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► Med - Anatomy & Physiology > Gastroenteritis and Food Poisoning > Flashcards

Gastroenteritis and Food Poisoning Flashcards

1
Q

What condition causes GI symptoms, diarrhoea, vomiting, abdominal pain and relates to invasion of tissue +/- toxin production?

A

Food poisoning

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2
Q

What is the commonest cause of food poisoning?

A

Campylobacter

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3
Q

What cause of food poisoning is rare, but can lead to morbidity and outbreaks?

A

E coli O157

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4
Q

What two organisms have a short incubation period of 1-6 hours?

A

Staph aureus and Bacillus cereus

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5
Q

What two organisms have a medium incubation period of 12-48 hours and there is invasion/toxin in gut which can often cause blood diarrhoea?

A

Salmonella

CI perfringens

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6
Q

What 2 organisms have a long incubation period of 2-14 days and can cause bloody diarrhoea?

A

Campylobacter and E coli O157

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7
Q

How long does it take for labarotory confirmation of bacteria?

A

48 hours for culture result

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8
Q

What two food products can campylobacter come from?

A

Raw milk

Poultry

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9
Q

Which organism rarely causes outbreaks, occurs in small numbers and results in pain, blood and a fever?

A

Campylobacter

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10
Q

What is the treatment for campylobacter?

A

Ciprofloxacin/erythromycin

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11
Q

What 3 food products can salmonella enteritidis come from?

A

Poultry, meat, raw egg

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12
Q

Where is salmonella occuring?

A

In animal gut

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13
Q

What is the treatment for salmonella enteritidis, which causes diarrhoea, vomiting, blood and fever?

A

Ciprofloxacin

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14
Q

What are the three most common groups of salmonellae?

A

B, C and D

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15
Q

What king of diarrhoea does E coli O157 cause?

A

Bloody

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16
Q

Is the infectious dose low or high for E coli O157?

A

Low

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17
Q

What two food products can E coli O157 come from?

A

Beef and raw milk/water

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18
Q

How can E coli O157 be transmitted?

A

Person to person

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19
Q

What toxin does E coli O157 produce?

A

Verotoxin (VTEC)

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20
Q

What organism can cause bloody diarrhoea nad haemorrhagic colitis?

A

E coli O157 VTEC

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21
Q

What syndrome can Haemolytic Uraemic Syndrome (HUS)?

A

E coli O157

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22
Q

`What three things does verotoxin do?

A
  1. Binds to receptors found on renal cells, RBC and others
  2. Inhibits protein synthesis
  3. Causes cell death
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23
Q

What is this a presentation of: abdominal pain, fever, pallor, petechiae, blood diarrhoea and oliguria?

A

HUS

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24
Q

What patients are commonly infected by HUS?

A

Under 16 years old

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25
Q

In HUS what are the white cells like, platelets, Hb, LDH?

A

High WWC
Low platelets
Low Hb
LDH > 1.5 x normal

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26
Q

How is HUS investigated?

A

Send stool culture samples for all bloody diarrhoea samples

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27
Q

Other than U&S, FBC, film, LFT, clotting what else would you send for?

A

Urine (dipstick/micro)

Lactate dehydrogenase

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28
Q

What are three complications of HUS?

A
  1. Acute renal failure
  2. Thrombocytopaenia
  3. Haemolytic anaemia
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29
Q

What 3 drug types are NOT given in HUS?

A
  1. Antibiotics
  2. Anti-motility agents
  3. NSAIDS
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30
Q

What kind of diagnosis are these factors involved in: selective culture, sorbitol non fermenter, E coli isolated, check for O157 antigen?

A

Microbiological diagnosis

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31
Q

What infection is associated with contacting farm animals and private drinking water?

A

E coli O157

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32
Q

What two things must you notify the Health Protection Unit on?

A

Haemolytic Uraemic Syndrome or O157

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33
Q

What is the likely cause of blood diarrhoea in children and elderly?

A

E coli O157

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34
Q

What virus is the commonest cause in kids

A

Rotavirus

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35
Q

How is rotavirus transmitted?

