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Year 3 > Infectious Diarrhoea > Flashcards

Infectious Diarrhoea Flashcards

1
Q

define diarrhoea

A

subjective

fluid and frequent stools

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2
Q

define gastroenteritis

A

objective

3 or more loose stools per days and companying features

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3
Q

define dysentery

A

obvious with large bowel inflammation and bloody stools

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4
Q

what may cause gastroenteritis?

A

contaminated food e.g. chicken and campylobacter
poor storage of produce
travel related e.g. salmonella
person to person spread - norovirus

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5
Q

what is the most common foodborne pathogen?

A

campylobacter

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6
Q

what is the pathogen linked to the most hospital admissions?

A

salmonella

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7
Q

commonest organisms causing gastroenteritis in scotland (3)

A

campylobacter
salmonella
e. coli O157

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8
Q

what defences do we have against enteric infections?

A

hygiene
stomach acid
normal flora
immunity

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9
Q

clinical features of non-inflammatory/secretory diarrhoea

A

secretory toxin mediated
frequent watery stools with little abdo pain
rehydration

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10
Q

example of non-inflammatory/secretory diarrhoea

A

cholera

enterotoxigenic e. coli ETEC

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11
Q

mechanism of diarrhoea in cholera

A

increased cAMP levels and Cl secretion

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12
Q

example of inflammatory diarrhoea

A

shigella

dysentery

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13
Q

clinical features of inflammatory diarrhoea

A

inflammatory toxin damage and mucosal destruction causing pain and fever
bacterial infection/amoebic dystenery
antimicrobials may be appropriate but rehydration alone often enough

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14
Q

what may cause mixed non-inflammatory and inflammatory diarrhoea

A

C. diff

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15
Q

assessing a patient with diarrhoea

A

symptoms and duration
risk of food poisoning
assess hydration
features of inflammation

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16
Q

it is unlikely to be infective gastroenteritis if it lasts longer than?

A

2/52

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17
Q

fluid and electrolyte losses in diarrhoea

A

These can be severe with secretory diarrhoea – 1-7l/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).

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18
Q

investigations in diarrhoea

A 
stool culture
blood culture
renal function
blood count - neutrophilia, haemolysis
AXR if abdomen distended and tender
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19
Q

differential diagnosis for infective diarrhoea

A

IBD
spurious diarrhoea secondary to constipation
carcinoma

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20
Q

diarrhoea and fever can occur with sepsis outside the gut. what make this more likely?

A

lack of abdo pain and tenderness goes against gastroenteritis
no blood or mucus in stool

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21
Q

treatment of infective diarrhoea

A

rehydration
oral with salt/sugar
iv saline

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22
Q

incubation period of campylobacter

A

7 days

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23
Q

when will stool samples be negative for campylobacter?

A

6 weeks

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24
Q

severity of abdo pain in campylobacter

A

severe

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25
Q

post infection sequelae of campylobacter

A

Guillain-Barre syndrome

Reactive arthritis

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26
Q

what makes it difficult to find a pathogen in stool cultures?

A

normal flora

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27
Q

how long does it take to complete all tests in a stool culture?

A

3 days

28
Q

common strains of campylobacter

A

c. jejuni

c. coli

29
Q

how long after exposure do symptoms of salmonella develop?

A

<48 hrs

30
Q

how long does diarrhoea in salmonella gastroenteritis last?

A

<10days

31
Q

20% of patients with salmonella gastroenteritis will still have +ve stools after how long?

A

20/52

32
Q

what is prolonged carriage of salmonella associated with?

A

gallstones

33
Q

what condition is common after salmonella gastroenteritis?

A

post-infectious irritable bowel

34
Q

culturing salmonella

A
  • Screened out as lactose non-fermenters then antigen and biochemical tests
  • Thousands of species with individual names
  • Genetically most are serotypes of the same species – salmonella enterica
35
Q

what salmonella species cause enteric fever and not gastroenteritis?

A

s. typhi and s. paratyphi

36
Q

how is e. coli O157 spread?

A

contaminated meat

person to person

37
Q

typical illness in e. coli O157

A

frequent bloody stools

38
Q

what does e. coli O157 produce?

A

verocyto toxin

39
Q

e. coli stays in the gut, where does the toxin go?

A

blood

40
Q

the e. coli O157 toxin can cause?

A

haemolytic uraemic syndrome

41
Q

what is HUS? and how to treat

A

characterised by renal failure, haemolytic anaemia and thrombocytopenia
o Treatment supportive no antibiotics
o Toxin binds to globotriaosylceramide
o Platelet activation stimulated
o Micro-angiopathy results
o Attach to endothelial glomerular tubule and mesangial cells

42
Q

what other bacteria may cause diarrhoea?

A 
shigella
other forms of ecoli: enteropathogenic, enterotoxic, enteroinvasive
staph aureus
bacillus cereus
clostridium perfringens
43
Q

when are antibiotics indicated for gastroenteritis?

A 
immunocopromised
severe sepsis or invasive infection
valvular heart disease
chronic illness
diabetes
44
Q

clostridium difficile infection is commonly associated with what antibiotics?

A

clindamycin
cephalosporins
co-amoxiclav
ciprofloxacin

45
Q

severity of diarrhoea in clostridium difficile

A

mild to severe colitis

46
Q

what does clostridium difficile produce?

A

enterotoxin and cytotoxin

47
Q

treatment of clostridium difficile

A 
metronidazole
oral vancomycin
fidaxomicin
stool transplant
surgery
48
Q

prevention of clostridium difficile

A

reduce broad spectrum
isolate symptomatic patients
wash hands

49
Q

what parasites may cause diarrhoea?

A

protoza and helmonths
giardia lamblia
cryptosporidium parvum
entamoeba histolytica

50
Q

parasite diarrhoea diagnosis

A

generally by microscopy

51
Q

where is girardia lamblia found?

A

contaminated water

52
Q

what does girardia lamblia cause?

A

diarrhoea, malabsorption, failure to thrive

53
Q

where may a vegetive form of girardia lamblia be found?

A

duodenal bioposy

54
Q

what is seen on stool microscopy of girardia lamblia?

A

cysts

55
Q

treatment of girardia lamblia

A

metronidazole

56
Q

where is cryptosporidium parvum found?

A

contaminated water - animal faeces

57
Q

what is seen on stool microscopy of cryptosporidium parvum?

A

cysts

58
Q

treatment of cryptosporidium parvum

A

none

59
Q

entamoeba histolytica causes?

A

amoebic dysentery

60
Q

long term complication of entamoeba histolytica

A

amoebic liver abscess - anchovy pus

61
Q

treatment of entamoeba histolytica

A

metronidazole

62
Q

causes of viral diarrhoea

A

adenovirus
norovirus
rotavirus

63
Q

most common cause of viral diarrhoea in children under 5

A

rotavirus

64
Q

how is viral diarrhoea diagnosed?

A

antigen detection

65
Q

when is viral diarrhoea most common?

A

winter

66
Q

where does norovirus commonly cause outbreaks?

A

hospital
community
cruise ships

67
Q

diagnosis of norovirus

A

PRCR

Year 3 (164 decks)

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