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Infections > Infectious diarrhoea > Flashcards

Infectious diarrhoea Flashcards

1
Q

How is diarrhoea defined?

A

Increased frequency and fluidity as defined by the patient - subjective

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2
Q

How is gastro-enteritis defonined?

A

Objectively defined as 3 or more loose stools per day with accompanying features

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3
Q

What accompanying features come with gastro-enteritis?

A

Abdominal pain

Blood in stool

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4
Q

What is dysentry?

A

Large bowel inflammation with blood stools

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5
Q

What are the 7 stages on the bristol stool chart?

A
  1. Seperate hard lumps
  2. Sausage shaped but lumpy
  3. Sausage shaped with cracks on the surface
  4. Like a sausage, smooth and soft
  5. Soft blobs with clear cut edges
  6. Fluffy pieces with ragged edges - mushy
  7. Entirely liquid
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6
Q

What is the epidemiology of gastro-enteritis?

A

Contamination of food stuffs
Poor storage of produce
Travel related infections
Person to person spread

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7
Q

What is the most common bacterial organism to cause gastroenteritis?

A

Campylobacter

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8
Q

What food is the most common cause of food poisoning?

A

Undercooked chicken

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9
Q

What is the most common cause of GI infection?

A

Viruses

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10
Q

What pathogen causes the most food poisoning hospital admissions each year?

A

Salmonella

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11
Q

What defences do we have against enteric infections?

A

Hygiene
Stomach acidity
Normal gut flora
Immunity

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12
Q

What can have adverse effects on stomach acidity’s effect on defence against enteric infections?

A

Antacids and infections - raise pH

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13
Q

What are the 2 main types of diarrhoeal illness?

A

Secretory/non inflammatory - cholera

Inflammatory - Shigella dysentry

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14
Q

What is the difference between secretory and inflammatory diarrhoea at presentation?

A

Secretory is enormous volumes of watery stool with generally no other systemic upset, inflammatory may have other symptoms such as blood in the stool

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15
Q

What is the mechanism for secretory diarrhoea?

A

Secretory toxin-mediated - Increased cAMP levels and chloride secretion

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16
Q

How is non inflammatory diarrhoeal illness treated?

A

Rehydration - little role for antimicrobials

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17
Q

How does inflammatory diarrhoea typically present?

A

Diarrhoea with abdominal pain and fever

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18
Q

How is inflammatory diarrhoea treated?

A

Rehydration alone is often sufficient but antimicrobials may also be appropriate

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19
Q

How long does a gastroenteric infection typically last?

A

Less than 2 weeks

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20
Q

What drop in postural blood pressure would you indicate dehydration?

A

20mmHg from lying to standing

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21
Q

What should you assess patients for when they present?

A

Symptoms and their duration
Risk of food poisoning
Hydration
Features of inflammation

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22
Q

What factors could put a patient at risk of food poisoning?

A

Diet
Contact
Travel history

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23
Q

How is hydration of patients assessed?

A

Check postural change in BP
Skin turgor
Pulse - check for tachycardia

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24
Q

What features of inflammation would you look for in a patient?

A

Fever

Raised WCC

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25
Q

What features would a dehydrated infant show?

A 
Sunken eyes and cheeks
Sunken fontanelle
Few/no tears
Decreased skin turgor
Dry mouth or tongue
26
Q

Why is it important to make sure fluid given to patients with secretory diarrhoea has plenty of electrolytes?

A

They lose a lot of electrolytes as a result of cAMP activating so these must be replaced to avoid hyponatraemia

27
Q

What assessments can be done on the patient?

A 
Stool culture
Blood culture
Renal function
Blood count
Abdominal X-Ray/CT if distended or tender abdomen
28
Q

What blood counts should be done?

A

Neutrophilia
Haemolysis
Electrolytes

29
Q

How many stool samples is typically recommended for culture?

A

3

30
Q

Why should imaging be done on a patient with distension/tenderness?

A

They may be at risk of perforation

31
Q

What are differential diagnoses for infectious diarrhoea?

