GI infections - CDiff, Diverticulitis, Gastroenteritis, Mesenteric adenitis Flashcards
CDiff
-pathophysiology
-risk factors
-presentation
-investigations
-management
Anerobic G+ve spore/toxin producing bacillus
Fecal oral ingestion of spores
Exotoxins => act on inflammatory cells, causing colitis
Clindamycin
Cephalosporins
Coamox
Ciprofloxacin
PPIs
Diarrhoea
Abdo pain
High WCC
May have
-fever
-evidence of severe colitis (abdo/radiological signs)
-low BP
-partial/complete ileus
-toxic megacolon
CDiff toxin in stool
-antigen only shows exposure to bacteria
REVIEW CURRENT ABx and STOP IF NEEDED
1st line - PO vancomycin 10days
2nd line - PO fidoxomicin
3rd line - PO vancimycin +- IV metronidazole
-if life threatening - PO vanc + IV metronidazole
If recurrent
-PO fidoxomicin within 12wks of symptoms resolution
-PO vancomycin/fidaxomicin after 12wks of symptom resolution
Diverticulosis, diverticular disease, diverticulitis
-risk factors
-management
-complications
Multiple outpouchings of bowel wall (mainly sigmoid colon)
Age
Low fibre diet
Diverticular disease if symptomatic
-altered bowel habit
-colicky LIF pain
Diverticulitis if infected
-LIF pain, tender
-anorexia, N+V+D
-infection features - fever, high WCC, CRP, HR
Confirmed with CT
Mild - PO ceftriaxone+metronidazole, liquid diet, pain relief
Severe or no change in 72hrs => IV ceftriaxone+metronidazole, IP
Infectious gastroenteritis
-causative organism
-risk factors
-presentation
-investigations
Viral infection => inflammation of stomach and small intestine
Adults - norovirus, no lifelong immunity
Children - rotavirus, gives lifelong immunity
Fecal oral spread/envrionmental contamination
Close contact with infected individual
-viral particles are shed in feces after 24hrs of symptoms
Self limiting, lasts U14days
-non bloody diarrhea 3+/day for U14 days
-vomiting
-mild fever (if 38+ in children => urgent IP)
-abdo pain
Assess degree of dehydration
If fever very high, bloody diarrhoea, 14+days => could be bacterial
Admit if fluid resus needed/risk of dehydration
Symptomatic support at home
-fluids, electrolytes, meals as per appetitte
Limit spread
-wash hands
-don’t share towels
-wash soiled clothes separately
-disinfect high contact surfaces
STAY AT HOME UNTIL 48HRS AFTER V+D HAVE STOPPED
Mesenteric adenitis
-pathophysiology
-presentation and risk factor
-investigations
-management
Common cause of abdo pain in children
Acute/chronic inflammation of mesenteric LN
- mainly due to PO viruses => enter gastric lymphatic system
LN enlargement => RIF pain and guarding
-often preceding illness
-fever
-N+V+D
Abdo US - help differentiate from appendicitis
Self limiting, resolving within 4wks
-hydration, analgesia
Gastroenteritis - ecoli
-presentation
-sources
-investigations
-management
-complications
Abdominal cramps + diarrhoea
Can be bloody
-travellers diarrhoea is non-bloody
Contaminated beef, milk
Clinical diagnosis, stool test
Conservative
Can lead to HUS
Gastroenteritis - giardiasis
-presentation
-sources
-investigations
-management
Abdominal cramping + diarrhoea + gassy
Drinking, eating contaminated food and water
Contact with stool from infected people
Clinical diagnosis, stool test
Metronidazole
Gastroenteritis - cholera
-presentation
-sources
-investigations
-management
1-3 days => Sudden painless watery diarrhoea + vomiting => can lead to severe dehydration within hours
-rice water diarrhoea
Contaminated food (shellfish), water with infected stool
Inadequate sanitation
Stool culture
U&E - dehydration and kidney function
ORS
ABx - doxy, cipro
Gastroenteritis - shigella
-presentation
-sources
-investigations
-management
Painful abdo cramps + watery diarrhoea, tenesmus
Inadequate sanitation
Contaminated water
Stool culture
ORS
ABx - azithromycin, cipro, ceftriaxone
Gatroenteritis - staph aureus
-presentation
-sources
-investigation
-management
Abrupt onset within 30mins + nausea/vomiting + cramping
Duration - 1 day
Contaminated foods
Clinical diagnosis
Conservative - fluids
Gatroenteritis - campylobacter
-presentation
-sources
-investigation
-management
2-5 days post-exposure => can be bloody diarrhoea + nausea, vomiting + high fever + muscle aches
Duration - 1 week
Contaminated water, raw milk, undercooked meat
Stool culture
Conservative, self resolving
Can use ABx - axithromycin
Gastroenteritis - bacillus cereus
-presentation
-sources
-investigation
-management
Emetic syndrome - 30mins-6hrs onset
Diarrhoea syndrome - 8-16hrs onset, abdo pain, diarrhoea
Undercooked/reheated rice
Self resolving in 24hrs
Conservative
Gastroenteritis - amoebiasis
-presentation
-sources
-investigation
-management
-liver abscess presentation and investigations
Majority are asymptomatic, long incubation period
Profuse bloody diarrhoea + crampy abdo pain + weight loss, fever
Fecal oral route
Poor sanitation
Stool tests
Metronidazole + diloxanide furoate
Liver abscess - single mass in right liver lobe
-fever
-RUQ pain
-systemic unwell
-hepatomegaly
US and serology
PO metronidazole + diloxanide furoate
