Gastroenteritis

Question 1

Define Gastroenteritis

Answer 1

Gastroenteritis is the term used to describe a condition in which there is diarrhoea +/- vomiting from an infectious origin

Question 2

Give some common viral causes of gastroenteritis

Answer 2

Norovirus, Rotavirus and Adenovirus

Question 3

Give some bacterial causes of gastroenteritis

Answer 3

Campylobacter, E.coli, Salmonella and Shigella

Question 4

Give some parasitic causes of gastroenteritis

Answer 4

Cryptosporidium, Entamoeba and Giardia

Question 5

How do you assess patients with gastroenteritis?

Answer 5

A to E assessment
Stabilise before any further assessment

Treat dehydration early

Rule out any severe abdominal pathology

Question 6

Give the organism:
Bloody diarrhoea with fever and cramps
Incubation period = 8-24 hours

Answer 6

Salmonella

Question 7

Give the organism:
Predominantly vomiting, with watery diarrhoea
Incubation period 12-48 hours

Answer 7

Norovirus

Question 8

Give the organism:
Diarrhoea in young children
Incubation period = 1-7 days

Answer 8

Rotavirus

Question 9

Give the organism:
Profuse watery bloody diarrhoea with fever and cramps
Incubation period = 2-5 days

Answer 9

Campylobacter

Question 10

Give the organism:
Usually mild self-limiting diarrhoea for less than 72 hours
Incubation period = 12-72 hours

Answer 10

E. Coli

Question 11

Give the organism:
Acute watery diarrhoea that may be accompanied by mucus, pus or blood. Fever and abdominal pain.
Incubation period = 2-3 days

Answer 11

Shigella

Question 12

Give the organism:
Diarrhoea following antibiotics
Incubation period = 1-7 days

Answer 12

C. difficile

Question 13

Give the organism:
Profuse watery diarrhoea without abdominal pain or fever
Incubation period = 2-5 days

Answer 13

Cholera

Question 14

Give the organism:
HIV/ immunocompromised, prolonged diarrhoea
Incubation period = 4-12 days

Answer 14

Cryptosporidium

Question 15

Give the organism:
Prolonged diarrhoea
Incubation period = 1-4 weeks

Answer 15

Giardia

Question 16

What is the important condition associated with VTEC E.Coli? (and explain the features of the condition)

Answer 16

Haemolytic uraemic syndrome

Characterised by AKI, haemolytic anaemia and thrombocytopaenia

Question 17

How should a patient be managed with infective diarrhoea that has no systemic signs, is not immunocompromised and has not had any recent travel?

Answer 17

The patient should receive symptomatic treatment

A stool culture is not needed

Question 18

How should a patient be managed with infective diarrhoea that is systemically unwell?

Answer 18

Hospital admission

IV fluids and empirical Abx (ciprofloxacin) should be given

Stool culture is required

Question 19

What is routinely looked for on a stool culture?

Answer 19

Campylobacter, E.Coli, Salmonella, Shigella and Cryptosporidium

If another organism is suspected it must be requested

Question 20

If polymorphs are seen on direct faecal smear what does this indicate?

Answer 20

Shigella, Campylobacter or E.coli

Question 21

If no polymorphs are seen on direct faecal smear what does this indicate?

Answer 21

Salmonella, E.coli or C.difficile

Question 22

If the patient has severe diarrhoea and dehydration what blood tests should be performed?

Answer 22

FBC, U&Es, CRP/ESR, LFTs

If very severe = ABG

Question 23

If there is evidence of electrolyte imbalance what should be done?

Answer 23

An ECG

Question 24

How should patients with diarrhoea be managed?

Answer 24

• Isolated in a side room
• Consultant of infectious diseases notified
• Barrier nursing
• Hydration with oral/ IV fluids

If severe Sxs:
- Prochlorperazine or loperamide or codeine phosphate

In some cases of infectious diarrhoea:
- Abx

Question 25

Why is symptomatic management not recommended in all cases?

Answer 25

It slows the clearance of the pathogen

Question 26

What can be given for symptomatic relief of diarrhoea?

Answer 26

- Prochlorperazine 12.5mg QDS PRN - Loperamide 2mg after each loose stool (max 16mg/ 24hr) - Codeine phosphate 30mg TDS

Question 27

What is given in traveller's diarrhoea?

Answer 27

Ciprofloxacin 500mg BD for 3/7 or Azithromycin 500mg BD for 3/7 These can also be used for prophylaxis

Question 28

In parasitic infections what antibiotic is most effective?

Answer 28

Metronidazole

Question 29

When are antibiotics given?

Answer 29

- Immunocompromised | - Severe/ prolonged infection

Question 30

What type of organism is C. difficile?

Answer 30

Gram positive rod

Question 31

Who commonly gets C.diff infections?

Answer 31

In patients treated with broad spectrum Abx

Question 32

Give some common antibiotics that lead to C.diff infections

Answer 32

Clindamycin and Meropenem

Question 33

How is C.diff identified?

Answer 33

C.diff toxin (A+B toxins) are identified on stool analysis

Question 34

How should a patient with a C.diff infection be managed?

Answer 34

- Isolate the patient in a side room and introduce barrier nursing Moderate disease: - Metronidazole PO 500mg TDS for 10/7 Severe disease: - Vancomycin PO 125mg QDS for 10/7

Question 35

What can be considered if antibiotic therapy is ineffective?

Answer 35

Foecal transplantation

Question 36

What is a potential complication of C.diff? and what can it lead to?

Answer 36

Pseudomembranous colitis If severe can cause toxic megacolon and bowel perforation

Question 37

How can pseudomembranous colitis be identified?

Answer 37

Flexi sig would show yellow adherent plaques on an inflamed mucosa

Question 38

What should be done if patients with C.diff develop abdo distension?

Answer 38

ABG (to check lactate) and AXR Urgent colectomy may be required