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Infectious Diseases > The Patient with Diarrhoea > Flashcards

The Patient with Diarrhoea Flashcards

1
Q

What is Diarrhoea?

A

Very subjective

Decreased stool consistency from water, fat, or inflammatory discharge.

Characterised by fluidity and frequency

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2
Q

What is gastro-enteritis?

A

3 or more loose stools/day

accompanying features

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3
Q

What is dysentry?

A

Large bowel inflammation, bloody stools

Typically diarrhoea and visible blood

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4
Q

Describe type 1 on the bristol stool chart

A

Separate hard lumps, like nuts (hard to pass)

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5
Q

Describe type 2 on the bristol stool chart

A

Sausage shaped but lumpy

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6
Q

Describe type 3 on the bristol stool chart

A

Like a sausage but with cracks on the surface

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7
Q

Describe type 4 on the bristol stool chart

A

like a sausage or snake, smooth and soft

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8
Q

Describe type 5 on the bristol stool chart

A

Soft blobs with clear cut edges

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9
Q

Describe type 6 on the bristol stool chart

A

Fluffy pieces with ragged edges, a mushy stool

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10
Q

Describe type 7 on the bristol stool chart

A

Watery, no solid pieces

Entirely liquid

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11
Q

What 4 things protect against enteric infections?

A

Hygiene

Stomach acidity

Normal flora

Immunity

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12
Q

What may decrease stomach acidity and therefore increase risk of infection?

A

Antacids (omeprazole and ranitidine) and infection

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13
Q

What may decrease normal flora in the gut and therefore increase risk of infection?

A

Antibiotics (4 C’s) leading to, classically, C. difficile

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14
Q

What are the 3 types of diarrhoea and give a basic example of each?

A

Non-inflammatory/ secretory
-e.g. Cholera

Inflammatory
-e.g. Shigella dysentery

Mixed Picture
-e.g. C. difficile

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15
Q

How is non-inflammatory diarrhoea usually mediated?

Give 2 examples

A

Secretory toxin mediated

  • Cholera (increases cAMP levels and Cl secretion
  • Enterotoxigenic E. coli (travellers’ diarrhoea)
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16
Q

What are the features of non-inflammatory diarrhoea?

A

Frequent watery stools with little abdominal pain

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17
Q

What is the mainstay treatment for non-inflammatory diarrhoea?

A

Rehydration

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18
Q

Give two examples of inflammatory diarrhoea

A

Bacterial Infection

Amoebic dysentery

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19
Q

How does infection cause the symptoms seen in inflammatory diarrhoea?

What are these symptoms?

A

Inflammatory toxin damage and mucosal destruction -> pain and fever

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20
Q

What is the basics of treatment in inflammatory diarrhoea?

A

Antimicrobials may be appropriate but rehydration alone is often sufficient

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21
Q

What duration of symptoms are unlikely to be infective gastro-enteritis?

A

> 2 weeks

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22
Q

How can you assess hydration in an adult?

A

Postural BP

Skin Turgur

Pulse

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23
Q

What are some of the signs of dehydration in babies?

A

Sunken Fontanelle

Few or No Tears

Dry Mouth or Tongue

Sunken Eyes and Cheeks

Decreased Skin Turgur

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24
Q

What investigations do you want to consider in someone presenting with diarrhoea?

A

Stool culture

Blood culture

Renal function

Blood count- neutrophilic, haemolysis

Abdominal X-ray if abdomen distended, tender

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25
Q

What are the differential diagnosis of diarrhoea?

A

Inflammatory bowel disease

Spurious diarrhoea- secondary constipation

Carcinoma

Sepsis outside the gut

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26
Q

Diarrhoea and fever can occur with sepsis outside the gut.

What are the signs and symptoms of this?

A

Lack of abdo pain/tenderness

No blood/ mucus in stools

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27
Q

How do you treat gastro-enteritis?

A

Rehydration

  • Oral rehydration with salt/sugar solution
  • IV saline

?Antimicrobials

Treatment of complications

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28
Q

What do you not give routinely in gastro-enteritis?

A

Antidiarrhoeals

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29
Q

What is the incubation period for campylobacter gastroenteritis?

What does this mean for finding the cause?

A

Up to 7 days incubation so dietary history may be unreliable

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30
Q

When do the stools become negative in campylobacter gastroenteritis?

A

Within 6 weeks

31
Q

What is it about abdominal pain that can point to possible campylobacter gastroenteritis?

A

Abdominal pain can be severe

32
Q

What post infective sequelae may occur with campylobacter gastroenteritis?

A

Guillain-Barre syndrome

Reactive arthritis

33
Q

How many days does it take to complete all tests in routine bacterial culture?

A

3 days

34
Q

What is the commonest cause of bacterial food poisoning in UK?

A

Campylobacter such as C. Jejuni and C. coli

35
Q

Do bacterial food poisoning cases caused by campylobacter occur in isolated cases or outbreaks?

