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MSPA- Gastroenterology > GI infections > Flashcards

GI infections Flashcards

1
Q

What is the definition of diarrhoea ?

A

3 or more stools / day or loose or liquid stools or type 06 or 07 stools more frequently in a day is defined as diarrhoea.

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2
Q

What is acute diarrhoea?

A

It lasts less than 2 weeks, typically 1 to 2 days. Most cases are caused by viral infections.

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3
Q

What is the duration of persistent diarrhoea ?

A

2 to 4 weeks.

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4
Q

What is chronic diarrhoea?

A

It prolongs > 4 weeks and Most cases are caused by IBD, ischaemic gut,
parasitic infections, radiation, colon cancer or polyps.

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5
Q

What is Inflammatory diarrhoea (‘dysentery’ or ‘invasive’)?

A

It primarily affects the mucosa of the large intestine resulting in bloody diarrhoea, abdominal pain, fever with Fecal leukocytes.

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6
Q

What is Non-Inflammatory diarrhoea (‘watery diarrhoea’)?

A

It is less sever than inflammatory diarrhoea caused by infection of the small intestine by viruses, bacteria or parasites. It presents with Large, watery stool with cramping but no blood or fever or fecal leukocytes.

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7
Q

What is the organism that can cause both inflammatory and or non-inflammatory diarrhoea ?

A

Clostridium difficile.

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8
Q

What are the viral ethologies of non inflammatory diarrhoea ?

A

Norovirus, Rotavirus, Enteric adenovirus, astrovirus and sapovirus.

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9
Q

What are the bacterial ethologies of non inflammatory diarrhoea ?

A

Clostridium perfringens and Enterotoxigenic E.coli.

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10
Q

What are the parasitic ethologies of non inflammatory diarrhoea ?

A

Giardia lamblia and Cryptosporedium pavum.

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11
Q

What are the organisms responsible for inflammatory diarrhoea ?

A

Salmonella, C. Jejuni, Shigella, Enterohemoryhagic E.colli, Yersinia, Vibrio Parahemolyticus, and Entamoeba histolytica.

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12
Q

What is Gastroenteritis?

A

Acute inflammation of the lining of the stomach & the intestines Caused by food poisoning, irritating food or drink, or psychological factors,
such as stress.

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13
Q

What are the systemic complications of food poisoning ?

A

listeriosis, enteric fever, botulism, mercury and mushroom toxicity.

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14
Q

When to test stool ?

A
  • When Patient is systemically unwell and in need of hospital admission or antibiotics.
  • When there is blood, mucus, or pus in the stool.
  • In Children with acute painful or bloody diarrhoea.
  • Hx of foreign travel or more than 14 days of recurrent diarrhoea.
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15
Q

What is the purpose of stool culture ?

A

To identify the bacteria behind the inflammatory diarrhoea.

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16
Q

What is the purpose of stool microscopy for O&P?

A
  • Giardia lamblia ( ELISA can also be done)
  • Cryptosporidium spp
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17
Q

What are the common test in Diarrhoea ?

A
  • Faecal leukocyte count
  • Clostridium difficile stool toxin assay
  • Clostridium perfringens stool toxin assay
  • Escherichia coli VTEC (enterohemorrhagic) stool toxin assay
  • Escherichia coli ETEC (enterotoxigenic) stool toxin assay
  • Entamoeba histolytica stool antigen or DNA assay
  • Rotavirus stool toxin assay (high false negative rate)
  • Adenovirus stool toxin assay
  • Norovirus stool or vomitus RT-qPCR assay
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18
Q

What are the indications for blood culture ?

A
  • Early detection of salmonella infection which takes longer to show up in stool.
  • Anyone who is severely ill (fever, hypovolaemic) because they may have septicemia
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19
Q

What are the key elements of Hx in Diarrhoea ?

A
  • Onset of symptoms and Duration
  • Recent travel and Food
  • Were other people sick?
  • Medications such as gastric acid suppressants
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20
Q

What is the Tx in diarrhoea ?

