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Infection > Infectious Diarrhoea > Flashcards

Infectious Diarrhoea Flashcards

1
Q

What is clinical definition of gastro-enteritis?

A
  • three or more loose stools/day - accompanying features
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2
Q

What is dysentery?

A
  • large bowel inflammation, bloody stools
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3
Q

What are the 7 types of faeces on the bristol stool chart?

A

Type 1 - separate hard lumps Type 2 - Sausage shaped but lumpy Type 3 - sausage shaped but cracked Type 4 - like a sausage or snake, smooth Type 5 - soft blobs with clear cut edges Type 6 - fluffy pieces with ragged edges Type 7 - entirely liquid

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4
Q

What are the 4 common causes of gastroenteritis?

A
  • contamination of food stuffs - poor storage of food stuffs - travel related infections - person to person spread
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5
Q

What is the most common causative pathogen of gastroenteritis?

A

Viruses are commonest cause with campylobacter being the commonest bacterial pathogen.

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6
Q

Which pathogen causes the most hospital admissions per year?

A

Although campylobacter is the most common causative pathogen, salmonella causes the most admissions per year (around 2500)

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7
Q

Which food is most commonly linked with food poisoning?

A
  • Poultry meat
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8
Q

Which pathogen causing GE is on the rise?

A

E. Coli

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9
Q

What are the 4 main defences we have against enteric infections?

A
  • Hygiene - Stomach acidity - Normal flora - Immunity
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10
Q

What 3 different types of diarrhoeal infection?

A
  1. Non-inflammatory/secretory (cholera) 2. Inflammatory (shigella dysentery) 3. Mixed picture (c. difficile)
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11
Q

What causes the effects in non-inflammatory diarrhoeal infection?

A

It is secretory toxin mediated: causes rise in cAMP and Cl secretion.

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12
Q

What are the symptoms of non-inflammatory diarrhoea? Tx?

A
  • Frequent watery stools with little abdo pain - oral rehydration salts
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13
Q

What causes the effects in inflammatory diarrhoea?

A

Inflammatory toxin damage and mucosal destruction

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14
Q

What are the symptoms of inflammatory diarrhoea? Tx?

A
  • Diarrhoea, pain and fever - Antimicrobials may be appropriate but rehydration alone is often sufficient
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15
Q

What are RF for food poisoning?

A

BBQ (dietary) Contact Travel history

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16
Q

How long does it take for suspection of infective gastro-enteritis?

A

10-14 days at least, some hospitals will not admit until past this threshold

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17
Q

How do we access hydration?

A

Postural BP Skin turgor Pulse

18
Q

What are common findings on assessment for infective gastro-enteritis in infants?

A

Sunken eyes and cheeks Sunken fontanelles Sunken abdomen Few or no tears Decreased skin turgor Dry mouth

19
Q

What is lost from the body during severe secretory diarhoea?

A

1-7 l fluid per day containing 80-100 mmol Na Hyponatraemia due to sodium loss with fluid replacement by hypotonic solutions Hypokalaemia due to K loss in stool (40-80mmol/l of K in stools)

20
Q

What are the investigations for diarrhoea?

A

3 stool cultures until satisfied. Blood are rarely positive Renal functions will check how sodium is doing Haemolysis is useful as will show haemolytic anaemia

21
Q

DDx for diarrhoea?

A
  • IBD - Spurious diarrhoea (secondary to constipation) - Carcinoma
22
Q

Tx for diarrhoea?

A

Depending on severity - oral rehydration salts (H2O + salt + glucose) - IV fluids

23
Q

What are symptoms of campylobactor infection?

A

abdominal pain can be severe <1% invasive

24
Q

How are different strains of pathogen identified?

A
  • difficult to find pathogen in the midst of complex normal flora - selective and enrichment methods of culture necessary - variety of media and incubation conditions - takes 3 days to complete all tests
25
Q

What are signs and symptoms of salmonella gastroenteritis?

A
  • symptom onset usually <48 hrs after exposure - diarrhoea usually lasts <10 days - <5% positive blood cultures - 20% patients still have positive stools at 20/52 - Prolonged carriage may be associated with gallstones - Post-infectious IBS is common
26
Q

How can we differentiate out the different sub-species of salmonella?

A

Salmonella is a non-lactose fermenter Salmonella remains a beige colour on agar Only way to separate out sub-species of salmonella is by looking at the antigens

27
Q

What are the most common strains of salmonella in the UK?

A

Salmonella enteritidis and Salmonella typhimurium

28
Q

How does E. Coli spread?

A

contaminated meat or person-to-person spread (low incoulum)

29
Q

What is E coli illness characterised by?

A

Typical illness characterised by frequent bloody stools

30
Q

What can the E. coli toxin cause?

A

Toxin can cause hemolytic-uraemic (HUS) syndrome (haemolytic anaemia and renal failure). HUS: renal failure, haemolytic anaemia and thrombocytopenia. Treatment supportive – antibiotics NOT indicated

31
Q

When are antibiotics indicated in gastroenteritis?

A

immunocompromised severe sepsis or invasive infection valvular heart disease chronic illness diabetes

32
Q

What causes a clostridium difficile infection?

A

Some gut bacteria will be effected by antibiotics – this causes inbalance which will allow c diff infection

33
Q

What are the main drivers of inflammation on a c.diff infection?

A

Produces toxins which are thought to be the main drivers of inflammation

34
Q

How can we avoid c.diff infection?

A

Reduction in broad spectrum antibiotic prescribing Avoid 4 Cs – cephalosporins, co-amoxiclav, clindamycin, clarithromycin

35
Q

What is the management of c.diff infection?

A

Stop precipitating antibiotic (if possible) Follow published treatment algorithm – oral metronidazole if no severity markers Oral vancomycin if 2 or more severity markers

36
Q

What is a protozoa?

A

single cell parasite

37
Q

What is a helminth?

A

worm parasite

38
Q

How do we diagnose parasites?

A

Send stool with request “parasites, cysts and ova please” or P, C and O

39
Q

What is the UK parasite? How does it infect and what are the symptoms?

A

Giardia Lamblia - contaminated water - diarrhoea, malabsorption and failure to thrive

40
Q

What are the causes of viral diarrhoea?

A

Adenovirus Rotavirus in children under 5 Norovirus

41
Q

How is norovirus diagnosed?

A

Diagnosis by PCR - ward closures are common - strict infection measures needed

Infection (12 decks)

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