Gastro-enteritis Flashcards
Definition
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Epidemiology
25% of population have infectious intestinal disorder each year
2% visit GP each year because of GI infection
Viruses is the most common cause
Campylobacter is the most common bacterial
Pathophysiology
Non Inflammatory:
- E.Coli & Cholera
- Increased cyclicAMP = Loss of Cl from cells
- Loss of Na and K too
- Osmotic effect is water out of cells
Inflammatory
- Shingella dysentry
Etiology/Risk Factors
Contamination of food stuff (intensely farmed chicken)
- BBQs
Person to Person spread (novovirus)
Presentation
Non-Inflammatory
- Frequent watery stools
- Little abdominal pain / Fever
Inflammitory
- Pain & Fever
- Frequent watery stools
Mixed
- C. Difficele
Duration of symptoms = Non-infective over long time
Travel & Diet history
Asses hydration / BP / Pulse
Features of inflammation (fever & raised WWC)
Lab Work Up
Stool culture:
Ag testing
Blood culture
- Consider underlying cause
Renal function
- Asses requirements for rehydration (U&Es)
Blood count:
- Neutrophilia
- Hamolysis (E. Coli)
Abdominal X-ray
- Dilatation of large bowl (surgery)
Campylobacter (very hard to grow - needs 5% O2)
Salmonella
- First line screen out E.Coli (salmonella doesn’t secrete lactose)
- Second line check for antibodies
Most common Salmonella Enteridis and Typhimurium (50% from abroad)
Shigella (4 speeches) gramm negative
Imagining
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Complications
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Differential Diagnosis
Inflammatory Bowl Disease (longer time)
- Bloody diarrhoea with no culture
Spurious
- Secondary to constipation
- PR exam
Carcinoma
Sepsis
- No abdominal pain or tenderness
- Fever and Diarrhoea
Treatment
Preventative: Hand hygiene Adequate cooking Stomach acidity (antacids & infection) Normal gut flora (C diff - reduce broad spectrum antibiotics) Immunity (HIV)
Non-Inflammatory: Rehydration therapy (with glucose as linked to transporting Na across cell wall)
Inflammatory:
Rehydration therapy (with glucose as linked to transporting Na across cell wall)
Anti-Microbial
C.Diff: Metronidazole Oral vancomycin (normally not given orally due to large molecules however in the case this is a benefit as it stays in the Gut) Fidaxomicin Stool Transplants Possible surgery
Prognosis
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Histology
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Types
INFECTIVE: Campylobacter Gastroenteritis: - 7 day incubation - Stools negative within 6 weeks - - Severe abdo pain - Post infection sequelae (Reactive arthritis)
Salmonela Gastroenteritis:
- 2 day incubation
- Stools positive at 20 weeks
- 5% of blood cultures positive
- Post infective irritable bowl is common
E. Coli O157:
- Infective form (low incoulum)
- Prominent frequent bloody stool
- Prominent abdominal pain
- Little fever
- Stays in the Gut not in the blood (Shiga Toxin)
- Hemolytic-Uraemic syndrome (Anaemia (clumping of platelets) and Renal failure)
- Antibiotics destroy and release toxin (do NOT use)
INTOXICATION (quick symptoms/quick resolution):
Staph aureus (toxin)
Bacillus cereus
Clostridium perfringens