A

Person-person and faecal oral

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36
Q

What is diarrhoea like in rotavirus?

A

Not bloody, mild and watery

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37
Q

Along with diarrhoea, what 2 other symptoms occur in rotavirus?

A

Vomiting and fever first

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38
Q

What is the infectious dose like in rota virus?

A

Low

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39
Q

How is rota virus diagnosed?

A

PCR diagnosis on faeces

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40
Q

What is management for rotavirus?

A

Hydration

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41
Q

What is the rota virus vaccine like?

A

Oral and live attenuated

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42
Q

What is the ‘Winter Vomiting Disease’?

A

Norovirus

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43
Q

How is norovirus spread?

A

Faecal-oral/droplet routes spread, person to person or on contaminated food/water

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44
Q

What is the infectious dose like for norovirus?

A

Low

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45
Q

What is diarrhoea anad vomiting like in norovirus?

A

Explosive and sudden

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46
Q

What is the incubation for norovirus like?

A

Short

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47
Q

In what 2 ways is norovirus diagnosed?

A
  1. PCR on stool takes 6 hours

2. PCR on vomit using red Copan viral swabs

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48
Q

What is the management for norovirus?

A

Hydration

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49
Q

What infection is a side effect on antibiotic treatment?

A

Cl difficile

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50
Q

What two toxins does Cl difficile produce?

A

Enterotoxin and cytotoxin

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51
Q

Does CI difficile produce spores?

A

Yes

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52
Q

Where can CI difficile cause symptoms?

A

In the colon

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53
Q

What infection is related to “mild, bloody pseudomembranous colitis”?

A

C diff

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54
Q

What patients are most likely affected with C diff?

A

Elderly females >65

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55
Q

What 4 factors cause a high index of suspicion for C difficile?

A
  1. Recent antibiotics
  2. Surgery
  3. Hospital
  4. Use of stomach acid suppressants like PPIs
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56
Q

What is the diagnosing test for C diff?

A

Toxin/antigen sensitive screening test: 24 hour turnaround

57
Q

On sigmoidoscopy of C diff patient, what is seen?

A

Membranous lesions

Pseudomembranous colitis

58
Q

What two types of C diff are virulent strains producing 20x more toxin and lead to aggressive disease and death?

A

027

078

59
Q

What is the term for inflammation of stomach or intestines - it inhibits nutrient absorption and excessive H2O and electrolyte loss?

A

Gastroenteritis

60
Q

What are 3 preformed organisms that cause food poisoning?

A
  1. Staph auresu
  2. Clostridium perfringens
  3. Bacillus cereus
61
Q

What 2 organisms cause in vivo production of toxin related food posioning?

A
  1. Vibrio

2. Enterotoxigenic E.coli

62
Q

What are the three clinical syndromes of acute enteritis?

A
  1. Fever
  2. Diarrhoea and vomiting
  3. Abdominal pain
63
Q

What are the three clinical syndromes of enteric fever like illness?

A
  1. Fever
  2. Rigors
  3. Pain
64
Q

What 4 organisms can cause bloody diarrhoea and usually indicate colonic inflammation?

A
  1. Campylobacter
  2. Shigella
  3. E coli
  4. Amoebiasis
65
Q

What is a rare, but important complication of Campylobacter?

A

Guillain-Barre

66
Q

What can severe cases of campylobacter be treated with?

A

Clarithromycin or azithromycin

67
Q

What condition involves tingling of the feet, leading to progressive paralysis of the legs, arms and rest of body?

A

Guillain-Barre Syndrome

68
Q

What type of fever is typhoid?

A

Enteric fever

69
Q

What type of enteric fever is imported from India, SE Asia, Far East, Middle East and Africa?

A

Typhoid

70
Q

What two ways is typhoid transmitted?

A

Food and water

Carrier

71
Q

What are the 3 features of presentation of typhoid?

A
  1. Asymptomatic. mild
  2. Bacteraemia
  3. Enterocolitis
72
Q

What is key to diagnosis of typhoid, but what can also be done to help?

