Gastroenteritis and Antibiotic Associated Colitis

Question 1

In which areas is there the most normal flora?

Answer 1

> Oral cavities

> Colon

Question 2

What is an obligate anaerobic bacteria?

Answer 2

One that is poisoned by oxygen.

Question 3

What is a facultative anaerobic bacterium?

Answer 3

One that can either be aerobic or anaerobic.

Question 4

What metabolic capacity does faecal flora equal?

Answer 4

That of the liver.

Question 5

What are the benefits of gut commensal flora?

Answer 5

> Antibody induction
Colonisation resistance
Metabolism

Question 6

What are the most common commensal flora types in the gut?

Answer 6

“In the gut gym, steroides are most prevalent”
> Bacteroides
> Prevotella

Question 7

Clostridia and Bifidobacteria are examples of what type of commensal flora?

Answer 7

Obligate Anaerobes

Question 8

Enterobactericae and Enterococchi are examples of what type of commensal flora?

Answer 8

Facultative Anaerobes

Question 9

What are the presenting symptoms of Gastroenteritis?

Answer 9

> Vomiting
Diarrhoea
Abdominal pain
Systemic FX i.e fever

Question 10

What complications can occur because of Gastroenteritis?

Answer 10

> Toxic Megacolon
> Guillan Barre
> Dehydration
> Renal failure
> Haemolytic Uraemic Syndrome
> Salmonella

Question 11

What investigations for gastroenteritis should be done?

Answer 11

> FBC
> Abdominal xray if severe disease
> Stool 
 - Ova, parasites and           cysts
 - Microscopy, culture and   
   sensitivity 
 - C.Difficile Toxin 
 - Viral PCR

Question 12

What is the cause of, symptoms, duration and transmission of Viral Gastroenteritis ?

Answer 12

Cause : Most common - Norovirus
Symptoms: Diarrhoea and projectile vomiting.
Duration: 48-72 hours
Transmission: Faecal-oral

Question 13

What parasites cause Parasitic Gastroenteritis?

Answer 13

> Guardia Lamblia
Entamoeba Histolytica
Cryptosporidium

Question 14

What are Cryptosporidium oocysts resistant to?

Answer 14

Chlorine disinfectants

Question 15

In whom are Cryptosporidium infections common in?

Answer 15

Children

Question 16

Which bacteria produces both enterotoxins and does adherence?

Answer 16

E. Coli

Question 17

What type of E.Coli causes colitis/haemolytic uraemic syndrome?

Answer 17

EHEC = Enterohaemorrhagic

Question 18

What type of E.Coli causes Traveller’s diarrhoea?

Answer 18

ETEC = Enterotoxigenic
EAggEC = Enteroaggregative

Question 19

What type of E.Coli causes Children’s diarrhoea?

Answer 19

EPEC = Enteropathogenic

Question 20

What type of E.Coli causes Dysentery like symptoms?

Answer 20

EIEC = Enteroinvasive

Question 21

What is the source of E.Coli 0157?

Answer 21

Cattle

Question 22

What is the mechanism of action of E.Coli ?

Hint: Similar to Cholera

Answer 22

1) Toxin activates G protein.
2) Increases cAMP levels
3) Chloride ions move out of cell
4) Water follows = Diarrhoea

Question 23

How is Salmonella transmitted?

Answer 23

Food/drink

Question 24

What does Salmonella cause?

Answer 24

Food poisoning, typhoid, paratyphoid.

Question 25

Why should antibiotics in Gastro-E be avoided?

Answer 25

> Worsens E. Coli

> Prolongs salmonella carriage.

Question 26

What happens if you disrupt gut flora with antib’s?

Answer 26

Diarrhoea

Question 27

What are the symptoms of antibiotic associated diarrhoea?

Answer 27

> Mild diarrhoea to pseudomembranous colitis

> Toxic megacolon, shock, perforation

Question 28

Which antibiotics cause a high risk of C.Difficile Infection?

Answer 28

> Clindamycin
Cephalosporins

” Linda spotted a high risk of C.Diff”

Question 29

Which antibiotics cause a medium risk of C.Difficile infection?

Answer 29

> Macrolides
Flouroquinolones
Co-trimoxazole
Ampi/Amoxycillin

” Sliding alone isn’t as good as co-chillin”

Question 30

What two antibiotics are used to treat CDI?

Answer 30

> Oral Metronidazole

> Oral Vancomycin

Question 31

Which antibiotic should be used in severe CDI?

Answer 31

> Vancomycin