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ANKI GI > [22] Gastroenteritis > Flashcards

[22] Gastroenteritis Flashcards

1
Q

What is gastroenteritis?

A

The general term used to describe inflammation of the gastrointestinal tract

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2
Q

What is the origin of gastroenteritis?

A

Usually is infective in origin, although may have non-infective causes

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3
Q

What is the most common cause of gastroenteritis?

A

Viral

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4
Q

What % of cases of gastroenteritis are viral in developed countries?

A

30-40%

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5
Q

What can reveal the causative agent in gastroenteritis?

A

Subtle differences between the length of time between ingestion of food and development of symptoms

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6
Q

How long is there between the ingestion of food and the development of symptoms in bacterial toxins causing gastroenteritis?

A

Hours

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7
Q

How long is there between the ingestion of food and the development of symptoms in viral gastroenteritis?

A

Days

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8
Q

How long is there between the ingestion of food and the development of symptoms in bacterial gastroenteritis?

A

Weeks

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9
Q

How long is there between the ingestion of food and the development of symptoms in parasitic gastroenteritis?

A

Months

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10
Q

What is diarrhoea?

A

3 or more loose stools, or stools with increased liquid, per day

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11
Q

What is acute diarrhoea?

A

Diarrhoea lasting less than 14 days

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12
Q

What is chronic diarrhoea?

A

Diarrhoea lasting more than 14 days

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13
Q

What is dysentery?

A

Gastroenteritis characterised by loose stools with blood and mucus

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14
Q

What is travellers’ diarrhoea?

A

More than 3 loose stools commencing within 24 hours of foreign travel. with or without cramps, nausea, fever, or vomiting

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15
Q

What is the most common cause of travellers’ diarrhoea?

A

Enterotoxigenic E. Coli

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16
Q

How might travellers’ diarrhoea be prevented?

A

Patient’s travelling to at risk areas may be required to take prophylactic anti-microbials

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17
Q

What are the risk factors for gastroenteritis?

A

Poor food preparation, handling, and cooking
Immunosuppression
Poor personal hygiene

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18
Q

What are the symptoms of gastroenteritis?

A 
Cramp-like abdominal pain
Diarrhoea with or without blood or mucus
Vomiting
Pyrexia
Night sweats
Weight loss
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19
Q

What will be found on examination in gastroenteritis?

A

The patient may be dehydrated, with possible pyrexia and/or hypovolaemia

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20
Q

What specific features from the history should be elicited to help determine the cause of gastroenteritis?

A

Bowel movements
Affected family or friends
Recent travel
Recent use of antibiotics within previous 4 weeks

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21
Q

What do you need to know about the bowel movements in gastroenteritis?

A

Quantity

Character - blood stained, mucus, profusely watery

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22
Q

Why is it important to know if a person presenting with gastroenteritis has had any antibiotics within the previous 4 weeks?

A

It can suggest a potential C. difficile infection

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23
Q

Why are investigations not necessary for most cases of gastroenteritis?

A

As the condition is usually self limiting

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24
Q

What investigation may be required in gastroenteritis?

A

Stool culture

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25
Q

When might a stool culture be required in gastroenteritis?

A

If there is blood or mucus in stool
If patient is immunocompromised
If severe or persistent

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26
Q

What are the general points of management for any patient with gastroenteritis?

A

Rehydration
Education to prevent future episodes
Exclusion from work for 48 hours from last episode of vomiting or diarrhoea

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27
Q

How should dehydration be achieved in gastroenteritis?

A

Encourage oral fluids if possible

If severe dehydration or unable to tolerate oral fluid, consider admitting patient for IV fluid

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28
Q

What needs to be considered when giving the patient IV fluids for rehydration following gastroenteritis?

A

Need to ensure suitable potassium replacement if severe or persistent vomiting or diarrhoea

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29
Q

Is gastroenteritis a notifiable disease in the UK?

A

Food poisoning and infectious bloody diarrhoea are

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30
Q

What is meant by food poisoning and infectious bloody diarrhoea being notifiable diseases?

A

It is the duty of the diagnosing doctor to notify the appropriate body

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31
Q

What organisms causing gastroenteritis are notifiable diseases?

A

Campylobacter

Salmonella

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32
Q

Who is responsible for notifying Public Health about cases of campylobacter or salmonella?

A

The laboratory

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33
Q

What are the viral causes of gastroenteritis?

A

Norovirus
Rotavirus
Adenovirus

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34
Q

What is the most common form of viral gastroenteritis in adults?

A

Norovirua

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35
Q

What kind of virus is norovirus?

A

RNA virus

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36
Q

How does norovirus present?

A

Abdominal cramps
Watery diarrhoea
Vomiting

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37
Q

How long does gastroenteritis caused by norovirus last?

A

Usually about 1-3 days

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38
Q

What is the most common cause of severe diarrhoea in infants and young children?

