Gastroenteritis

Question 1

What is gastroenteritis?

Answer 1

This is inflammation of the stomach or intestines which inhibits nutrient absorption and excessive water and electrolyte loss

Question 2

What can gastroenteritis be caused by?

Answer 2

Bacteria, virus, parasites or poisoning by microbial toxins

Question 3

What is the most common cause of gastroenteritis?

Answer 3

Infection

Question 4

How do patients present with food poisoning?

Answer 4

Fever
Abdominal pain
Diarrhoea
PR bleeding in some cases

Question 5

what can cause toxin mediated food poisoning?

Answer 5

staph. aureus, bacillus cereus or enterotoxigenic E. Coli

Question 6

Is there blood or pus in the faeces of a patient with toxin mediated food poisoning?

Answer 6

No - usually not

Question 7

What can Arizonan turtles cause?

Answer 7

Salmonella

Question 8

Give examples of resivoirs for salmonella

Answer 8

reptiles, eggs and undercooked poultry

Question 9

What are the causes of non-infectious diarrhoea?

Answer 9

Fish toxins
Endocrine disorders
Withdrawl
Diverticulitis
Ischemic gut
Numerous drugs
GI bleed

Question 10

What symptoms are caused by the norovirus?

Answer 10

Abrupt nausea, vomiting, diarrhoea, cramps, myalgia

Question 11

what is myalgia?

Answer 11

Pain in a muscle or a group of muscles

Question 12

What are the presenting complains in a patient with acute enteritis?

Answer 12

fever, diarrhoea, vomiting and abdominal pain

Question 13

What are the presenting complains in a patient with acute colitis?

Answer 13

fever, pain, bloody diarrhoea

Question 14

What are the presenting complains in a patient with enteric fever?

Answer 14

fever, rigors and pain - perhaps a little diarrhoea

Question 15

what does bloody diarrhoea suggest?

Answer 15

Infection - usually colonic inflammation

Question 16

what kind of bacteria can cause bloody diarrhoea?

Answer 16

Campylobacter, shigella spp or E. coli

Question 17

what can campylobacter mimic?

Answer 17

appendicitis

Question 18

name an important complication to remember of campylobacter

Answer 18

Guillain-Barre syndrome

Question 19

what can be used to treat campylobacter?

Answer 19

if severe treat with clarithromycin and azithromycin

Question 20

what is Guillain-Barre syndrome?

Answer 20

Autoimmune response - leads to tingling of the feet and progressive paralysis of the legs, arms then rest of the body

Question 21

what are the symptoms of enteric fever like illness?

Answer 21

fever, systemic illness, abdominal pain and constipation - may have short history of diarrhoea

Question 22

Give an example of an enteric fever?

Answer 22

typhoid fever

Question 23

how does typhoid fever present?

Answer 23

Asymptomatic, mild, bacteraemia, enterocolitis

Question 24

How is typhoid fever diagnosed?

Answer 24

blood, stool and urine cultures

Question 25

What is used to treat typhoid fever?

Answer 25

Usually azithromycin - in Asia there is a resistance to chloramphenicol and ciprofloxacin

Question 26

what is important when taking a drug history?

Answer 26

To find out if they have been on recent antibiotics or PPIs

Question 27

what investigations can be ordered for gastroenteritis?

Answer 27

``` Stool microscopy Stool culture Stool toxin - for C diff Blood cultures - Salmonella PCR FBC AXR ```

Question 28

what are the severity markers for CDI?

Answer 28

Suspicion of pseudomembranous colitis/toxic megacolon/colonic dilatation increased WCC Increased Creatinine CDI symptoms despite 2 treatments

Question 29

What are the complications of bacterial enteritis intestinal?

Answer 29

Severe dehydration and renal failure Acute colitis, toxic dilatation Post infective irritable bowel Transient secondary lactase intolerance

Question 30

What are the complications of bacterial enteritis extra-intestinal?

Answer 30

``` Bacteriaemia leading to sepsis metastatic infection: meningitis, aortitis, Ostyeomyelitis, endocarditis Reactive arthritis Meningism Neurological Haemolytic uraemic syndrome ```

Question 31

what are the objectives of antibiotic treatment?

Answer 31

treat invasive disease reduce severity of symptoms eradicate faecal excretion

Question 32

what is the treatment for gastroenteritis?

Answer 32

Oral rehydration - IV fluids Anti-spasmodics Anti-motility (short term)

Question 33

what are risk factors for gastroenteritis?

Answer 33

age immunosuppression PPI use Hospitalisation

Question 34

Key factors to the treatment of C. Difficile?

Answer 34

treat according to severity reduce acute complications reduce likelihood of recurrence

Question 35

which patients are more at risk of C. Diff?

Answer 35

``` Elderly Antibiotic treatment Prolonged hospitalisation Defective immune response to toxin A Gastric acid suppression ```

Question 36

what are the drivers for C. Difficile infections?

Answer 36

``` Broad spectrum antibiotic therapy certain antibiotic types long duration of therapy total amount of antibiotic use vulnerable groups ```

Question 37

How should patients with vomiting and diarrhoea be managed?

Answer 37

oral rehydration

Question 38

what should be avoided in patients with vomiting and diarrhoea?

Answer 38

anti-motility agents

Question 39

what can cause travel related diarrhoea?

Answer 39

amoebiasis giardiasis cryptosporidiosis

Question 40

how should traveller's diarrhoea be treated?

Answer 40

treat symptomatically ciprofloxacin short term anti-diarrhoeals

Question 41

what is amoebiasis?

Answer 41

Protozoal infection spread by faeco-oral route or by an ill or asymptomatic carrier

Question 42

how can amoebiasis be diagnosed?

Answer 42

examination of hot stool for ova and cycsts | Amoebic serology

Question 43

what may occur during amoebiasis?

Answer 43

an amoebic liver abscess may form

Question 44

how does giardiasis spread?

Answer 44

by cysts found in normal drinking water

Question 45

how is giardiasis diagnosed?

Answer 45

examination of stools for ova and cysts | duodenal aspiration

Question 46

How is giardiasis treated?

Answer 46

Metronidazole

Question 47

how is Cryptosporidiosis | transmitted?

Answer 47

water, food, contact with animals - highly infectious

Question 48

how is Cryptosporidiosis | diagnosed?

Answer 48

duodenal aspirate

Question 49

How is Cryptosporidiosis | treated?

Answer 49

supportive - nitizoxamide can be used