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GI: Gastroenteritis > Gastroenteritis - nathwani > Flashcards

Gastroenteritis - nathwani Flashcards

1
Q

what is gastroenteritis?

A

Inflammation of stomach or intestines

Inhibits nutrient absorption and excessive H2O and electrolyte loss

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2
Q

what are the causes of gastroenteritis?

A
  • mainly infection (bacteria, parasites, viruses - majority, and microbial toxins)
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3
Q

what are the core clinical problems of gastroenteritis (3)

A
  • fever
  • abdo pain
  • diarrhoea ± blood
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4
Q

microbial toxins may be ____-____ or __ ___-

A

pre-formed or in vivo

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5
Q

which organisms pre-form toxins?

A

staph aureus, clostridium perfringens or bacillus cereus

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6
Q

which organisms form toxins in vivo

A

Vibrio, enterotoxigenic E.coli

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7
Q

what is the onset time for microbial toxin causing gastroenteritis?

A

1-6 hours

diarrhoea > few hours , abdo pain and afebrile

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8
Q

with microbial toxin causing gastroenteritis there is no ___ or ___ in the faeces

A

no blood or pus

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9
Q

how long does it take for microbial toxin causing gastroenteritis to resolve?

A

1-6 hours

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10
Q

treatment with ____ ____ has a role in the emergence of gastroenteritis

A

acid suppression

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11
Q

what are some causes of non-infectious diarrhoea? 7

A 
GI bleed
Ischemic gut
Diverticulitis
Endocrine disorders
Numerous drugs
Fish Toxins
Withdrawal
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12
Q

the approach to any clinical infection syndrome!!!

A
  1. What are the key clinical symptoms and signs that suggest the infection?
  2. Differential diagnosis
  3. Severity of Infection
  4. Site and microbiological diagnosis: investigations
  5. Antibiotic and supportive management
  6. Infection Control
  7. Public Health
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13
Q

what organism causes the most gastroenteritis

A

norovirus

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14
Q

norovirus occurs in ___ ___ or ____ and is a cause of community wide ____

A

older children, adults, outbreaks

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15
Q

what makes norovirus so infectious?

A

the virus is ejected in vomit and it has aerosol transmission

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16
Q

viruses have a ____ incubation period than bacteria

A

shorter

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17
Q

what is the incubation period for norovirus?

A

24- 48 hours

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18
Q

what are the three presenting clinical syndromes of food poisening

A
  1. Acute enteritis : fever. D&V, abdominal pain
  2. Acute colitis: fever, pain, bloody diarrhoea
  3. Enteric fever like illness : fever, rigors, pain but little diarrhoea - around 10 % of patients will have this
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19
Q

differential diagnosis of bloody diarrhoea

A

infection - usually indicates colonic inflammation

IBD

Malignancy

Ischaemia

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20
Q

which organisms cause bloody diarrhoea?

A
  1. campylobacter
  2. shigella
    E.coli 0157
  3. amoebiases
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21
Q

campylobacter infection is closely related to meals with ___

A

chicken

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22
Q

incubation period for campylobacter: __-___ days

A

2-5 days

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23
Q

what is a common misdiagnosis of campylobacter?

A

appendicitis

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24
Q

____ ___ is a rare but IMPORTANT COMPLICATION of camplyobacter

A

guillian barr

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25
Q

how long does campylobacter last

A

5-14 days

26
Q

treatment for campylobacter is ____ however in severe cases may be treated with _____ or ____

A

supportive, clarithromycin or azithromycin

27
Q

what is guilllian barr syndrome symptoms?

A

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

28
Q

the stool exam for leukocytes -erythrocytes is ____ for campylobacter

A

positive

29
Q

what may you see on X-ray with gastritis?

A

thumbprinting - usually caused by oedema, related to an infective or inflammatory process (colitis)

30
Q

what happens in thumbprinting?

A

the normal haustra become thickened at regular intervals appearing like thumbprints projecting into the aerated lumen

31
Q

someone presents with fever, they are systemically unwell and have rigors and abdo pain.

They had short history of diarrhoea 1 month ago, what is this?

A

enteric fever like illness

32
Q

____ ___ is an enteric fever

A

typhoid fever

33
Q

_____ is Almost always imported (Indian subcontinent, SE Asia, Far East, Middle East, Africa, Central/
South America)

A

typhoid

34
Q

what are the carriers of typhoid?

A

primarily food but can be water

35
Q

what are the symptoms of typhoid? 4

A

Asymptomatic, mild, bacteraemia, enterocolitis

36
Q

what is the key to diagnosis with typhoid?

