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Medicine Gastrointestinal > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Things impacting GI diseases

A
  • Poor sanitation
  • Commercialisation of food production
  • Import of food from other countries
  • Increase in day care/care home
  • International travel
  • Acid suppression
  • Healthcare associated infections of the GI tract
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2
Q

GI infection risk factors

A

Malnutrition/deficiency, closed/semi-closed communities, exposure to contaminated food/water/travel, immunosuppression

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3
Q

Diarrhoea

A

> 3 unformed stools a day, stools hold shape of the container

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4
Q

Bristol stool chart

A
  • Type 1 – separate hard lumps, like nuts
  • Type 2 – sausage-shaped but lumpy
  • Type 3 – sausage shaped, but with cracks on the surface
  • Type 4 – sausage or snake like, smooth and soft
  • Type 5 – soft blobs with clear-cut edges (easy to pass)
  • Type 6 – fluffy pieces with ragged edges, mushy
  • Type 7 – watery, no solid pieces (entirely liquid)
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5
Q

Dysentery

A

Inflammation of the intestine, particularly the colon, causing diarrhoea associated with blood or mucus

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6
Q

Bacteria causing dysentery

A

Shigella, campelobacter

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7
Q

Symptoms of dysentery

A

Fever, abdominal pain, tenesmus

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8
Q

What do bacteria need to multiply?

A
  • Time
  • Temperature
  • Food source
  • Moisture
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9
Q

Gastroenteritis

A

Illness caused by eating food contaminated with microorganisms, toxins, poisons etc

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10
Q

Symptoms of gastroenteritis

A

Diarrhoea, blood, mucous, vomiting, abdominal pain

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11
Q

Questions to ask when taking a history relating to gastroenteritis

A

Travel, contacts, food history, medication history

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12
Q

Bacillus cerues:

  • Gram negative or gram positive?
  • What foods is it found in?
  • Describe the spores
  • What can it cause?
  • Incubation period
A
  • Gram positive bacillus
  • Starchy foods - can get it from reheated rice
  • Spores are heat resistant
  • Profuse vomiting
  • 1-6 hours
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13
Q

Staph aureus:

  • Gram positive or gram negative?
  • Which foods is it found in?
  • What does it act on?
  • Incubation period
A
  • Gram positive coccus
  • Foods left at food temperature e.g. milk, meat, fish
  • Acts on vomiting centre in brain causing vomiting and abdominal pain
  • 1-6 hours
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14
Q

Bacillus cereus:

  • What type of pathogen is it?
  • What foods can it come from?
  • What can it cause?
  • Incubation period
A
  • Diarrhoeal toxin
  • Meat, stew, gravy, vanilla sauce
  • Abdominal cramps, watery diarrhoea, nauseua
  • 8-16 hours
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15
Q

Clostridium perfringens:

  • What type of pathogen is it?
  • What foods can it come from?
  • What can it cause?
  • Incubation period
A
  • Toxin
  • Meat, poultry, gravy, dried or precooked foods, time and/or temperature-abused food
  • Watery diarrhoea, nausea, abdominal cramps
  • 8-16 hours
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16
Q

What is the most common bacteria?

A

Campylobacter jejuni

17
Q

What tests do all stool cultures get?

A

Salmonella/shigella/campylobacter/O 157 and cryptosporidium, all >4 years old get C.difficile

18
Q

Types of Shigella

A
  • Shigella dysenteriae (group A)
  • Shigella flexneri (group B)
  • Shigella boydii (group C)
  • Shigella sonnei (group D)
19
Q

What does the shiga toxin in shigella bind to?

A

Receptors found on renal cells, RBC and inhibits protein synthesis causing cell death

20
Q

What does E.coli do?

A

Adhere to intestinal epithelial cells and elaborate shiga toxin

21
Q

How does shiga toxin cause disease in E.coli?

A

Bind to absorptive enterocytes on the luminal surface of the small and large intestines, enter the cell and irreversibly inhibit protein synthesis causing cell death

22
Q

How do shiga toxins cause death of vascular endothelial cells?

