Gastrointestinal Infections (Complete) Flashcards
List 4 examples of causes of infectious diarrhoea in patients who have investigation findings indicative of inflammation/infection (e.g. elevated CRP and WCC)
Clostridium difficile
Klebsiella oxytoca
Clostridium perfringens
Salmonella spp
List 6 examples of causes of non-infectious diarrhoea in patients who have investigation findings indicative of inflammation/infection (e.g. elevated CRP and WCC)
Antibiotics side effect
Post-infectious irritable bowel syndrome
Inflammatory bowel disease
Microscopic colitis
Ischaemic colitis
Coeliac disease
List 4 examples of investigations that can help determine whether the diarrhoea has an infectious or non-infectious cause
Stool sample for C. difficile toxin
Stool culture
Imaging (AXR, CT)
Endoscopy (e.g. Flexible sigmoidoscopy, Colonoscopy)
Stool sample findings show a positive for C. diff. What is the management plan for this patient?
Move patient to a side room (Infection control)
Discontinue any antibiotics (e.g. co-amoxiclav) the patient is on and start them on vancomycin, fidaxomicin or metronidazole.
Management of fluids, nutrition & diarrhoea
What two investigation parameters can be looked at to measure the severity of a c.diff infection?
WCC
Creatinine (Measure of kidney function)
What values must WCC and creatinine levels fall under to consider a c. diff infection as being non-severe?
WCC<15
Creatinine <150
What values must WCC and creatinine levels fall under to consider a c. diff infection as being severe?
WCC>15
Creat >150
What is a rare but severe consequence of a c. diff infection?
Fulminant colitis
What are some of the sypmtoms associated with fulminant colitis?
Toxic megacolon
Hypotension or shock
Ileus (lack of muscles contractions in intestines)
Define toxic megacolon
Non-obstructive widening of the colon due to swelling and inflammation
Patient has a c.diff infection with WCC 14 and creatinine 140. What is the management/treatment plan for this patient?
Isolate the patient in a side room
Stop any current antibiotics and place them on vancomycin, fidaxomicin or metronidazole.
Role of Faecal Microbiota Transplantation (FMT) [If its an option]
Management of fluids, nutrition & diarrhoea
Patient has a c.diff infection with WCC 16 and creatinine 170. What is the management/treatment plan for this patient?
This patient has a severe infection and potentially may have fulminant colitis.
Isolate the patient in a side room
Stop any current antibiotics and place them on vancomycin, fidaxomicin or metronidazole.
Supportive care and close monitoring
Early surgical consultation
What is the management plan for a patient with fulminant colitis with toxic megacolon?
Medical therapy with antibiotics and supportive management
ITU transfer for invasive monitoring
Potential surgery
What are the 5 main indications for surgery in patients with fulminant colitis?
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