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Gastroenteritis Flashcards

1
Q

Define gastroenteritis

A

Syndrome of diarrhoea and vomiting that refers to non-inflammatory involvement of the upper small bowel or inflammation of the colon.

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2
Q

What is the most common cause of gastroenteritis?

A

Infection.
The vast majority is caused by a virus.
Bacteria - 20%
Parasites < 6%

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3
Q

What percentage of gastroenteritis cases are not infectious?

A

15%

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4
Q

Give some non-infectious diarrhoea examples

A 
GI bleed
Ischaemic gut
Diverticulitis
Endocrine disorders
Numerous drugs
Fish toxins
WIthdrawal
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5
Q

What is the approach to any clinical infection syndrome?

A

What are the key clinical symptoms and signs that suggest the infection?
Differential diagnosis
Severity of Infection
Site and microbiological diagnosis: investigations
Antibiotic and supportive management
Infection Control
Public Health

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6
Q

What is another name for the norovirus?

A

Norwalk agent

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7
Q

Which pathogens cause toxin-mediated food poisoning?

Which of these pathogens pre form toxins and which are formed in vivo?

A 
Preformed:
Staph aureus
Clostridium perfringens
Bacillus cereus
In vivo production:
Vibrio
Enterotoxigenic E. coli
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8
Q

What are the presenting clinical syndromes of food poisoning?

A 
1. Acute enteritis (i.e. inflammation of the small intestine):
Fever
Diarrhoea
Vomiting
Abdominal pain
2. Acute colitis:
Fever
Pain
Bloody diarrhoea
3. Enteric fever-like illness:
Fever
Rigors
Pain
Little diarrhoea
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9
Q

List infective and non-infective causes of bloody diarrhoea

A 
Infection:
bloody diarrhoea usually indicates colonic inflammation
Campylobacter. spp
Shigella. spp
E. coli 0157
Amoebiasis

Non infective:
IBD
Malignancy
Ischaemia

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10
Q

Describe the symptoms of enteric fever-like illness

A

Fever
Systemically unwell
Abdominal pain
Constipation but possibly short history of diarrhoea

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11
Q

What is typhoid?

A

A bacterial infection that can spread throughout the body involving multiple organs.

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12
Q

Where does Typhoid come from?

A

It is almost always imported
From:
Indian subcontinant, South East Asia, Far east, middle east, Africa, central/south america, Increasing in Eastern Europe.

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13
Q

How is typhoid transmitted?

A

Food, water or carrier

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14
Q

How can typhoid present?

A

It can be asymptomatic
It can be mild
It can cause bacteraemia
it can cause enterocolitis

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15
Q

How is typhoid diagnosed?

A

Blood cultures are the key to diagnosis.

Stool and urine cultures also done.

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16
Q

How is typhoid treated?

A

Chloramphenicol and ciprofloxacin- some strains resistant to this
Ceftriaxone or azithromycin

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17
Q

How can typhoid be prevented?

A

There is an IV or oral vaccine.

It is not effective against paratyphoid.

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18
Q

What are key features in a gastroenteritis history?

A

Diarrhoea: frequency, nocturnal, constistency, colour, presence of blood
Associated symptoms: abdominal pain, vomiting, fever, urgency, incontinence
Anyone in family or work with similar symptoms
Occupation
Pets and animal contact
Travel abroad
History of medication- particularly recent Abx and PPIs

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19
Q

What are key features in a gastroenteritis examination?

A

Fever
Skin rashes, e.g. rose spots, erythema nodosum
Dehydration: pulse, mental state, dry tongue, skin turgor, blood pressure, postural drop
Abdominal tenderness
Abdominal distension
PR exam: stool, blood, tenderness

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20
Q

What investigations are carried out to help diagnosis a gastroenteritis?

A

Stool microscopy when appropriate (e.g. history of travel, for giardia, amoeba etc)
Stool culture: Salmonella, Camppylobacter, Shigella
Stool toxin for C diff (culture not routinely done), adn cytotoxin for E. coli
Blood cultures (salmonella)
PCR : .e.g norovirus
FBC- wcc key in severity of CDI
U, Es - renal function important
AXR

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21
Q

What are severity markers of CDI?

A

One or more of the following:
Suspicion of PMC or toxic megacolon or ileus or colonic dilatation in CT/AXR of >6cm
WCC > 15 cells/mm3
Creatinine > 1.5 x baseline

22
Q

What are intestinal complications of bacterial enteritis?

A

Severe dehydration and renal failure
Acute colitis, toxic dilatation
Post infective irritable bowel
Transient secondary lactase intolerance

23
Q

What are extra-intestinal complications of bacterial enteritis?

