboma (inflammatory abdominal mass)

extra intestinal- high swinging Fever, liver abscess (rare) , RUQ pain and hepatomegaly

105
Q

How do you diagnose Amoebiasis?

A

stool microscopy of cysts and trophozoites via sigmoidoscopy

biopsy sample

amoebic antibody detection in extraintestinal disease (especially with liver abscess)

PCR can distinguish E. histolytica

AXR for toxic mega colon

potentially abnormal LFT

106
Q

How do you manage amoebiasis?

A

Metronidazole or tinidazole

luminal agent such as diloxanide furoate should be used

107
Q

What is enteric fever?

A

primarily a tropical disease it is. an acute systemic illness

108
Q

What are the two main types of enteric fever

A

typhoid- salmonella typhi

paratyphoid- salmonella paratyphi

109
Q

How does typhoid spread?

A

faecal oral

from contaminated food or water

110
Q

What are the signs and symptoms of typhoid?

A

diarrhoea

fever

headache

abdominal pain

abdominal tenderness

hepatosplenomegaly

maculopapular rash ( rose spots)

111
Q

What are the complications of typhoid?

A

intestinal haemorrhage

meningitis

lobar pneumonia

112
Q

How do you diagnose enteric fever?

A

blood culture is usually positive in first two weeks of both bacteria

113
Q

How do you manage typhoid?

A

quinolones ( ciprofloxacin)

if resistant to quinolone then ceftriaxone

114
Q

How do you diagnose acute traveller’s diarrhoea?

A

Stool culture

check stool for amoebic trophozoites( mainly) and cysts

115
Q

How do you treat acute traveller’s diarrhoea?

A

Supportive- fluid rehydration

treat systemic issues

fluoroquinolone ( ciprofloxacine) if travelling

116
Q

When examining a returned traveller what should you look for?

A

fever ( could be anything from pneumonia to arboviruses) - not just traveller’s diarrhoea

rash

hepatosplenomegaly

lymphadenopathy

insect bites

wounds

117
Q

where are helminth infections associated with?

A

eosinophilia

118
Q

give example of Helminths.

A

Nematodes (roundworms)

trematodes (flukes)

cestodes. ( tapeworm)

119
Q

How are Helminths often diagnosed?

A

eggs in stool culture or adult worm passed

120
Q

What are the complication of flukes?

A

schistosomiasis- from fresh water

chronic infection can cause hepatomegaly, liver fibrosis and portal hypertension

121
Q

What are the complications of tapeworms?

A

From undercooked Pork or beef which contain their larval cysts

cause cysticercosis even neuro form which can lead to seizures

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