A

Blood cultures

Stool and urine culture

73
Q

What 4 antibiotics are used to treat Tyhpoid?

A
  1. Chloramphenicol and Ciprofloxacin

2. Ceftriaxone or azithromycin

74
Q

What two infections require an in depth travel history?

A

Giardia

Amoeba

75
Q

What investigation would be done for Salmonella, Campylobacter and Shigella?

A

Stool culture

76
Q

What two infections require toxin testing?

A

E Coli

C. difficle

77
Q

What organism would you do a blood culture for?

A

Salmonella

78
Q

What is creatinine like in C.diff?

A

> 1.5 x baseline

79
Q

What four factors are severity markers of C.diff?

A
  1. Pseuodemembranous colitis
  2. Toxic megacolon
  3. Ileus
  4. Colonic dilatation >6cm
80
Q

Give 4 complications of bacterial enteritis intestinal?

A
  1. Severe dehydration and renal failure
  2. Acute colitis, toxic dilatation
  3. Post infective irritable bowel (very common)
  4. Transient secondary lactase intolerance
81
Q

What are septicaemia, meningitis, aortitis, ostyeomyelitis, endocarditis, reactive arthritis, meningism, Guillian Barre Syndrome, haemolytic uraemic syndome all complications of?

A

Bacterial enteritis extra-intestinal

82
Q

Name two antimotility agents?

A

Opiates and loperamide

83
Q

Name tow anti-secretory agents?

A

Chlorpromazine, bismuth subsalycilate

84
Q

Name two absorbents?

A

Kaolin, charcoal

85
Q

What is an anaerobic gram-positive spore forming bacillus?

A

C. diff

86
Q

What are four antibiotics that are risk factors for C diff?

A
  1. Fluoroquinolones
  2. Cephalosporins
  3. Clindamycins
  4. Broad spectrum penicillins
87
Q

What are two medications that can be risk factors for C diff?

A
  1. PPI

2. H2 receptor antagonists

88
Q

What are the 4 C. dff causing antibiotics?

A
  1. Cephalosporins
  2. Clindamycin
  3. Ciprofloxacin (quinolines)
  4. Clarithromycin (macrolides)
89
Q

For pseudomembranous colitis, what drugs should be stopped and what antibiotic should be given?

A

Stop opiates, PPIs and anti-perstaltic drugs

Give oral vancomycin or metranidazole for non-severe cases

90
Q

What drug is used for a relapse of c diff?

A

Fidaxomicin

91
Q

What are 3 travel related diarrhoea causes?

A
  1. Amoebiasis
  2. Giardiasis
  3. Cryptosporidiosis
92
Q

What is a protozoal infection spread by faeco-oral route or by an ill or asymptomatic carrier?

A

Amoebiasis

93
Q

What areas is amoebiasis com mon in?

A

Areas of poor sanitation

94
Q

What is the diarrhoea like in amoebiasis?

A

Acute and bloody

95
Q

How is diagnosis ofintestinal amoebiasis made?

A

By examination of hot stool for ova and cysts (stool M & C)

96
Q

What is the treatment for amoebiasis?

A

Metronidazole. Remove from lumen by using diloxanide furate or paromomycin

97
Q

What is the diarrhoea like in giardiasis?

A

Explosive, protracted and foul smelling

98
Q

What infection is protozoan Giardia lambia trophozoites colonising the small bowel mucosa to produce diarrhoea?

A

Giardiasis

99
Q

How is Giardiasis spread?

A

Spread by cysts found in normal drinkng water

100
Q

How is giardiasis diagnosed?

A

Examine stools for ova and cysts but more accurately by duodenal aspiration.

101
Q

How is giardiasis treated?

A

With metronidazole

102
Q

What is one of the main causes of infectious diarrhoea in many parts of the world and is an important cause of travel related diarrhoea?

A

Cryptosporidiosis

103
Q

How is cryptosporidiosis transmitted?