A

IBD
Spurious diarrhoea - secondary to constipation
Carcinoma
Diarrhoea can occur with sepsis outside the gut

32
Q

What would differentiate diarrhoea caused by sepsis?

A

Lack of abdominal pain/tenderness

No blood/mucous in stool

33
Q

What is oral rehydration therapy?

A

Drinking water with salts to restore both fluid and electrolyte balance

34
Q

Why does oral rehydration have glucose in it?

A

Not all salt would be absorbed, but the gut has a sodium glucose cotransporter, which allows more sodium to be absorbed with glucose

35
Q

What are characteristics of campylobacter gastroenteritis?

A

7 days incubation, dietary history may be unreliable
Stools negative within 6 weeks
Can have severe abdominal pain
Almost never invasive into blood

36
Q

What condition can happen post infection of campylobacter?

A

Guillan Barre syndrome

37
Q

How is culture done to determine if an infectious organism is present?

A

Growing culture in a variety of media and incubation conditions and takes 3 days to complete all tests

38
Q

What are characteristics of salmonella gastroenteritis?

A

Symptom onset within 48 hours of exposure
Diarrhoea lasts less than 10 days
Around 5% of cases have positive blood cultures
Many patients still have positive stools at 20 weeks

39
Q

What is associated with prolonged carriage of salmonella?

A

Gallstones

40
Q

What are the 2 main species in the salmonella genus?

A

S.enterica

S.bongori

41
Q

How is salmonella screened in the lab?

A

It is a lactose non-fermenter

42
Q

How is E.coli O157 spread?

A

Contaminated meat or person to person spread

43
Q

Why do blood cultures come up negative with E.coli O157 even with symptoms of sepsis?

A

The organism stays in the gut - its toxin gets into the blood

44
Q

What is a major complication of E.coli O157 toxin being in the blood?

A

It can lead to Haemolytic uraemic syndrome

45
Q

What is Haemolytic Uraemic Syndrome (HUS)?

A

Haemolytic anaemia and renal failure

46
Q

Why are antibiotics contraindicated with E.coli O157?

A

Because they cause the organism to lysis and release greatly higher quantities of toxin

47
Q

What are common bacteria that cause infectious diarrhoea?

A

Campylobacter
Salmonella
E.coli O157
Shigella

48
Q

What patients with infectious diarrhoea should receive antibiotics?

A

Immunocompromised
Severe sepsis
Patients with chronic illness

49
Q

How do C.difficile diarrhoea cases typically present?

A

History of previous antibiotic treatment

Severity ranges from mild to severe

50
Q

How is C.difficile treated?

A

Metronidazole
Oral vancomycin
Fidaxomicin
Stool transplant

51
Q

Why is vancomycin taken orally for C.difficile but IV for almost everything else?

A

It is very poorly absorbed, meaning it stays in the gut and has little systemic effect but a great effect on the C.difficle

52
Q

How can C.difficile infection be prevented?

A

Reduce broad spectrum antibiotic prescribing
Isolate symptomatic patients
Wash hands with soap between patients
Cleaning environment

53
Q

What are the 4Cs of antibiotics that increase C.difficile risk?

A

Cephalosporins
Co-amoxiclav
Clindamycin
Ciprofloxacin

54
Q

How are protozoa infections diagnosed?

A

Microscopy - Parasites, cysts, and ova

55
Q

What are symptoms of giardia duodenalis infection?

A

Diarrhoea
Gas
Malabsorption
Failure to thrive

56
Q

How is Giardia duodenalis infection treated?

A

Metronidazole

57
Q

What are symptoms of cryptosporidium parvum?

A

Diarrhoea
Nausea and vomiting
Abdo pain

58
Q

How is viral diarrhoea diagnosed?

A

Antigen detection in stool

59
Q

Where is norovirus commonly picked up?

A

Hospitals
Schools
Care homes
Cruise ships

60
Q

How is norovirus diagnosed?

A

PCR

Infections (14 decks)

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