A

blood cultures,

then stool and urine cultures

37
Q

what antibiotics are given for typhoid?

A

chloramphenicol and ciprofloxacin, ceftriaxone or azithromycin

38
Q

there is a vaccine for ___ but it is only __% effective and is not effective against ______ strains

A

typhoid, 70%, paratyphoid

39
Q

what are the key features in the history

A

diarrhoea

associated symptoms: abdo pain, vomiting, fever, urgency, incontinence

anyone in family or work with similar symptoms

occupation

pets and ANIMAL CONTACT

Travel

Drug history - particularly PPI or antibiotics

40
Q

what do you want to know about the diarrhoea?

A
  1. frequency
  2. nocturnal - generally pathological
  3. colour and consistency
  4. presence of blood
41
Q

what are the key features of examination?

A
  • fever
  • skin rashes
  • dehydration: BP, postural drop, pulse
  • abdominal tenderness, distension
  • rectal examination: stool, blood, tenderness
42
Q

what rashes may appear?

A

rose spots, erythema nodosum

43
Q

what are signs of dehydration

A

pulse, mental state, dry tongue, skin turgor

44
Q

what are the options for tests? 6

A

STOOL:

  • microscopy
  • culture
  • toxin

BLOOD CULTURES

PCR

FBC

Us and Es

AXR

45
Q

when do you do microscopy?

A

if parasite

e.g history of travel for giardia, amoeba etc

46
Q

when would you do a culture?

A

Salmonella, Campylobacter, Shigella suspected

47
Q

when would you do a toxin?

A

c.diff

48
Q

_____ test for E.coli 0157

A

cytotoxin

49
Q

why do renal tests?

A

need to know if they are dehydrated

50
Q

factors in assessment of severity?

A

there are lots but:

Colonic dilatation- from AXR

laboratory : WCC, renal function

these are important, were bold in the lecture

51
Q

Severity of C.diff : one or more of the following severity markers for treatment to be classed as severe not mild (note treatment options differ for mild and severe)

  1. Suspicion of ________ _____ (PMC) or ___ -___ or ____or ___ ____ in CT/AXR >6cm
  2. WCC >__ cells/mm3
  3. Creatinine >___ x baseline
  4. Persisting symptomatic CDI despite __ treatments
A
  1. Suspicion of Pseudomembranous colitis (PMC) or toxic megacolon or ileus or colonic dilatation in CT/AXR >6cm
  2. WCC >15 cells/mm3
  3. Creatinine >1.5 x baseline
  4. Persisting symptomatic CDI despite 2 treatments
52
Q

what are the complications of Bacterial Enteritis? Intestinal - 4

A
  1. severe dehydration and renal failure
  2. acute colitis, toxic dilatation
  3. post infective irritable bowel (very common)
  4. transient secondary lactase intolerance
53
Q

what are the complications of Bacterial Enteritis? extra-intestinal - 6

A
  • Bacteriaemia leading to sepsis
  • Reactive arthritis
  • Meningism
  • Neurological [Guillian Barre syndrome]
  • Haemolytic uraemic syndrome
54
Q

what metastatic infections can you get if you are bacteraemic? and what else can occur in sepsis?

A

metastatic infection: meningitis, aortitis.

Ostyeomyelitis, endocarditis

55
Q

______ from ____ causes the haemolytic uraemic syndrome

A

toxin from e.coli 0157

56
Q

why do we give antibiotics therapy ? 3 reasons

A

To prevent and treat invasive disease especially in immunocompromised patients

To reduce the severity and duration of symptoms

To eradicate faecal excretion in order to reduce environmental contamination and to limit the spread of infection in the community

57
Q

how is gastritis generally treated?

A

supportive therapy :
Oral rehydration
Intravenous fluids (saline important) if very unwell

may need antibiotics - only in specific situations though

58
Q

what are the indications for antibiotics? which bugs? 8

A
  • Enteric fever [TYPHOID]
  • Shigellosis [non sonnei species]
  • Enterotoxigenic E coli [SOMETIMES]
  • Cholera
  • Clostridium difficile diarrhoea
  • Giardiasis
  • Amoediasis
  • Invasive salmonellosis
59
Q

Does the patient need admitted to ID unit? (eg ____, ____)

A

Does the patient need admitted to ID unit? (eg Salmonella, E coli O157)

60
Q

which bugs have a low infectious dose?

A

viruses, E.coi

61
Q

what are some other infections spread by faecal-oral route?

A

hep A and E

Resistant bacteria that are carried in the GI tract, e.g vancomycin-resistant enterococci, highly resistant Gram negative organisms (CPEs)

GI: Gastroenteritis (10 decks)

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