A

Water, food, animal contact, highly infectious and resilient

104
Q

What patient types usually get cryptosporidiosis (C.parvum)?

A

West African Children

105
Q

How is cryptosporidiosis diagnosed?

A

By duodenal aspirate/stool

106
Q

How is cryptosporidiosis treated?

A

Supportive

107
Q

How is diagnosis of extra-intestinal ameobiasis made?

A

Requires serology

108
Q

Name two arboviruses?

A

Dengue

Chikungunya

109
Q

What is the definition of acute tranveller’s diarrhoea?

A

3 loose stools in 24 hours

110
Q

What typically causes acute traveller’s diarrhoea?

A

Enterotoxigenic E. coli

111
Q

Other than E.coli, what three other causes of acute traveller’s diarrhoea are there?

A

Campylobacter, Salmonella and Shigella

112
Q

What is commonly caught on Cruise ships?

A

Noravirus or rotavirus

113
Q

What infection is often associated with outbreaks in refugee camps?

A

Cholera

114
Q

What two investigations are done for acute traveller’s diarrhoea?

A
  1. Stool culture

2. Stool wet prep on recently passed stool for amoebic trophozoites

115
Q

What is the treatment for Acute traveller’s diarrhoea?

A

Supportive - fluid rehydration

In travelling patients, ciprofloxaacin single dose can stop worsening

116
Q

What is most common from travellers returning from India subcontinent or SE Asia?

A

Typhoid or paratyphoid fever (enteric fever)

117
Q

Where is Salmonella typhi usually isolated from?

A

Blood, stool or urine

118
Q

How is Salmonella typhi treated?

A

With ceftriaxone

119
Q

What three things can be a cause of fever and pre-hepatic jaundice?

A

Malaria, HUS (E.coli O157/Shigella), sickle cell crisis

120
Q

What does leptosirosis cause?

A

Weils disease (icteric, haemorrhagic and renal failure)

121
Q

What is a post-hepatic cause of fever and jaundice?

A

Ascending cholangitis and helminths

122
Q

How is malaria investigated?

A

Blood film and rapid antigen

123
Q

What is this: incubation period 9-20 weeks, fever, cough, aching abdominal pain, hepatomegaly, sometimes a history of GI upset and usually male?

A

Amoebic liver abscess

124
Q

How is amoebic liver abscess investigated?

A

CXR (raised right hemidiaphragm)

Abnormal LFTs, US/CT, serology,

125
Q

What is the management for amoebic liver abscess?

A

Metronidazole and paramomycin/diloxanide to clear gut lumen of parasites

126
Q

What are Helminth infections - parasites - often diagnosd by?

A

The adult worm passed or eggs in stool

127
Q

What are two types of nematodes (round worms)?

A 
Intestinal roundworms
Tissue roundworms (filariasis)
128
Q

What are trematodes?

A

Flukes

129
Q

What are cestodes?

A

Tapeworms

130
Q

What is the most common helminthic infection in the world?

A

Ascariasis

131
Q

What is the life-cycle of a helminth infection?

A

Egg ingested and hatches in small intestine. Invades gut wall into venous system and via liver and heart reaches lungs. Breaks into alveoli and ascends tracheobronchial tree then becomes swallowed. In the gut develops into adult worm where they start to produce eggs.

132
Q

Name a trematode (fluke) and where can you get it from?

A

Schistosomiasis - fresh water exposure

133
Q

What can adult worms located in portal venules lead to?

A

Hepatomegaly, liver fibrosis and portal hypertension

134
Q

How can cestodes such as tapeworms Taenia solium or Saginatum, be aquired?

A

By eating undercooked meat containing infectious larval cysts

135
Q

What can Taenia solium eggs cause?

A

Cysticercosis - tissue cysts muscle and brain

136
Q

What protozoa is involved in Chagas disease?

A

Trypanasoma cruzi

137
Q

How is Chagas disease transmitted?

A

By the kissing bug

138
Q

What happens to the oesophagus in Chagas’ disease?

A

Megaoesophagus

► Med - Anatomy & Physiology (130 decks)

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