A
  • Usually supportive treatment
    only as no role for abx in the vast
    majority of cases.
    – Fluid and electrolyte replacement
    – Avoid anti-diarrhoeals, if possible
    – If hospitalised: Isolate with contact precautions
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21
Q

What are the preventive measures in diarrhoea ?

A

*Hazard Analysis Critical Control Points to prevent food poisoning in restaurants etc.
* Early recognition of outbreaks and report to public health.
* Clean: Wash all fruit /vegetables fully before eating
* Cook: Cook food right through and serve when still very hot. Follow manufacturer’s instructions in the preparation of all foods.
* Chill: Keep your fridge at 5 degrees C or below. Put chilled food in the fridge straight away.
* Check: Throw out food that has passed the ‘use by’ date, and if the food packet has been opened, use within 2 days.
* Separate: Keep cooked food and raw food away from each other.

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22
Q

what is salmonellosis ?

A

It is a disease caused by Salmonella typhi and paratyphi. which presents as Typhoid fever and occasionally diarrhoea. The main source is contaminated meet and poultry rarely vegetables.

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23
Q

what is the presentation of salmonellosis ?

A

– Abdominal pain, cramping, Fever and Diarrhoea ± blood.

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24
Q

What is the work up and Tx in salmonellosis ?

A

The work-ups consist of stool culture and culture independent diagnostic test. The treatment is mainly hydration and antibiotics is not often indicated as it may prolong carrier state and increase relapse risk. Abx is Not indicated for non-typhoid infections.

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25
Q

What are the strains and sources of Shigella ?

A

S. sonnei is the most common and S. flexneri, S. dysenteriae are rare and deadly. The sources are Faecal-oral, waterborne, contaminated foods.

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26
Q

What is the presentation of shigella infection ?

A

It occurs aso in school/creche, recent travel abroad. The patients presents with Fever, Abdominal pain and Diarrhoea ± bloody diarrhoea

27
Q

What is the workup and Tx in shigella ?

A

The testing consist of stool culture and microscopy ( nonspecific findings). The treatment consist of hydration, Bismuth subsalicylate, Avoid agents that slow the gut such as loperamide, Avoid ABX if possible, resistance is emerging.

28
Q

Which is the Most common cause of
bacterial gastroenteritis in
Ireland and Europe?

A

Camplylobacter jejuni (most common), C. coli. form Consumption of contaminated /
undercooked poultry.

29
Q

What is the prsentation of Camplylobacter infection?

A

It is associated with travel abroad and presents with fever, severe abdominal pain and crmaping. May mimic apendicitis. May have nausea and vomiting, diarrhoea can be bloody or non-bloody. Can cause sepsis in immunocompromised.

30
Q

What is the testing and Tx in Camplylobacter infection?

A

Testing consist of Stool culture and Stool microscopy which will show rapidly motile
curved gram-negative rod.
The treatment consist of hydration.

31
Q

What is the pathophysiology of ENTEROHAEMORRHAGIC E. COLI infection?

A

E. coli 0157:H7 (aka ‘VTEC’) which produce shiga like toxin which damages endothelial cells and result in HUS. It is Rare, only about 1% of all E. coli infections. The main source is Contaminated undercooked beef .

32
Q

What is the presentation of ENTEROHAEMORRHAGIC E. COLI infection?

A

– Severe abdominal pain
– Fever
– Bloody diarrhoea and/or rectal bleeding

33
Q

What are the tests in ENTEROHAEMORRHAGIC E. COLI infection?

A

– Stool culture will grow E. coli
– VTEC toxin assay taken from culture
growth

34
Q

What is the Tx of ENTEROHAEMORRHAGIC E. COLI infection?

A

– Rehydration
– Avoid agents that slow the gut (e.g.,
loperamide)
– If sepsis occurs, hospitalization, blood
transfusions and haemodialysis may be
required
– No ABX treatment exists

35
Q

What is the source and presentation of Y. enterocolitica?

A

The source is raw or undercooked pork and common in children. It presents often with RLQ abdominal pain, fever and bloody diarrhoea.

