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Infection > Infective Diarrhoea > Flashcards

Infective Diarrhoea Flashcards

1
Q

define diarrhoea

A

fluidity and frequency of stools

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2
Q

define gastro-enteritis

A 
3 or more loose stools a day plus one of:
> fever
> vomiting
> pain
> blood or mucus in the stools
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3
Q

define dysentery

A

this is inflammation of the bowel resulting in bloody stools

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4
Q

what are the defences (both internal and external) against enteric infections?

A 
> hygiene
> stomach acid
> normal flora
> immunity
> gut motility
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5
Q

what is the commonest cause of infective diarrhoea?

A

viruses (campylobacter)

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6
Q

what causes the most hospitalised cases of infective diarrhoea?

A

salmonella

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7
Q

what percentage of the population have infective diarrhoea each year?

A

25%

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8
Q

describe the presentation of non-inflammatory diarrhoea

A

> frequent watery stools

> little abdominal pain

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9
Q

true or false:

non-inflammatory diarrhoea is secretory toxin mediated

A

true

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10
Q

how does cholera cause non-inflammatory diarrhoea?

A

increase cAMP levels and chlorine secretion

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11
Q

does E.coli cause inflammatory or non-inflammatory diarrhoea?

A

non-inflammatory (via enterotoxins)

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12
Q

list 3 things you would want to clarify in the history of presenting complaint in a patient with diarrhoea?

A

> duration of symptoms
frequency
stool quality

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13
Q

what are the risk factors for infective diarrhoea?

A 
> contaminated food
> occupation
> travel
> antibiotics
> institutionalisation
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14
Q

what should you look for when examining a patient for dehydration?

A

> pulse
skin turgor
urine output
muscle cramps

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15
Q

what investigations could you carry out in infective diarrhoea?

A 
> stool culture (3)
> blood culture
> sigmoidoscopy
> x-ray (distension and tenderness)
> serology
> blood count (haemolysis)
> renal function
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16
Q

what is the differential diagnosis for a patient presenting with these symptoms?

A

> inflammatory bowel disease
carcinoma
sepsis outside the gut
spurious diarrhoea

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17
Q

what post infection sequelae can occur in campylobacter infections?

A

> Gillian barre syndrome

> reactive arthritis

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18
Q

what is the principle pathogen in campylobacter infections?

A

c jejuni (antigens)

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19
Q

what is the incubation for campylobacter?

A

up to 7 days

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20
Q

true or false

severe abdominal pain is seen in campylobacter infections?

A

true

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21
Q

in what patients may campylobacter infection become invasive?

A

in the immunocompromised

22
Q

what is the symptom onset time for salmonella?

A

<48hrs

23
Q

how long does infective diarrhoea from salmonella usually last?

A

<10 days

24
Q

what is prolonged carriage of salmonella bacteria associated with?

A

gallstones

25
Q

true or false

post infective IBS is not associated with salmonella infection

A

false it is relatively common

26
Q

what symptoms would you expect to see in an E.coli 0157 infection?

A

frequent bloody stools

27
Q

does the E.coli bacteria enter the blood stream?

A

no but the shigella like toxin it produces does

28
Q

what syndrome does the SLT produced by E.coli cause?

A

haemolytic uremic syndrome

29
Q

in what patients in haemolytic uremic syndrome a problem in?

A

children and the elderly

30
Q

what does haemolytic uremic syndrome cause?

A

> anaemia
renal failure
thrombocytopenia

31
Q

what is the treatment for E.coli 0157?

A

supportive (not antibiotics)

32
Q

what is the reservoir for E.coli 0157?

A

cattle

33
Q

what can complicate a shigella infection?

A

> haemolytic uremic syndrome

> seizures

34
Q

true or false

shigella is an infection of childhood and travel

A

true

35
Q

what 3 organisms are the commonest cause for traveller diarrhoea?

A

> E.COLI
campylobacter
shigella
?staph aureus??

36
Q

when are antibiotics not indicated in gastroenteritis?

A

a healthy patient with a non-invasive infection

37
Q

when are antibiotics indicated in gastroenteritis?

A 
> immunocompromised
> severe sepsis
> invasive
> valvular heart disease
> chronic illness
> diabetes
38
Q

what does clostridium difficile produce?

A

enterotoxin and cytotoxin

39
Q

what does cytotoxin produced by c.diff cause?

A

inflammation and necrosis

40
Q

what is the treatment for c.diff?

A

> metronidazole
oral vancomycin
stool transplant
surgery?

41
Q

what preventative measures exist for c.diff infections?

A

> avoiding the 4 C’s (clindamycin, cephalosporins, co-amoxiclav, clarithromycin)
isolate symptomatic patients
antimicrobial managing team
hand hygeine

42
Q

how are parasite infections diagnosed?

A

microscopy

43
Q

what symptoms and signs does giardia lamblia cause?

A

> smelly diarrhoea
malabsorption
failure to thrive

44
Q

why in a giardia lamblia infection do several stool samples need to be taken?

A

as cysts are shed intermittently

45
Q

what is used to treat a giardia lamblia infection?

A

metronidazole

46
Q

true or false

cryptosporidium parvum is found in contaminated water so its main reservoir is not cattle?

A

false its found in contaminated water and its main reservoir is cattle

47
Q

what can an Entamoeba histolytica infection mimic?

A

ulcerative colitis

48
Q

what is a long term complication of entamoeba histolytica infection?

A

liver abscesses

49
Q

how is an entamoeba histolytica infection treated?

A

metronidazole

50
Q

what is the most common cause of viral diarrhoea?

A

rotavirus

51
Q

what is the transmission of rotavirus?

A

faecal oral

52
Q

how is norovirus diagnosed?

A

PCR

Infection (13 decks)

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