Gastroenteritis

Question 1

What is gastroenteritis?

Answer 1

Gastroenteritis is inflammation all the way from the stomach to the intestines and presents with nausea, vomiting and diarrhoea

Question 2

What is teh main concern in GE?

Answer 2

Dehydration

Question 2

What is the main concern in GE?

Answer 2

Dehydration

Question 3

What is first step in managing GE?

Answer 3

Isolate patient in paeds assessmnet unit or hospital ward
Barrier nursing

Question 4

What need to assess in children presenting with GE

Answer 4

Whether can manage with conservativ hydration or need IV fluids

Question 5

Key differentials for patients with loos stools?

Answer 5

• Infection (gastroenteritis)
• Inflammatory bowel disease
• Lactose intolerance
• Coeliac disease
• Cystic fibrosis
• Toddler’s diarrhoea
• Irritable bowel syndrome
• Medications (e.g. antibiotics)

Question 6

Common causes of GE?

Answer 6

Rotavirus
Norovirus
(adenovirus less common -> subacute diarrhoea)

Question 7

How is E coli spread

Answer 7

Infected faeces
Unwashed salads
Contaminated water

Question 8

What bacteria can cause haemolytic uraemic syndrome?

Answer 8

E.coli 0157 -> shigella toxin

Question 9

What does the shiga toxin cause?

Answer 9

Abdo cramps, bloody diarrhoea and vomitting
Destroys RBCs -> haemolytic Uraemic S

Question 10

Why should antibiotics be avoided in some GE cases?

Answer 10

If suspect E coli may be cause as antibiotics increase the risk of Haemolytic uraemic syndrome

Question 11

What is most common cause of travellers diarrhoea?

Answer 11

Campylobacter

Question 12

What type of bacteria is campylobacter?

Answer 12

Gram negative ‘
Curved or spiral shape

Question 13

How is campylobacter spread?

Answer 13

Raw/uncooked poultry
Untreated water
Unpasteurised milk

Question 14

What is the incubation and symptom resolution for travellers diarrhoea?

Answer 14

Incubation - 2-5 days
Symptoms resolve - 3-6 days

Question 15

SYmptoms of travellers diarrhoea

Answer 15

Abdo cramps
Diarrhoea often with blood
Vomitting
Fever

Question 16

When are antibiotics used in campylobacter travellers diarrhoea?

Answer 16

Severe symptoms
Other risk factors HIV or HF

Question 17

Antibiotics for travellers diarrhoea

Answer 17

Azithromycin or ciprofloxacin

Question 18

What is salmonella spread by?

Answer 18

Eating raw eggs, poultry or food contaminated with infected faeces of small animals

Question 19

What is incubation and resolution of salmonella?

Answer 19

Incubation - 12 hours to 3 days
Resooution - 1 week

Question 20

Symptoms of salmonella

Answer 20

Watering diarrhoea can be ass with muscus or blood
Abdo pain
Vomitting

Question 21

What should antibitoics be guided by in salmonella of treatment?

Answer 21

Stool culture and sensitivites

Question 22

What type of bacteria is bacilus cereus?

Answer 22

Gram positive rod

Question 23

How does bacileius cereus spread?

Answer 23

Inadequately cooked food and not refrigerated after cooking
eg fried rice at room temp

Question 24

What toxin comes from bacilius cereus

Answer 24

Cereulide

Question 25

What symptoms does cereulide cause?

Answer 25

Abdo cramping and vomitting within 5 hours of ingestion Then causes watery diarrhoea when reaches the intestine

Question 26

Typical course of bacilius cereus infection

Answer 26

Comitting within 5 hours, then diarrhoea after 8 hours then resolution within 24 hours V short incubation time and recovery in 24 hours

Question 27

What type of bacteria is yersinia?

Answer 27

Gram negative bacillus

Question 28

What can cause yerisnia infection?

Answer 28

Raw or undercooked pork - pigs are carriers Urine or faeces of other mammals eg rats and rabbits

Question 29

What does yersinia cause in children?

Answer 29

Water or bloody diarrhoea Abdo pain Fever Lymphadenopathy

Question 30

Incubation and duration of yersinia illness

Answer 30

5-7 dyas incubation 3 weeks +

Question 31

Why do older children with yersinia often get mistaken for appendicitis?

Answer 31

RHS abdo pain due to mesenteric lymphadenitis (inflammation in intestitnal lymph nodes) Fever

Question 32

What toxins do S.aureus produce?

Answer 32

Enterotoxins

Question 33

Symptoms of S.aureus enterotoxins

Answer 33

Diarrhoea Perfuse vomitting Abdominal cramps Fever Affect small intestine

Question 34

What is the course of S.aureus toxin incubation and symptoms resolution

Answer 34

Start within hours 12-24 hours settle

Question 35

What is giardiasis?

Answer 35

Microscopic parasite Lives in small intestines of mammals Causes GE

Question 36

Transmission of giardiasis

Answer 36

Faeco-oral

Question 37

Symptoms of giraridiasis inection

Answer 37

Asymptomatic Chronic diarrhoea

Question 38

Diagnosis for giardiasis

Answer 38

Stool microscopy

Question 39

Treatment for giardiasis

Answer 39

Metronidazole

Question 40

How long do children need to stay off schoo, iwth GE

Answer 40

48 hours after symptoms completely resolved

Question 41

What is a fluid challenge

Answer 41

Record small vol fluid given orally every 5-10 mins to ensure they can tolerate it and adequately hydrated

Question 42

What to introduce after fluid challenge after GE

Answer 42

Dry light diet eg toast

Question 43

What medication is generall not recommended in GE?

Answer 43

antidiarrhoeals eg loperamide antiemetics eg metoclopramide

Question 44

When are antidiarrhoeals particuarly avoided?

Answer 44

e.coli 0157 and shigella Where bloody diarrhoea and fever

Question 45

Post GE complications

Answer 45

Lactos eintolerance IBS Reactive arthritis Guillian Barre syndrome