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Diarrhoea an Enteric Infection Flashcards

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1
Q

What bacteria can cause diarrhoeal illness?

A
  • Salmonella
  • Campylobacter
  • E. coli 0157
  • Shigella
  • Clostridium Difficile
  • Cholera
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2
Q

How long after onset do symptoms of Salmonella associated Diarrhoea present?

A

<48hrs

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3
Q

How long does Salmonella associated diarrhoea normally last for?

A

<10 days

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4
Q

What are the different types of diarrhoea?

A
  • Osmotic Diarrhoea
  • Secretory Diarrhoea
  • Inflammatory Diarrhoea
  • Abnormal motility
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5
Q

What can prolonged carriage of Salmonella be associated with?

A

Gallstone formation

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6
Q

What can be a common problem post-infection for someone who has had Salmonella?

A

Irritable Bowel Syndrome

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7
Q

What species of campylobacter is the main pathogen in diarrhoeal infection?

A

Campylobacter jejuni

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8
Q

What are the most common sources of campylobacter infection?

A
  • Contaminated Milk
  • Chickens
  • Puppies
  • Water
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9
Q

What is the incubation time for Campylobacter?

A

2-5 days

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10
Q

What are the main symptoms of Campylobacter infection?

A
  • Severe Abdominal Pain - often becomes continuous and radiates to right iliac fossa
  • Watery Diarrhoea
    • Can become bloody
  • Fever
  • Nausea and Vomiting
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11
Q

How long does it normally take for Campylobacter infection to clear?

A

3 weeks

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12
Q

How long does it take stools to become negative in Campylobacter infections?

A

6 weeks

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13
Q

What are some of the long term post-infective sequelae of Campylobacter infection?

A
  • Guillain Barre Syndrome
  • Reactive Arthritis
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14
Q

What is secretory diarrhoea?

A

Both active intestinal secretion of fluid and electrolytes as well as decreased absorption

Cholera toxin is regarded as the classic model of this

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15
Q

What are common causes of secretory diarrhoea?

A
  • Enterotoxins
  • Hormones
  • Bile salts (in the colon) - following ileal resection
  • Fatty acids (in the colon) - following ileal resection
  • Some laxatives
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16
Q

What is the pathophysiology of diarrhoea caused by cholera?

A
  • Increases cAMP levels
  • Increases protein kinases
  • Inhibit Na+ and Cl- absorption
  • Cl- secretion
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17
Q

What bacteria cause secretory diarrhoea?

A
  • Cholera
  • E. Coli
  • C. Difficile
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18
Q

How do you distinguish between secretory and inflammatory diarrhoea?

A

Inflammatory diarrhoea is accompanied by PAIN AND FEVER

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19
Q

What is osmotic diarrhoea?

A

Gut mucosa acts as a semipermeable membrane and fluid enters the bowel if there are large quantities of non-absorbed hypertonic substances in the lumen

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20
Q

What can cause osmotic diarrhoea?

A
  • Non-absorbable substance
  • Malabsorption so that high concentrations of solute remain in the lumen
  • Specific absorptive defect - coeliac disease
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21
Q

How can you distinguish between osmotic diarrhoea and other types of diarrhoea?

A
  • Remove the malabsorptive substance
  • Bloating?
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22
Q

What is inflammatory diarrhoea?

A

Damage to the intestinal mucosal cell so that there is a loss of fluid and blood

In addition, there is defective absorption of fluid and electrolytes

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23
Q

What are the causes of inflammatory diarrhoea?

A
  • Infection (Shigella)
  • Inflammatory conditions (UC, Crohn’s)
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24
Q

What can cause diarrhoea due to abnormal motility?

