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FFP GI upset > Unwell traveller > Flashcards

Unwell traveller Flashcards

1
Q

IF they’ve gone on holiday, what is important to ask about

A

Where they went

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2
Q

What infectious diseases can travellers have

A 
Malaria
Gastroenteritis
Enteric fever
Hepatitis
UTI, upper and lower RTI
TB
HIV and STI
Soft tissue infection
Typhus
Dengue fever
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3
Q

Common presenting complaints

A

Fever+

Diarrhoea, jaundice, other

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4
Q

How to take a travel history

A
  • HPC e.g. symptoms and systems review, timeline
  • Where they’ve been: country and city/town/villages. Rural, urban, seaside, jungle? Dates and stop-overs on the way back. When they went
  • Any other relevant travel in the last few years
  • Timeline and location of when symptoms began
  • Beach holiday, city, working. IF working, what did they do.
  • Where did they stay? hut or hotel?
  • Swimming- sea or fresh? where?
  • Other outdoor activities e.g. jungle treks
  • Contact with animals
  • Whay did they eat
  • Insect/mosquito bites? did they try to cover up?
  • Drug use? New tattoos? unprotected sex?
  • Fever: when? acute or insidious? how long? when and where did it start? how often?
  • Diarrhoea: how many times a day? how long? colour? blood? mucous?
  • Associated symptoms: diarrhoea, sore throat, cough, ear ache, muscle ache, dysuria, vomiting, swollen joints, headache
  • Did they visit the doctors or oversea hospitals?
  • PMH, allergies, SHx
  • IN drugs, ask about pre-trip immunisations and malaria prophylaxis
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5
Q

Onset of bacterial and viral gastroenteritis

A

Will start when patient is abroad or shortly after return

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6
Q

Onset of protozoal diarrhoea

A

up to 2 weeks. Chronic onset

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7
Q

onset of typhoid/paratyphoid diarrhoea

A

starts around week 3 of illness

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8
Q

Cause of bloody diarrhoea

A

E.coli, campylobacter, shigella or amoebiasis

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9
Q

Cause of mucuous diarrhoea

A

Mucous is suggestive of large bowel pathology

Mucous + blood common in dysentry

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10
Q

Pus in diarrhoea

A

Likely bacterial

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11
Q

Watery diarrhoea e.g. rice water

A

CHOLERA

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12
Q

Colour of c.diff diarrhoea

A

Green

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13
Q

Diagnosis?

A 
PHYSICAL exam
stool- OCP, cultures
Blood culturesmand malaria investigations if pyrexic
Typhoid fever diagnosed by blood culture
malaria or ibd?
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14
Q

bacterial causes

A

All the normal causes of an acute gastroenteritis (such as the range of viral causes) still exist abroad
Viral causes include rotavirus and norovirus
Bacterial toxins tend to cause disease within a few hours
Again less exotic causes such as bacillus cereus (classically from rice) and staph aureus fit this
Otherwise an incubation period is required (anything from 6-72 hours)

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15
Q

What is the likely cause of bloody diarrhoea. Gram?

Incubation period?

A

Shigellosis (gram -)

-3 days

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16
Q

Features of a shigellosis infection

A

Gut wall invasion plus shiva toxin production. Inflammation, ulceration, micro-abscesses and bleeding in large bowel.

17
Q

Presentation of shigellosis

Complications

A

Can be mild like Water diarrhoea or severe diarrhoea which contains blood mucus and pus. Can cause:

  • Shock
  • MAssive haemorrhage
18
Q

Diagnosis of shigellosis

A

Recurrent jelly stool- MC&S or rectal swab

19
Q

Features of campylobacter

A

Flu like pro-drone then abdo pain, fever and diarrhoea (may be bloody)

20
Q

Complication of campylobacter

A

Guillain barre syndrom

21
Q

E.coli presentation

A

Diarrhoea with nausea and abdo cramps, initially watery and may become bloody

22
Q

Complication of e.coli

A

Haemolytic urea syndrom

23
Q

What is typhoid fever caused by

A

Salmonella type or paratyphi strains

24
Q

Incubation of typhoid fever and its presentation

A

5-21 days

1st week- headache, cough, anorexia, sore throat, weak and achey, gradual onset fever and abdo discomgert

2nd week- patient is toxic- sustained fever, rose spots, abdo pain, diarrhoea or constipation, hepatosplenomegaly

3rd week- fever begins to break and patient slowly settles or complications can occur

25
Q

Complication of typhoid fever

A

Perforation, GI haemorrhage or severe toxaemia and shock

26
Q

Diagnosis of typhoid

A

Stool and blood culture

Serology- not useful in endemic areas (can’t distinguish past infection)

27
Q

Management of typhoid fever

A

Supportive, abx and management of complications

28
Q

What cause can diarrhoea lasting over 14 days have

A

parasites. also have a longer incubation period

29
Q

Symptoms of Giardia

A

Bloating, flatulence and burping. Prolonged diarrhoea is water/ greasy

30
Q

Symptoms of entamoeba

A

Can be asymptomatic. ON endoscopy can find ulcers. Insidious onset abdo discomfort and diarrhoea. May be blood and mucuous

31
Q

Symptoms of cyclospora and cryptosporium

A

Bloating, weight loss, fever, malaise, watery diarrhoea and abdo cramps

FFP GI upset (9 decks)

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