A

Isolated cases

36
Q

What may cause bacterial food poisoning? (campylobacter)

A

Chickens

Historically contaminated milk

Puppies

37
Q

When do symptoms onset after salmonella gastroenteritis exposure?

A

Usually

38
Q

How long does diarrhoea last in salmonella gastroenteritis?

A

Usually lasts

39
Q

What cultures are the best way to catch salmonella gastroenteritis?
(blood or stool)

A

Stool
-20% patients still have positive stools at 20 weeks

-

40
Q

What post infective sequelae is common with salmonella gastroenteritis?

A

Post-infective irritable bowel

41
Q

How is salmonella identified in routine bacterial culture?

A

Screened out as lactose non-fermenters

-Then antigen and biochemical tests

42
Q

How does E.coli O157 spread?

A

Contaminated meat or person-to-person spread

43
Q

How is E.coli O157 typically spotted (symptoms)?

A

Typical illness characterised by frequent bloody stools

44
Q

What toxin does E.coli O157 produce?

A

Verocyto-toxin

45
Q

Where does verocytotoxin go once it is released?

A

E.coli O157 stays in the gut but the toxin gets into the blood

46
Q

What syndrome can verocytotoxin cause?

A

Toxin can cause hemolytic-uraemic syndrome (HUS = haemolytic anaemia and renal failure)

47
Q

How does verocytotoxin cause Haemolytic-uraemic syndrome?

A

Toxin binds to globotriaosylceramide

Platelet activation stimulated

Micro-angiopathy results

Attach to endothelial, glomerular, tubule and mesangial cells

48
Q

What other forms of E.coli cause diarrhoea?

not O157

A

Enteropathogenic

Enterotoxic (travellers diarrhoea)

Enteroinvasive

49
Q

How many species of shigella are there?

A

4

50
Q

What bacteria may cause occasional food poisoning outbreaks?

A

Staph aureus (toxin)

Bacillus cereus (re-fried rice)

Clostridium perfringens (toxin)

51
Q

When are antibiotics indicated in gastroenteritis?

A

Immunocompromised

Severe sepsis or invasive infection

Valvular heart disease

Chronic illness

Diabetes

52
Q

What does the severity of Clostridium difficile diarrhoea range between?

A

Mild diarrhoea to severe colitis

53
Q

What does C. Diff produce?

A

Enterotoxin (A)

Cytotoxin (B)

54
Q

How do you treat C. Diff?

A

Stop precipitating antibiotic (if possible)

Oral Metronidazole (if no severity markers)

Oral Vancomycin (if 2 or more severity markers)
-The ONLY disease you give oral vancomycin

Surgery may be required

55
Q

What is pathognomonic for C. Diff?

A

Pseudomembranous colitis

56
Q

What are the 4 C’s associated with C. Diff infection?

A

Cephalosporins
Co-amoxiclav
Clindamycin
Clarithromycin

(broad spectrum antibiotics)

57
Q

Why do you need to wash hands between patients in relation to C. Diff infection?

A

C. Diff spores are resistant to alcohol gel

58
Q

How is diagnosis usually achieved in parasitology?

A

Generally by microscopy

Send stool with request “parasites, cysts and ova” (P, C and O)

59
Q

Give 2 broad parasite types that can cause diarrhoea

A

Protozoa and Helminths

60
Q

What does giardia lamblia infection lead to?

Signs and symptoms

A

Diarrhoea
Malabsorption
Failure to thrive

61
Q

How is giardia lamblia diagnosed?

A

Vegetative form in duodenal biopsy or “string test”

Cysts seen on stool microscopy

62
Q

What is the treatment for giardia lamblia?

A

Metronidazole

63
Q

How can people get Cryptosporidium parvum?

A

Contaminated water (animal faeces)

64
Q

How is cryptosporidium parvum diagnosed and treated?

A

Cysts seen on microscopy

No treatment

65
Q

What is the other name for Entamoeba histolytica infection?

A

Amoebic dysentery

66
Q

How is entamoeba histolytica infection diagnosed?

A

Vegetative form in symptomatic patient (“hot stool”)

Cysts seen in asymptomatic patient

67
Q

What complication may occur with amoebic dysentery?

A

Amoebic liver abscess may be long term complication (“anchovy pus”)

68
Q

How do you treat amoebic dysentery?

A

Metronidazole

69
Q

What is a common cause of diarrhoea in children under 5?

A

Rotavirus

Common in winter

70
Q

How do you diagnose rotavirus diarrhoea?

A

Antigen detection

71
Q

Appart from rotavirus what other virus can cause diarrhoea?

A

Adenovirus

Noroviruses

72
Q

What is a common viral cause of diarrhoea outbreaks?

A

Norovirus

Winter vomiting disease

73
Q

How do you diagnose norovirus?

A

PCR

74
Q

How infectious is norovirus?

A

VERY

Ward closures common

If one person vomits on a ship the whole ship can be infected

Infectious Diseases (4 decks)

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