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Gastroenteritis Flashcards

(61 cards)

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1
Q

What is gastroenteritis?

A

Inflammation of the stomach or intestines

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2
Q

What does gastroenteritis do?

A

inhibits nutrient absorption and excessive H2O and electrolyte loss

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3
Q

What are the 4 causes of gastroenteritis

A

Bacterial
Viral
Parasitic
Poisoning by microbial toxins

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4
Q

What makes you feel worse - bacterial or viral?

A

Bacterial

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5
Q

What is the most common cause of gastroenteritis

A

Infection mostly caused by a virus, bacteria or parasite

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6
Q

Why is there a lower incidence of Gastroenteritis in Dundee than there is in London

A

The number of parasites increases with the population of a city

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7
Q

What are the main common presentations of gastroenteritis

A

Fever
Abdo pain
Diarrhoea
Sometime blood PR

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8
Q

Why is there only sometimes blood PR

A

Certain pathogens cause blood- some are more likely than others

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9
Q

What is an example of a pathogen likely to cause blood

A

Campylobacter

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10
Q

When is the onset for toxin mediated food poisoning

A

1-6 hours after exposure

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11
Q

Why is foodborne illness a rapidly emerging crisis in industrialised countries

A 
Poor sanitation and hygiene 
Change in eating habits 
Importation of food 
Increase in day care centre attendance 
Increase in elderly care 
institutes 
Increased travel 
Pets carry many pathogens
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12
Q

What do poultry and eggs carry? How could we get this?

A

Campylobacter - if we do not cook the meat well enough

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13
Q

What are some non-infectious diarrhoea examples

A 
GI bleed
Ischaemic gut 
Diverticulitis
Endocirne disorders
Numerous drugs
Fish toxins 
Withdrawl
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14
Q

How do we approach any clinical infection syndrome

A

Find what the key clinical symptoms and signs are that suggest infection
Differential diagnosis
Severity of infection
Site and microbiological diagnosis and investigations
Antibiotic and supportive management
Infection control
Public health

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15
Q

How does the norovirus spread

A

As a spray in vomit

Faecal/ oral

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16
Q

How long does it take for the norovirus to resolve

A

24-48 hours

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17
Q

What are the common symptoms of norovirus

A

Abrupt nausea, vomiting, diarrhoea, cramps, myalgias

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18
Q

Who is most likely to get the norovirus

A

Older children and adults - not children

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19
Q

What are the 3 common presentations of food poisoning

A

Acute enteritis: fever, D&V, abdo pain
Acute colitis: fever, pain, bloody diarrhoea
Enteric fever like illness: fever, rigors, pain, but little diarrhoea by the time the present

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20
Q

What does blood diarrhoea usually indicate

A

Infection
IBD
Malignancy
Iscahemia

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21
Q

What is a complication of campylobacter

A

Guillain Barre

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22
Q

How long does Campylobacter affect us for

A

5-14 days

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23
Q

What do indentations on an AXR indicate

A

Inflammation

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24
Q

What are the common symptoms of enteric fever like illness

Give an example of enteric fever

A

Fever
Systemically unwell
Abdo pain
Constipation but possibly short history if diarrhoea

Typhoid is an example

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25
What is typhoid?
A type of salmonella
26
In what countries is typhoid present?
``` India SE Asia Far East, Middle East Africa Central America South America ```
27
How is typhoid carried?
In food and water
28
What are the symptoms of typhoidW
Usually asymptomatic, mild, bacteriaemia, enterocolitis
29
Define enterocolitis
inflammation of the small intestine and the colon
30
How can we diagnose typhoid
Blood, Stool and urine cultures
31
How can we treat typhoid?
Chloramphenicol and ciprofloxacin
32
What antibiotics are used in India, China or Middle east and why are they different?
Ceftriaxone or axithromycin | Resistance - the antibiotics were over used there
33
How can we prevent Typhoid? | How effective is this method?
VI or oral vaccine | 70% effective
34
What does the thyphoid vaccine not protect against?
Paratyphoid
35
What are the 3 main investigations for determining the pathogen of gastroenteritis
Stool microscopy Stool culture Stool toxin
36
What investigation should be done for salmonella, campylobacter and shigella
Stool culture
37
What investigation should be done for a history of travel for giardia, amoeba etc
Stool microscopy
38
What investigation should be done for C difficile, cytotoxin for E coli 0157
Stool toxin
39
What would PCR detect?
Norovirus
40
How can you assess the severity of gastroenteritis?
``` Underlying medical condition Presence or absence of fever Rigors Shock (hypotension / tachycardia) Blood in stools Abdo pain Number of stools in 24 hours Colonic dilation WCC, U&Es ```
41
What determines how severe CDI is?
Suspicion of psudomembranous colitis (PMC) or toxic megacolon or ileus or colonic dilation in CT / AXR >6cm WCC >15cells / mm3 Creatinine >1.5 x baseline
42
Name 4 complications of Bacterial Enteritis within the small bowel
Severe dehydration and renal failure Acute colitis, toxic dilation Post infective irritable bowel Transient secondary lactase intolerance
43
Name 6 complications of bacterial enteritis outside of the bowel
``` Septicaemia Metastatic infection: meingitis , aortitis, endocarditis Reactive arthritis Guillian Barre syndrome Haemolytic uraemic syndrome ```
44
What supportive treatment is given>
``` Oral rehydration IV fluids (saline!!) ```
45
What are specific treatments which can be used
Anti-spasmodics Anti-motility Antibiotics - only in specific regions
46
What is bad about long term antimotility drugs
They stop the normal peristaltic movements and prevent the body naturally clearing toxins
47
What 3 drugs are used as antidiarrhoeal agents
Antimotility agents Antisecretory agents Absorbents
48
Name 4 indications for antibiotic treatment
Enteric fever (tyohoid) Shigellosis Cholea C difficile diarrhoea
49
What are the 3 main aims of antibiotic treatment
To prevent and treat invasive disease especially in immunocompromised patients To reduce the severity and duration of symptoms To eradicate faecal excretion in order to reduce environmental contamination and to limit the spread of infection to the community
50
What type of organism is clostridium difficile
Anaerobic, gram positive spore forming bacillus
51
What is the major cause of diarrhoea and colitis in patients exposed to antibiotics
C diff
52
How can we minimise the spread of CDI
Patients positive in a private room where possible Full barrier praucations Soap and water and not gel!
53
How do we treat c diff
Treeat according tot he severity Reduce the acute complitions Reduce the likelihood of recurrence Treat recurrence
54
What are 3 pathogens found in travel related diarrhoea
Amoebiasis Giardiasis Cryptosporidiosis
55
What is the most common cause of traveller's diarrhoea
ETEC
56
How long does traveller's diarrhoea last
Around 4 days
57
What is amoebiasis
A protozoal infection which is spread by faeco-oral route or by an ill or asymptomatic carrier
58
Where is there a high prevelance of amoebiasis
In areas of poor sanitation
59
What is Giardiasis
Protozoon Giardia lambia trophoxoites colonises the small bowel mucosa to produce diarrhoea and malabstoptions
60
How is Giardiasis spread
Cysts found in the normal drinking water
61
How can we treat giardiasis
Metronidazole

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