Gastrointestinal Infections Flashcards
What can cause infectious diarrhoea?
Clostridium difficile
Klebsiella oxytoca
Clostridium perfringens
Salmonella spp
What can cause non-infectious diarrhoea?
Antibiotics side effect Post-infectious irritable bowel syndrome Inflammatory bowel disease Microscopic colitis Ischaemic colitis Coeliac disease
What fo Dry oral mucosa and reduced skin turgor suggest?
Dehydration
What is the management of C. diff infection?
Infection control
The patient is moved into a side room
Discontinue inciting antibiotic agents
Co-amoxiclav is stopped
Management of fluids, nutrition & diarrhoea
How do you distinguish severe and non severe C. diff. infection?
Non-severe infection
WCC<15, Creat <150
Severe infection
WCC>15, Creat >150
What is fulminant colitis?
Most severe manifestation
Hypotension or shock, ileus, toxic megacolon
What is the management for non-severe disease?
Antibiotic therapy with oral vancomycin or fidaxomicin or metronidazole
Role of Faecal Microbiota Transplantation (FMT)
What is the management to severe disease or fulminant colitis?
Antibiotic therapy, supportive care and close monitoring
Early surgical consultation
What is 1st line treatment for fulminant colitis with toxic megacolon?
Medical therapy with antibiotics and supportive management
Transfer to ICSU
What is done in ICU for fulminant colitis with toxic megacolon?
IV fluid resuscitation & inotropic support
What are the main features of pseudomembranous colitis?
Most often associated with C. difficile infection
Manifestation of severe colonic disease
Characteristic yellow-white plaques that form pseudomembranes on the mucosa
Confirmed on endoscopy +/- biopsy
What are the indications for surgery?
Colonic perforation
Necrosis or full-thickness ischaemia
Intra-abdominal hypertension or abdominal compartment syndrome
Clinical signs of peritonitis or worsening abdominal exam despite adequate medical therapy
End-organ failure
What non-infectious differentials can be associated with bloody diarrhoea?
Inflammatory bowel disease Haemorrhoids Post-infectious irritable bowel syndrome Microscopic colitis Ischaemic colitis Coeliac disease
What comprises mild UC?
4 x BMs/day, no systemic toxicity, normal ESR/CRP, mild symptoms.
What comprises moderate UC?
> 4x BMs/day, mild anaemia, mild symptoms, minimal systemic toxicity, nutrition maintained and no weight loss.
