Gastroenteritis Flashcards

1
Q

Define gastroenteritis?

A

acute inflammation of lining of GI tract-> nausea, vomiting, diarrhoea, and abdominal discomfort

infectious colitis= swelling and irritation of colon

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2
Q

outline the aetiology of gastroenteritis?

A

Caused by viruses, bacteria, protozoa or toxins contained in contaminated food or water (faecal-oral route)

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3
Q

what are the risk factors for gastroenteritis?

A

exposure to contaminated food or water sources

close contact with infected people

poor hygiene

extreme ages

HIV infection

organ transplantation

chronic ilness

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4
Q

what key questions should be asked for diagnosing gastroenteritis?

A

ASK ABOUT TRAVEL, PEOPLE AROUND HAVING SIM SYMP, SPEC TIME FROM STARTING

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5
Q

give examples of viruses , bacteria and protoctists that cause gastroenteritis?

A
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6
Q

which virus is likely to cause outbreaks of D + V in institutions with elderly?

A

norovirus

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7
Q

what organism is likely to be the cause of a uni student having watery diarrohea?

A

campylobacter jejuni

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8
Q

what organism is likely to cause rapid onset diarrhoea after a meal?

A
Staph Aureus ( toxins produced) 
Bacilus cereus
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9
Q

which organism is likely to be cause of elderly on antibiotics with explosive diarrhoea?

A

pseudomembranous colitis: C difficile

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10
Q
A
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11
Q

which organism is the cause of traveller’s diarrhoea?

A

E. coli

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12
Q

what are tuberculosis and yernia associated with? and what can they mimic?

A

RIF pain and travel

both mimic ileo-caecal crohn’s

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13
Q

which organisms cause bloody diarrhoea ( dysentry)

A

CHESS

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14
Q

which organisms are associated with improperly cooked meats?

A

S.aureus, C. perfringens

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15
Q

Which organisms are associated with old rice?

A

B cereus, S aureus

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16
Q

which organisms are associated with milk and cheese?

A

Listeria and campylobacter

17
Q

which organisms are associated with canned foods?

A

botulinism

18
Q

summarise the epidemiology of gastroenteritis?

A

common

serious cause of morbidity in the developing world

19
Q

what are the possible complications of gastroenteritis?

A

Dehydration

Electrolyte imbalance

Prerenal failure (due to dehydration)

Secondary lactose intolerance (particularly in infants)

Sepsis and shock

Haemolytic uraemic syndrome (associated with toxins from E. coli O157)

Guillain-Barre Syndrome may occur weeks after recovery from Campylobacter gastroenteritis

NOTE: botulism can lead to respiratory muscle weakness or paralysis

20
Q

what are the presenting symptoms of infective colitis?

A

abdo discomfort

diarrhoea

N and V

bloody/purulent/mucoid stools

severe abdo cramping

fever

tenesemus

21
Q

what are the presenting symptoms of gastroenteritis?

A

Sudden onset nausea, vomiting, anorexia

Viral gastroenteritis presents more with upper GI symp like N+V rather than D

DIARRHOEA (bloody or watery)
Note – dysentery is any type of gastroenteritis which causes bloody diarrhoea

Abdominal pain or discomfort

Fever and malaise

22
Q

how is the onset of symptoms caused by toxins different to symptoms caused by bacterial/ viral/ protozoal infection?

A

Toxins = early (1-24 hours)

Bacterial/viral/protozoal = 12+ hours

23
Q

what are the signs of gastroenteritis on physical examination?

A

Diffuse abdominal tenderness

Abdominal distension

Bowel sounds are often INCREASED

In SEVERE gastroenteritis: pyrexia, dehydration, hypotension and peripheral shutdown

IMPORTANT: ANY DIARRHOEAL CONDITION CAN LEAD TO DEHYDRATION so assess and address the patient’s hydration status immediately

24
Q

what are the appopriate investigations for gastroenteritis?

A

Bloods: FBC, blood culture (identify bacteraemia), U&Es (dehydration)

C diff causes raised WCC

Stool MC&S: faecal microscopy and analysis for toxins (particularly for the toxin causing pseudomembranous colitis (C. difficile toxin))

AXR or ultrasound: exclude other causes of abdominal pain (e.g. bowel perforation)

Sigmoidoscopy: usually unnecessary unless inflammatory bowel disease needs to be excluded

25
what is the treatment for c difficile
Isolate **Oral metronidazole 10-14 days** * cause a disulfiram-like reaction (nausea, vomiting, flushing, discomfort, hangover-like symptoms) to alcohol so avoid alcohol during treatment If refractory: vancomycin
26
generate a mangement plan for gastroenteritis?
Bed rest – should stay at home until D+V cleared for 48h Fluid and electrolyte replacement with oral rehydration solution (contains glucose and salt) IV rehydration may be necessary in those with severe vomiting/ pts with signs of hypovolaemia (e.g. Tachy, low BP) Most infections are self-limiting (so will go away with time) Antibiotic treatment **(ciprofloxacin or azithromycin)** is only used if severe or immunocompromised or if infective agent has been identified by a stool culture
27
if botulinim toxin is present due to clostridium botilinum, what is the treatment?
treat with botulinum antitoxin (IM) and manage in ITU
28
what is the prognosis for gastroenteritis?
good prognosis-\> most cases are self limiting