Diarrhoea & Gastro-enteritis

Question 1

What is the definition of diarrhoea?

Answer 1

Increased fluidity and frequency of stool

Question 2

What is the definition of gastro-enteritis?

Answer 2

Inflammation of the stomach and intestines

many things come under it

Question 3

What are the 2 main signs of dysentery?

Answer 3

Large bowel inflammation and bloody stools

Question 4

On the Bristol stool chart, what types are associated with gastro-enteritis?

Answer 4

Types 6 and 7

Question 5

What are the 3 types of diarrhoea illness?

Answer 5

Secretory (e.g. cholera)
Inflammatory (e.g. dysentery)
Mixed (e.g. C.diff infection)

Question 6

What is the main treatment for all types of diarrhoea illness?

Answer 6

Rehydration and fluids

Question 7

What is the difference between secretory and inflammatory diarrhoea illness?

Answer 7

Secretory -> no abdominal pain or fever

Inflammatory -> abdominal pain and fever

Question 8

What other treatments can be used for inflammatory diarrhoea illness?

Answer 8

Antibiotics

Question 9

What type of hypertension is associated with hydration?

Answer 9

Postural hypertension

Question 10

What are the signs of Systemic Inflammatory Response Syndrome (SIRS)?

Answer 10

Fever
Tachycardia
Increased WCC

Question 11

In diarrhoea, is it only water that is lost?

Answer 11

No, Na and K are also lost which means you are at risk of hyponatraemia and hypokalaemia

Question 12

What is the main type of virus that causes diarrhoea in children (under 5)?

Answer 12

Rotavirus

Question 13

What type of virus commonly causes diarrhoea in hospitals, schools, care homes etc?

Answer 13

Norovirus

very infectious

Question 14

How is norovirus diagnosed?

Answer 14

PCR

Question 15

What are the S & S of gastro-enteritis?

Answer 15

Diarrhoea (main)
Vomiting 
Abdominal pain 
Dehydration
Hyponatraemia
Hypokalaemia
Fever

Question 16

What investigations can be undergone for gastro-enteritis?

Answer 16

Bristol Stool Chart 
Stool culture
Blood culture
Molecular/antigen detection 
RFTs
Bloods
Abdominal X-rays/CT
PCR

Question 17

How does the Bristol Stool Chart describe stool?

Answer 17

With increasing fluidity i.e. Type 1 is constipation, whilst Type 7 is diarrhoea

Question 18

What are the treatments for gastroenteritis?

Answer 18

Rehydration (salt/sugar solution)
IV saline
Antibiotics
Stool transplants
Oral vancomycin 
Metronidazole

Question 19

What are the risk factors for gastroenteritis?

Answer 19

Over-seas travel
Deprived areas 
Poor hygiene
Antacids
Antibiotics
Immunosuppressants
Poor diet

Question 20

What is involved in the differential diagnosis with gastroenteritis?

Answer 20

IBD
Spurious diarrhoea (secondary to constipation)
Carcinomas

Question 21

What are some of the causes of gastroenteritis?

Answer 21

Viruses (main)
Food poisoning 
Bacteria
Parasites
Immunosuppression 
Sepsis

Question 22

Give examples of types of bacteria that can cause gastroenteritis.

Answer 22

Campylobacter (main)
Salmonella
E. coli O157
Shigella
C. diff

Question 23

Give examples of ways in which food poisoning can occur.

Answer 23

Poor farming
Poor storage (not chilled)
Poor cooking

Question 24

Why do antacids increases your susceptibility for gastroenteritis?

Answer 24

As stomach acid usually digests most bacteria, but if this acid is limited then bacteria can assert its affects more easily

Question 25

Why do antibiotics increases your risk of enteric infections?

Answer 25

As they affect normal gut flora

Question 26

If symptoms last for more than 2 weeks, is it likely to be gastroenteritis?

Answer 26

No, as it is unlikely to be an infection

Question 27

What type of diarrhoea occurs as a result of gastroenteritis?

Answer 27

Inflammatory

Question 28

What presents along with dehydration?

