Sepsis and gastroenteritis Flashcards
what is the def of sepsis?
a life threatening organ dysfunction caused by a dysregulated host response to an infection
what is the SIRS criteria?
Temp >38.3 or <36.0 Tachycardia >90bpm Tachyapnoea >20 or PCo2 <4.3kPa hyperglycaemia in absence of DM Confusion Leucocytosis >12 or leucopenia <4
what is the qSOFA criteria?
Confusion
Tachyapnoea >22
hypotension SBP <100mmHg
0 or 1 = not high risk
2-3 = high risk
what is sepsis 6?
o2 fluids Abx Lactate Urine output Cultures
Give 3 take 3
what investigations are useful in sepsis?
blood cultures lactate Hourly UO FBC ABG/VBG CRP Procalcitonin ECG - arrhythmias Urinalysis
What kind of bacteria is camplyobacter? how is camplybacter acquired?
Curved gram negative bacilli
contaminated poultry, milk or water
how does camplyobacter present and how is treated?
Bloody diarrhoea, cramping abdo pain, fever
Vomiting UNCOMMON
duration 2-10 days
fluid replacement for most
clarithromycin for severe
ciprofloxacin or gent for invasive
What type of bacteria is salmonella? how does it present?
Gram negative bacilli
Watery diarrhoea and vomiting
fever in invasive disease
can cause osteomyelitis, septic arthritis, meningitis
how is severe salmonella treated?
ciprofloxacin
what type of bacteria is shigella? how does it spread?
gram negative bacilli
faeco-oral
how does shigella present? what is a major complication?
watery diarrhoea followed by bloody diarrhoea
marked cramping abdo pain
fever
vomiting uncommon
Haemolytic uraemic syndrome
how does vibrio cholerae (cholera) infection present? how is treated?
comma shaped gram negative bacilli
faeco oral
Profuse watery diarrhoea (rice water stool)
electrolyte loss
rehydration
doxycycline
how does E.coli 0157:H7 present?
bloody diarrhoea with abdo pain and vomiting
Haemolytic uraemic syndrome in 5-10%
what is haemolytic uraemic syndrome?
Microangiopathic haemolytic anaemia
thrombocytopenia
renal failure
what type of food does staph auerus multiply in?
cooked meat, cakes, pastries
what bacteria is associated with fried rice related gastroenteritis?
bacillus cereus
can get emetic or diarrhoeal disease
what complications can arise from clostridium botulinium infection?
gram positive bacilli
neuromuscular blockade - flaccid paralysis and progressive muscle weakness
resp failure if diaphragm involved
which gram positive coccobacilli thrives in unpasteurised milk and soft cheese, pate and cooked meats? It causes a flu-like illness
listeria monocytogenes
how is listeria monocytogenes treated?
IV ampicillin and Gent
how is gastroenteritis investigated?
stool sample and culture - PCR
which pathogens cause bloody diarrhoea?
Camplyobacter, E. Coli and Shigella
how does norovirus present and how is it treated?
acute onset vomiting
watery diarrhoea
cramps and nausea
headache and fever in some
Oral/IV fluids
Antispasmodics
Analgesic and anti-pyretics
isolate and cohort
which ABx can cause C. Diff?
Clindamycin
Cephalosporins i.e cefriaxone
Co-amoxiclav
Ciprofloxacin
what are the S&S of C.Diff?
watery diarrhoea Abdo pain and tenderness fever N&V recent ABx
how is C. Diff investigated?
FBC
- leucocytosis
Stool PCR
- positive for C. Diff
AXR
- ordered in distension to check for dilation
Sigmoid/colonoscopy
- pseudomembrane or colitis
- pseudomembrane looks like raised yellow and white plaques agaisnt an inflamed mucosa
what are the C. Diff severity markers?
Colonic dilation >6cm WCC >15 Creatinine >1.5x baseline Temp >38.5 Immunosupression
how is C. Diff treated?
0 sev markers = metronidazole
> 1 sev markers = oral Vancomycin
Stop offending Abx
Surgery if complications
Faecal microbiota transplant if recurrent
what are the complications of C. Diff? How are they diagnosed and treated?
Ileus - worsening N&V, AXR shows dilation. NG tube and supportive therapy
Perf and peritonitis - acute abdo pain and rebound tenderness. High grade fever with shock. IV met and Vanc
toxic megacolon - increased abdo pain, distension and shock. IV met and Vanc. Colectomy