36
Q

What is the test and Tx of of Y. enterocolitica?

A

Stool culture for Y. enterocolitica and the Tx consist of hydration and Abx usually not needed.

37
Q

What is the presentation of S. aureus food poisoning?

A

The S. aureus multiply in contaminated food in room temperature and produce Heat-stable enterotoxin. which causes vomiting and occasional diarrhoea within 1 to 8 hrs of ingestion and the symptoms lasts for 8 to 24 hrs. The Dx is based on Hx and Tx is supportive.

38
Q

What is Type 1: Emetic Syndrome caused by Bacillus Cereus?

A

The preformed toxin of bacillus cereus in cooked rice stored for longtime will cause vomiting, abdominal cramps and maybe diarrhoea within 1-2 hrs of ingestion. The heating of the rice will not destroy the toxin. The symptoms last for 2 to 10 hrs. The Dx is based on hx and Tx is supportive

39
Q

What is Type 2: Diarrheal Syndrome caused by Bacillus Cereus?

A

bacillus cereus spores ingested through food genrminates and produces toxin within an incubation period of 6-14 hrs. The main presentation is diarrhoea lasting for 8-24 hrs. Th dx is based on Hx and Tx is supportive.

40
Q

Explain non-inflammatory diarrhoea caused by C. perfringens ?

A

C. perfringes is a spore forming bacteria that causes infection through uncooked or undercooked meat and poultry. The toxin from the spores are produced in vivo within in an incubation period of 8-24 hrs.
The symptoms are Profuse, watery diarrhea, ocassional vomiting and abdominal cramps.

41
Q

What is the Dx and Tx in C. perfringens ?

A
  • Testing
    – Stool culture AND culture of suspected
    contamination source
    – Stool microscopy shows spore-forming
    gram-positive rods
    – Toxin assay
  • Treatment
    – Hydration
    – Lasts 1-3 days
42
Q

What is CLOSTRIDIUM BOTULINUM infection?

A

C. botulinum produces neurotoxin that irreversibly inhibit ACh release at the pre-synaptic nerve endings leading to acute descending flaccid paralysis. The incubation period is 12 to 36 hours. It has a 20% high mortality rate. Tx require anti-toxin and mechanical ventilation.

43
Q

What is Enterotoxigenic E. coli infection ?

A

It produces heat-stable and heatlabile toxins and enters the body through Faecal contamination of food or water. It is commonly associated with travel abroad and causes Profuse watery diarrhoea and abdominal cramping. The Dx is made on the basis of ETEC Toxin assay. Tx is mainly hydration and the Abx is avoided if possible.

44
Q

What is C. difficile infection?

A

It is a spore-forming toxinproducing gram-positive anaerobic bacterium that causes antibiotic-associated colitis. It presents as a spectrum of symptoms ranging from watery to bloody diarrhoea, Afebrile to febrile, abdominal pain and cramping. The Dx is made on PCR stool for organism and toxin. The Tx is given to all patients who are symptomatic and have positive PCR.

45
Q

What is the Tx of Non-severe C. difficile infection?

A

– Fidaxomicin PO

46
Q

What is the Tx of severe C. difficile infection?

A

Vancomycin PO + Metronidazole IV

47
Q

What is the presentation, Dx and Tx of norovirus infection?

A

It is referred to as ‘winter vomiting bug and is highly transmissible. The main sources are Outbreaks in hospitals, nursing homes, schools, creches, cruises and Contaminated food, or waterborne. The presentation is mainly Nausea, vomiting and watery diarrhoea. Viral RNA or antigen detection assays available, but are rarely done. The Tx is only hydration.

48
Q

What is the presentation, Dx and Tx of Rotavirus infection?

A

The source is respiratory and fomite/contaminated
surfaces. Presnets with fever, vomiting, watery diarrhoea and abdominal pain. The Dx is based on EIA & latex agglutination assay of the stool. False-negative rate 50%. The tx is only hydration.

49
Q

What is the vaccination strategy for Rotavirus?