A

Shiga toxins enter bloodstream via damaged intestinal epithelium and cause death of vascular endothelial cells by inhibiting protein synthesis

23
Q

E.coli 0157:

  • When should it be suspected?
  • What can it cause?
  • Infectious dose
  • Which food is it found in?
  • How is it spread?
  • Incubation period
  • What toxin does it produce?
A
  • In bloody diarrhoea or blood per rectum
  • Haemorrhagic colitis
  • Very low infectious dose
  • Found in beef mostly, but wide range
  • Spread person-to-person or animal contact
  • 1-14 days
  • Verotoxin
24
Q

Presentation of haemolytic uraemic syndrome

A
  • Abdominal pain, fever, pallor, petechiae, oliguria
  • Most cases in <16 years old
  • Patients will have high white cells, low platelets, low haemoglobin, red cell fragments, LDH>1.5 x normal
25
Q

Investigations for haemolytic uraemic syndrome

A
  • Send stool culture samples
  • Send U&E, FBC, film, LFT, clotting, urine, lactate dehydrogenase
  • Close monitoring
  • Admission is usually needed
  • Check for acute renal failure, thrombocytopaenia, haemolytic anaemia
26
Q

How is haemolytic uraemic syndrome diagnosed?

A

Microbiologically

27
Q

Pathotypes of E.coli

A

Enterotoxigenic, enteropathogenic, enteroinvasive, enteroaggrative

28
Q

Enterotoxigenic E.coli:

  • What type of toxin does it produce?
  • What is it related to?
A
  • Heat labile and heat stable toxin

- Travel

29
Q

Enteropathogenic E.coli:

  • What does it do?
  • Who does it occur in?
A
  • Synthesises, secretes and inserts its own receptor into membranes
  • Non-breastfed children
30
Q

Enteroinvasive:

  • What symptoms does it cause?
  • What test can be done to diagnose this?
A
  • Watery diarrhoea, rare dysentery

- Sereny test

31
Q

Campylobacter:

  • Incubation period
  • Which foods is it present in?
  • Symptoms
A
  • 16-48 hours
  • Poultry and raw milk
  • Pain, blood, fever
32
Q

Salmonella enteriditis:

  • Incubation period
  • Where is it found?
  • Symptoms
A
  • 12-48 hours
  • Animal guts and multiplies in food, e.g. poultry, meat, raw egg
  • Diarrhoea and vomiting, blood in stool or vomit, fever
33
Q

Most common groups of salmonella

A

B, C, D

34
Q

Listeria monocytogenes:

  • Incubation period
  • Symptoms
  • Where is it found?
A
  • 9-48 hours
  • Fever, muscle aches, diarrhoea
  • Unpasteurised milk products, deli counter
35
Q

Diagnosis of listeria monocytogenes

A

Easier from sterile site, gram positive rod

36
Q

Rotavirus:

  • Who does it affect?
  • How does it spread?
  • Clinical presentation
  • Infectious dose
  • How long does it last?
  • Diagnosis
  • Management
A
  • Children, most common <3 years old
  • Person-to-person, faecal oral
  • Fever, vomiting, diarrhoea (watery but not bloody)
  • Low infectious dose
  • About a week
  • PCR on faeces
  • Supportive care - hydration is key
37
Q

Rotavirus vaccine:

  • How is it given?
  • What type of vaccine is it?
  • How is it secreted?
  • Who gets it?
A
  • Orally
  • Live attenuated
  • Faeces
  • 2 doses at 2 and 3 months old, not >24 weeks
38
Q

Norovirus:

  • How is it spread?
  • Infectious dose
  • Symptoms
  • Incubation
  • Diagnosis
  • Management
A
  • Faecal-oral, droplets, person-to-person or contaminated food/water
  • Low infectious dose
  • Explosive and sudden diarrhoea and vomiting
  • <24 hours, lasts 2-4 days
  • PCR on stool takes 6 hours, PCR on vomit using red copan viral swabs
  • Supportive - hydration

Medicine Gastrointestinal (24 decks)

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