A 
Septicaemia
Metastatic infection: meningitis, aortitis, osteomyelitis, endocarditis
Reactive arthritis
Meningism
Neurological- Guillian-Barre syndrome
haemolytic uraemic syndrome
24
Q

What is supportive treatment for gastroenteritis?

A 
Oral rehydration
IV fluids (saline important)
25
Q

What is specific treatment for gastroenteritis?

A

Anti-spasmodics
Anti-motility agents
Antibiotics- only in specific situations

26
Q

Name 2 antisecretory antidiarrhoeal agents

A

Chlorpromazine

Bismuth subsalycilate

27
Q

Name 2 absorbant antidiarrhoeal agents

A

kaolin

charcoal

28
Q

When are patients given empirical antibiotic therapy for gastroenteritis?

A
  1. They must have 3 or more unformed stools per day as well as one or more of: abdominal pain, nausea, vomiting, fever, blood in stool, tenesumus
  2. As well as 1, patients must either a) be high risk:
    immunocomprimised
    hypochlorhydria
    inflammatory bowel disease
    prosthetic intravascular device
    or b) have dysenteric symptoms:
    fever
    bloody diarrhoea
    abdominal pain
  3. A stool sample or rectal swab for culture is taken from these patients
  4. Patients are given ciprofloxacin 500mg BD for 3-5 days and their progress is reviewed
29
Q

What kind of bacterium is C difficile?

A

Anaerobic gram positive spore forming bacillus

30
Q

What are risk factors for C diff infection?

A

Antibiotics:
All, but greatest risk with broad spectrum e.g. fluoroquinolones, cephalosporins, clindamycins, broad spectrum penicillins
Medications:
PPI
H2RA
Advanced age - at least 65 years old
Chemotherapy, chronic renal disease, underlying IBD

31
Q

What drugs should be avoided in pseudomembrinous colitis?

A

Antibiotics which may be precipitating it
opiates
Anti-peristaltic drugs
PPIs

32
Q

What is the treatment for pseudomembranous colitis?

A

Oral therapy more reliable than parenteral therapy
Non-severe: metronidazole
Severe/failure of metronidazole: vancomycin
Do not use IV vancomycin

33
Q

What is the treatment for the 1st presentation of uncomplicated CDI?

A 
Oral metronidazole for 14 days
Stop other antibiotics
Review PPIs
Dont use anti-motility agents
No re testing unless symptomatic
Should improve within 3-5 days
34
Q

What is the treatment for CDI if it responds poorly to oral metronidazole, if the disease is severe, or if there is more than one severity marker?

A

Get help
Start oral vancomycin 125mg qds 10-14 days
Vancomycin isn’t absorbed so stays in the bowel to kill bacteria

35
Q

Why can C diff infection relapse?

A

Because although the bacteria are killed, they can leave behind spores

36
Q

What should be considered in persistent diarrhoea that lasts for more than a week?

A

Parasites

Screen for IBD

37
Q

Should antibiotics be used to treat Ecoli 0157?

A

No

38
Q

Which pathogens cause travel-related diarrhoea?

A

Amoebiasis
Giardiasis
Cryptosporadiasis

39
Q

What is the average duration of untreated traveller’s diarrhoea?

A

4 days

40
Q

How long can traveller’s diarrhoea persist for?

A

Up to 2 months, but this is only in 1-2% of people

41
Q

What is amoebiasis?
How is it spread?
How is it diagnosed?

A

A protozoal infection
It is spread by faeco-oral route or by an ill or asymptomatic carrier
Diagnosed by examination of hot stool for ova and cyts.
Serology may be of use, especially in extra-intestinal disease

42
Q

What can amoebiasis cause?

A

Acute bloody diarrhoea

Extra-intestinal spread to produce an abscess can occur

43
Q

What is giardiasis?

A

Protozoon Giardia lambia trophozoites colonizes the small bowel mucosa to produce diarrhoea and malabsorption; often explosive, protracted and foul smelling

44
Q

How is giardiasis spread?

A

Infection spread by cysts found in normal drinking water

45
Q

How is Giardiasis diagnosed?

A

Diagnosis is examination of stools for ova and cysts but more accurately by duodenal aspiration

46
Q

What is an important cause of traveller’s diarrhoea?

A

enterotoxigenic E coli

47
Q

What is Cryptosporidiosis?

A

A parasitic disease cryptosporidium, which is a protozoan parasite.

48
Q

How is Cryptosporidiosis transmitted?

A

Water, food, contact with animals. It is highly infectious and resilient.

49
Q

Does Cryptosporidiosis require treatment?

A

It is self limiting.

It is severe in immunosuppressed patients

50
Q

How is Cryptosporidiosis diagnosed?

A

Duodenal aspirate/stool

51
Q

What is the treatment for Cryptosporidiosis?

A

Supportive

GI (59 decks)

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