A

– Vaccine has been used routinely in
Ireland since 2016
– 82-94% protection against rotavirus
types
– Two-dose oral vaccine; given at 2
and 4 months
– Must be given prior to 8 months of
age

50
Q

What is the presentation, Dx and Tx of E. histolytica infection?

A

It is protozova that can burrow into the intestinal wall and cause septecmia and liver abscess. The mode of transmission is mainly Faecal-oral. It is usually self limited and asymptomatic. But chronic bloody diarrohea, weight loss, fatigue and abdominal pain can occur. testing is mainly stool antigen and microscopy to detect trophozoites or cysts. The treatment for intestinal disease is metronidazole.

51
Q

What is the presentation, Dx and Tx of G. lamblia infection?

A

It can occur as Waterborne, foodborne,
occasional outbreaks. It presents with Watery diarrhoea, Abdominal cramps and Bloating and foul-smelling stool. Test are mainly to detect ovoid and ellipsoid shaped cysts on microscopy, Stool antigen or nucleic acid detection assays. The Tx is mainly hydration and Abx is reserved for moderate to severe disease.

52
Q

What are the drugs in G. lamblia infection?

A

Tinidazole, nitazoxanide, or
metronidazole

53
Q

What is the presentation, Dx and Tx of cryptosporedium infection?

A

C. parvum and C. hominis are
intracellular protozoan parasites that causes Severe watery diarrhea through Foodborne, waterborne, fecal-oral, prepared foods. The tests are stool microscopy, and PCR. The Tx is mainly hydration and anti-diarrhoeals may be used. Antimicrobials are reserved for the immunocmpromised.

54
Q

What is gastroenteritis ?

A

It is the inflammation of the lining of the stomach, small bowel and large intestines; most cases are infectious but may be due to ingestion of certain drugs or toxins. It causes osmotic diarrhoea due to transudation of fluid and electrolytes into intestinal lumen from the enterocytes.

55
Q

What is the clinical presentation of gastroenteritis ?

A

Acute onset of anorexia ,nausea and vomiting with watery diarrhoea and abdominal pain. Fever and malaise can be present.

56
Q

What are the signs of dehydration seen in gastroenteritis ?

A

– Dry or cracked lips
– Poor skin turgor
– Tachycardia
rare signs are :
– Altered mental status
– Sunken eyes
– Weight loss

57
Q

What are the work-ups in gastroenteritis ?

A
  • Usually history is enough to make clinical diagnosis
  • Rule out bacterial causes with Stool culture, Microscopy and O&P
  • FBC may show elevated WBC (indicating infection)
    – May observe lymphocytosis with viral infection
  • Stool or vomit PCR for viral aetiologies is available but rarely required
58
Q

What is the Tx of gastroenteritis ?

A

The main stay of Tx is oral or IV rehydration. Drug therapy is not required as the symptoms resolves within 24 to 48 hrs and is never done in children. Probiotics can reduce the symptoms by 1 day.

59
Q

What is the definition of Travelers’ Diarrhoea?

A

Development of diarrhoea in individuals from a resource-rich setting during or within 10 days of returning from travel to a resource-limited setting.

60
Q

What is the presentation of Travelers’ Diarrhoea?

A

– Malaise, anorexia, abdominal cramps
– Sudden onset of watery diarrhoea
– Lasts 1 to 5 days

61
Q

What is the Dx approach in Travelers’ Diarrhoea?

A

– Clinical diagnosis, testing not usually required
– Can send stool for culture, microscopy and toxin assay if prolonged symptoms OR bloody diarrhoea OR severe symptoms with fever

62
Q

what is the Tx of Travelers’ Diarrhoea?

A

Fluids are the main stay. Solids can be avoided if nausea or vomiting. Azithromycin for severe disease. Loperamide can be used in mild cases without bloody diarrhoea.

63
Q

What are the preventive measures in Travelers’ Diarrhoea?

A
  • Avoid high-risk foods
  • Wash hands before every meal
  • Water purification
64
Q
A

MSPA- Gastroenterology (14 decks)

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