A

Rotavirus

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39
Q

What kind of virus is rotavirus?

A

A double stranded RNA virus

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40
Q

How long does rotavirus last?

A

Generally less than a week

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41
Q

What develops from rotavirus infection in childhood?

A

LIfelong immunity

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42
Q

Where is adenovirus a common cause of diarrhoea?

A

In children

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43
Q

What are the bacterial causes of gastroenteritis?

A

Campylobacter
E. Coli
Salmonella
Shigella

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44
Q

What is the most common cause of food poisoning?

A

Campylobacter

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45
Q

What kind of bacteria is campylobacter?

A

A gram negative bacillus

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46
Q

What does campylobacter infection typically result from?

A

Ingestion of chicken, eggs, or milk

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47
Q

What symptoms are caused by campylobacter?

A

May be a prodrome of fatigue, fever, and myalgia, followed by nausea, abdominal cramps, and diarrhoea

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48
Q

How is gastroenteritis caused by campylobacter treated?

A

If severe, treat with IV erythromycin

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49
Q

What kind of bacteria is E. Coli?

A

Gram -ve

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50
Q

How is E. Coli transmitted?

A

Typically through contaminated foodstuffs

Can also be from infected animals and from person-to-person

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51
Q

Which type of E. Coli is the most common form of travellers diarrhoea?

A

Enterohaemorrhaigc E. Coli (EHEC)

52
Q

What kind of bacteria is salmonellla?

A

A gram negative flagellated bacillus

53
Q

What are the two serotypes of salmonella most commonly associated with gastroenteritis?

A

S. typhimurium

S. enteriditis

54
Q

How is salmonella transmitted?

A

Through undercooked poultry or raw eggs

55
Q

What are the symptoms of gastroenteritis caused by salmonella?

A 
Fever
Nausea
Vomiting
Abdominal pain
Cramps
Bloody diarrhoea
56
Q

How is gastroenteritis caused by salmonella managed?

A

Management is generally conservative

57
Q

How long does gastroenteritis caused by salmonella generally last?

A

<7 days

58
Q

What kind of bacteria is shigella?

A

Gram -ve bacillus

59
Q

What is the most common serotype of shigella?

A

S sonnei

60
Q

How is shigella acquired?

A

From contaminated dairy products and water

61
Q

How does gastroenteritis caused by shigella present?

A

Fever
Abdominal pain
Rectal pain
Bloody diarrhoea

62
Q

How is gastroenteritis caused by shigella managed?

A

Management is usually conservative

63
Q

What complications can campylobacter infections lead to?

A

Reactive arthritis
Guillan Barre syndrome
Haemolytic uraemic syndrome
Thrombotic thrombocytopaenic purpura

64
Q

What complications can EHEC cause?

A

Haemorrhagic uraemic syndrome

65
Q

What do toxins from bacteria often cause?

A

An acute onset of diarrhoea and vomiting

66
Q

How long do symptoms tend to last in gastroenteritis caused by bacterial toxins?

A

Less than 24 hours

67
Q

What bacteria produce toxins that can cause gastroenteritis?

A

Staphylococcus aureus
Bacillus cereus
Clostridium perfringens
Vibrio cholera

68
Q

Where are staphylococcus aureus toxins typically found?

A

In cooked meat and cream products

69
Q

Does reheating cooked food destroy the staphylococcus aureus exotoxin?

A

No, even if the bacteria are destroyed

70
Q

How are toxins from bacillus cereus typically acquired?

A

Through reheating cooked rice

71
Q

What do the toxins from bacillus cereus cause?

A

Rapid onset nausea and vomiting

72
Q

How are clostridium perfringes toxins typically acquired?

A

From reheating cookd meat dishes

73
Q

What symptoms are caused by the toxins from clostridium perfringes?

A

Causes diarrhoea, but vomiting is unusual

74
Q

How are toxins from vibrio cholera obtained?

A

Typically from contaminated water supplies

75
Q

What symptoms do the toxins from vibrio cholerae typically cause?

A

Profound watery diarrhoea, often described as rice water, yet painless in nature

76
Q

How can gastroenteritis caused by toxins from vibrio cholera be avoided?

A

An oral vaccine is available

77
Q

When are parasites a much more likely causative organism in gastroenteritis

A

In any patient with Travellers’ diarrhoea

78
Q

What parasites can cause gastroenteritis?

A

Cryptosporidium
Entamoeba histolytica
Giardia intestinalis
Schistosoma

79
Q

What kind of parasite is cryptosporidium?

A

A protozoa

80
Q

What can cryptosporidium cause in most patients?

A

A self-limiting watery diarrhoea with abdominal cramps

81
Q

What can cryptosporidium cause in immunocompromised patients?

A

Life threatening infections

82
Q

What does the diagnosis of cryptosporidium involve?