Answer 28

Hyponatraemia | Hypokalaemia

Question 29

Why should an abdominal X-ray or CT be undergone for abdominal pain or tenderness?

Answer 29

To check for potential perforation or acute appendicitis

Question 30

What type of diarrhoea is secondary to constipation?

Answer 30

Spurious

Question 31

Why is glucose provided along with fluids?

Answer 31

As glucose has a co-transporter with Na

Question 32

Why is it difficult to find the causative bacteria in a stool sample?

Answer 32

As there is a vast number of both non-pathogenic and pathogenic bacteria

Question 33

What investigations are used alongside stools cultures?

Answer 33

Antigen detection | Molecular detection

Question 34

What is the difference between O and H antigens?

Answer 34

O: occur on the body of the bacteria H: occur on the flagella of the bacteria

Question 35

What is the most common causative bacteria for gastroenteritis?

Answer 35

Campylobacter

Question 36

What condition can campylobacter gastroenteritis occur after?

Answer 36

Gullian-Barre Syndrome

Question 37

What is a classic symptom of campylobacter gastroenteritis?

Answer 37

Sever abdominal pain | so it can be confused with acute appendicitis and perforation

Question 38

What are the 2 main species of campylobacter?

Answer 38

C. jejuni and C. coli | C= campylobacter

Question 39

What bacteria is the most common cause of food poisoning?

Answer 39

Campylobacter

Question 40

Where can campylobacter be found?

Answer 40

Contaminated chicken and milk

Question 41

What is the difference between salmonella gastroenteritis and campylobacter gastro-enteritis?

Answer 41

Salmonella -> presents quicker, more likely to spread into blood (but still not common) Campylobacter -> presents slower, less likely to spread into blood

Question 42

What are the 2 main species of salmonella?

Answer 42

S. enterica and S. bongori | (S= salmonella)

Question 43

What are the most common infection types of salmonella?

Answer 43

S. enteritidis and S. typhimurium

Question 44

What is the difference between E.coli O157 and salmonella?

Answer 44

E.coli O157 -> ferments lactose Salmonella -> does not ferment lactose

Question 45

What is the difference between E.coli O157 and other types of E.coli?

Answer 45

E.coli O157 doesn't spread into blood

Question 46

Where can you get E.coli O157?

Answer 46

Contaminated meat

Question 47

What is the main symptom of E.coli O157 gastroenteritis?

Answer 47

Frequent bloody stools

Question 48

What type of bacterium is E.coli O157?

Answer 48

A toxin-mediated bacterium, so the bacterium itself stays in the gut but the toxins it produces can spread into blood

Question 49

What is the name of the toxins produced by E.coli O157?

Answer 49

Shiga

Question 50

What can the Shiga toxins produced by E.coli O157 cause?

Answer 50

Haemolytic-Uremic Syndrome

Question 51

What are the S&S of Haemolytic-Uremic Syndrome?

Answer 51

Renal failure Haemolytic anaemia Low platelet count

Question 52

Why are antibiotics not used to treat E.coli O157 gastro-enteritis?

Answer 52

As antibiotics break down the bacteria, which would result in more toxins being produced and Haemolytic-Uremic Syndrome occurring

Question 53

Where is Shigella common?

Answer 53

In children nurseries

Question 54

When treating gastroenteritis, when are antibiotics indicated and contraindicated?

Answer 54

Indicated: immunocompromised, severe sepsis and chronic illnesses (e.g. cancer) Contraindicated: healthy patients with a non-invasive infection

Question 55

What is the likely cause of gastroenteritis if the patient has previously undergone antibiotic treatment of the 4 C's?(cephalosporins, co-amoxiclav, clindamycin and ciprofloxacin )

Answer 55

C. diff

Question 56

What type of toxins does C. diff produce?

Answer 56

Type A -> enterotoxin | Type B -> cytotoxin

Question 57

What drugs can be used to treat C. diff gastroenteritis?

Answer 57

Metronidazole | Vancomycin (oral)

Question 58

Give examples of viruses that can cause gastro-enteritis?

Answer 58

Rotavirus (common in children) | Norovirus (common in community areas)

Question 59

How is norovirus usually diagnosed?

Answer 59

PCR