Lecture 13 - gastrointestinal

Question 1

Symptoms of gastroenteritis

Answer 1

diarrhoea > 3 loose per day +- nausea and vomiting +- abdo pain +- fever

Question 2

1) what is dysentery ?

2) what is classed as chronic diarrhoea?

Answer 2

1) bloody diarrhoea specifically form an infection

2) diarrhoea over 3 weeks

Question 3

Common causes of desentry?

Answer 3

NOT VIRUS - entamoeba histolytica, campylobacter, salmonella shingella e coli c. diff

Question 4

What bacteria is pseudomembranous colitis associated with?

Answer 4

c. diff

Question 5

Name some possible diagnosis for chronic diarrhoea?

Answer 5

IBS, diverticular disease (muscle spasms in colon), ischaemic colitis (tender abdo), colorectal carcinoma (other symptoms may be present like weight loss) malabsorbtion (celiac), extra-intestinal infection e.g. pneumonia

Question 6

What would stool samples be analysed for with diarrhoea?

Answer 6

rotavirus, culture, microscopy (ova cysts and parasytes),c diff toxin and PCR

Question 7

What does it mean if a patient with diarrhoea has a positive PCR c diff but a negative toxin

Answer 7

if they are a carrier but its not the cause of diarrhoea

Question 8

How would you manage diarrhoea

Answer 8

rehydration (oral or iv), analgesia (paracetamol), antiemetics, avoid antidiarrhoeal agents, isolation, notify public health, avoid return to work/ school

Question 9

How would you manage suspected travellers diarrhoea?

Answer 9

ciprofloaxin as 80% is due to bacteria. 500mg stat or 500mg bd for 5 days. reduces duration if started early.

Question 10

How would you manage suspected travellers diarrhoea thats not responding to cipro or confirmed parasite?

Answer 10

• metrondiazole for giardida (sometimes steatorrhoea) and entamoeba histolytica (dysentery)
• nitazoxanide if needed for cryptosporidium in immunocompromised

Question 11

Discuss the pros of antibiotics in acute gastroenteritis. and who would you prescribe them to

Answer 11

1) shortens duration by 1-2 days if started early (especially in travellers)
2) the elderly, travellers and the severally ill

Question 12

what would you prescribe for campylobacter gastroenteritis if you had to prescribe an antibiotics

Answer 12

erythromicin

Question 13

Name the negatives of starting antibiotic therapy in acute gastroenteritis

Answer 13

can cause antibiotic associated diarrhoea, risk of adverse drug events e.g. rash, prolong the duration of carriage by killing normal flora e.g. salmonella, can potentially increase complications e.g. e.coli 1057 and HUS

Question 14

What is the link between antibiotics and E.coli 0157 HUS

Answer 14

-some studies proven Abx therapy can cause but other studies shown no link. HUS develops in 15% of 0157 and causes haemolytic anaemia and
thrombocytopenia which can lead to renal failure

Question 15

name three methods of oral rehydration of GE

Answer 15

special solution with water salt and sugar, cereal bases rehydration solution and breast feeding

Question 16

What is the benefit of probiotics in GE diarrhoea?

Answer 16

some benefit in preventing antibiotic associated diarrhoea but not great evidence. less effective in treating established diarrhoea