A
  • Diabetic (arse)
  • Post-vagotomy
  • Thyrotoxicosis
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25
What are the clinical features of Salmonella infection?
* **Diarrhoea** * **Vomiting** * **Fever** * **Septicaemia**
26
What type of E. Coli causes Enterohaemorrhagic E. Coli infection?
E. Coli O157:H7
27
What is the reservoirs of E. Coli O157?
Cattle
28
What are the clinical features of E. Coli O157?
Frequent Bloody Stools
29
What can E. Coli O157 cause?
Haemolytic Uraemic Syndrome
30
What is Haemolytic Uraemic Syndrome (HUS)?
Shiga-Like Toxin (SLT) binds to globotriaosylceramide -\> platelet activation stimulated -\> microangiopathy Platelets bind to endothelial, glomerular, tubular and mesangial cells
31
Who does HUS most commonly occur in, if it does occur?
Children and the Elderly
32
How long after the onset of diarrhoea can it take for HUS to develop in E. Coli O157 infection?
5-9 days
33
What is the definition of Food Poisoning?
Illness caused by eating contaminated foodstuffs
34
What bacteria can cause food poisoning?
* **Staphylococcus Aureus** * **Bacillus cereus (re-fried rice)** * **Clostridium Perfringens**
35
What is Dysentery?
Infection of the intestine causing severe diarrhoea with blood and mucus
36
What causes bacillary dysentery?
Shigella
37
What are the symptoms of bacillary dystentery?
* **Abdominal pain** * **Small volume Bloody diarrhoea + mucus** * **Sudden fever** * **Nausea**
38
What is the incubation period for bacillary dysentery?
1-6 days
39
How is bacillary dysentery spread?
Faecal-Oral
40
How is cholera spread?
Faecal-Oral route
41
Can you name the organism which causes cholera?
*Vibrio Cholerae* (Gram -ve rod)
42
How long does it take cholera to incubate?
A few hour to 5 days
43
What are the clinical features of Cholera?
* **Profuse watery stools (1L/h)** * **Fever** * **Vomiting** * **Rapid dehydration** * Associated Metabolic Acidosis
44
What can be a complication of Shigella Infection?
* **HUS** * **Seizures**
45
What is the definition of Colitis?
Inflammation of the colon
46
What are colitic symptoms?
* **Recurring bloody diarrhoea +/- pus** * **Lower Abdominal Pain** * **Faecal Incontinence** * **Fatigue** * **Unexplained Weight loos**
47
What is Gastroenteritis?
Inflammation of the stomach and intestine
48
What can cause Gastroenteritis?
Usually due to viral, bacterial infection or food-poisoning toxins
49
How do you objectively determine if someone has developed Gastro-enteritis?
3+ stools in 24 hrs, plus one of * **Fever** * **Vomiting** * **Pain** * **Blood/mucus in stools**
50
How long does gastroenteritis normally last?
3-5 days
51
What are the main features of gastroenteritis?
Dirrhoea +/- vomiting
52
What are the 4 main pathogenic mechanisms of bacterial gastroenteritis?
* **Mucosal adherence** **-** effacement of intestinal mucosa * **Mucosal invasion** - Penetration and destruction of mucosa * **Toxin production enterotoxin** - Fluid secretion without mucosal damage * **Cytotoxin** - Damage to mucosa
53
For each of the 4 pathogenic mechanisms of bacterial gastroenteritis, describe their clinical presentations
* **Mucosal adherence** - Moderate watery diarrhoea * **Mucosal invasion** - Dysentery * **Toxin Production** - Profuse Watery diarrhoea * **Cytotoxin** - Dysentery
54
What bacteria can cause gastroenteritis?
* Salmonella * Campylobacter * Shigella * EHEC * ETEC * Cholera
55
What organism causes pseudomembranous colitis?
C. Difficile
56
How does C. diff cause diarrhoea?
* **Toxin A - enterotoxin** * **Toxin B - cytotoxic**
57
How does C. diff infection present?
* **Severe Bloody Diarrhoea** * **Abdominal Pain** * **Gut perforation** * **Toxic Megacolon**
58
What are the 4 C's which put a patient at risk of C. diff colonisation?
* **Cephalosporins** * **Clindomycin** * **Clarythromycin** * **Co-Amoxiclav**
59
How would you manage someone with C. diff infection?
Stop causative ABx 10 days of treatment * **Non severe** - **Metranidazole** - 400 mg 8hrly * **Severe - Oral Vancomycin** - 125 mg 6 hrly
60
What is the most common cause of traveller's diarrhoea?
Enterotoxigenic E. Coli
61
What parasites can cause diarrhoea?
* **Cryptosporidium parvum** * **Giardia lamblia** * **Entamoeba histolytica**
62
What can be a complication of Entamoeba Histolytica?
Amoebic Liver Abscess
63
How does Entamoeba Histolytica Present
Similar to ulcerative colitis
64
How does giardia infection present?
* **Explosive Diarrhoea** * **Malabsorption** * **Bloating** * **Flatulence** * **Weight loss**
65
Where does giardia colonise in the gut?
Duodenum and jejunum
66
How would you treat giardia infection?
* **Metranidazole** * **Tinidazole**
67
How does Rotavirus cause diarrhoea?
Infects mature enterocytes of villous body and tip (not crypts) with cell death and lactose intolerance
68
How would you assess someone with suspected gastro-enteritis?
* **Symptoms and their duration -** \>2/52 unlikely to be infective gastro-enteritis * Frequency * Quality * Blood/Mucus * **Risk of food poisoning -** Dietary, contact, travel history * **Assess hydration -** postural BP, skin turgor, pulse * **Features of sepsis -** fever, raised WCC
69
How would you investigate someone with suspected gastro-enteritis?
* **Stool culture** * **Blood culture** * **Renal function** * **Blood count -** neutrophilia, haemolysis * **Abdominal X-Ray -** if abdomen distended, tender
70
What would make you suspect a non-infectious cause for diarrhoea?
\>2 weeks duration

Infection Medicine (12 decks)

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