A

Stool culture for ova, cysts, and parasites

83
Q

What is the organism Entamoeba Histolytica responsible for?

A

Amoebiasis

84
Q

How is entamoeba histolytica acquired?

A

From the ingestion of food/water contaminated with faeces

85
Q

How does ameobiasis present?

A

Bloody diarrhoea
Abdominal pain
Fever

86
Q

How does an amoebic liver abscess present?

A

RUQ pain
Swinging pyrexia
Hepatomegaly

87
Q

What is required for the diagnosis of amoebiasis?

A

Stool culture for ova, cysts, and parasites

88
Q

What is the recommended treatment for amoebiasis?

A

Metronidazole or tinidazole

89
Q

What is the giardia intestinalis organism responsible for?

A

Giardiasis

90
Q

How is giardia intestinalis transmitted?

A

Through direct contact, or faecal-oral route

91
Q

What can giardia intestinal cause?

A

Acute disease or chronic disease

92
Q

What are the symptoms of acute giardiasis?

A 
Explosive diarrhoea
Fever
Fatigue
Nausea
Bloating
93
Q

What are the symptoms of chronic giardiasis?

A

Steatorrhoea
Malabsorption
Weight loss

94
Q

What might stool culture for ova, cysts, and parasites show in giardiasis?

A

Trophozoites

95
Q

How do trophozoites appear on microscopy?

A

‘Tear drop’ shaped

96
Q

What might be shown on duodenal biopsy in giardiasis?

A

Villous atrophy

97
Q

How is giardiasis managed?

A

Usually metronidazole or tinidazole

98
Q

What does the organism schistosoma cause?

A

Schistosomiasis

99
Q

How is schistosoma acquired?

A

Contaminated water

100
Q

How long after infection does acute schistosomiasis present?

A

About a month

101
Q

How does acute schistosomiasis present?

A 
Fever
Malaise
Abdominal pain
Bloody diarrhoea
Hepatosplenomegaly
102
Q

What can the hepatosplenomegaly in acute schistosomiasis develop into?

A

Chronic liver disease and portal hypertension

103
Q

What may be found on FBC in schistosomiasis?

A

Eosinophilia

104
Q

What is required for the diagnosis of schistosomiasis?

A

Stool culture for ova, cysts, and parasites

105
Q

How is schistosomiasis treated?

A

Praziquantel

106
Q

What are the major species for hospital acquired gastroenteritis?

A

C. difficile

107
Q

What kind of bacteria is C. difficile?

A

A gram +ve organism

108
Q

When does C. difficile typically develop?

A

After treatment with broad-spectrum antibiotics, particularly cephalosporins

109
Q

Why does C. difficile develop after treatment with broad-spectrum antibiotics?

A

They disrupt the normal microbiota of the bowel

110
Q

What toxins are produced by C. difficile?

A

Exotoxins A and B

111
Q

What do exotoxins A and B cause?

A

An inflammatory response in the bowel, that results in an inflammatory exudate on the colonic mucosa with intervening areas of normal mucosa

112
Q

What does the inflammatory response cause by exotoxins A and B culminate in?

A

Severe bloody diarrhoea

113
Q

What does the bloody diarrhoea in C. difficile have the potential to develop into?

A

Toxic megacolon

114
Q

What is toxic megacolon?

A

A severely dilated bowel with a high risk of perforation

115
Q

What does investigation of C. difficile require?

A

Stool culture specificially including the C. difficile toxin

116
Q

What may the results of C. difficile stool culture show?

A

The presence of the bacteria, but absence of toxin

117
Q

What should be done if the stool culture results show the presence of C. difficile bacteria, but not the toxin?

A

The results should be interpreted relative to the clinical picture

118
Q

How is C. difficile treated?

A

IV fluid rehydration
Oral metronidazole
Isolation

119
Q

When is vancoymycin used in C. difficile?

A

In severe disease, or if no improvement seen after 72 hours

120
Q

What are the non-infective causes of gastroenteritis?

A

Radiation colitis
Inflammatory bowel disease
Microscopic colitis
Chronic ischaemic colitis

121
Q

What is radiation colitis?

A

Inflammation of the gastrointestinal tract secondary to radiation therapy

122
Q

What does microscopic colitis cause?

A

A chronic watery diarrhoea

123
Q

Who does microscopic colitis typically affect?

A

Females

124
Q

What happens to the colon in microscopic colitis?

A

It appears normal on endoscopy, however biopsy demonstrates an increase in the number of inflammatory cells

125
Q

What is chronic ischaemic colitis caused by?

A

A compromise in blood supply to the colon

126
Q

Where does chronic ischaemic colitis commonly affect?

A

The watershed area around the splenic flexure

127
Q

How is a diagnosis of chronic ischaemic colitis confirmed?

A

On endoscopy, where one might observe ‘blue swollen mucosa’

ANKI GI (43 decks)

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