Gastroenteritis and Food Poisoning Flashcards Preview

JL Gastrointestinal > Gastroenteritis and Food Poisoning > Flashcards

Flashcards in Gastroenteritis and Food Poisoning Deck (138):
1

What condition causes GI symptoms, diarrhoea, vomiting, abdominal pain and relates to invasion of tissue +/- toxin production?

Food poisoning

2

What is the commonest cause of food poisoning?

Campylobacter

3

What cause of food poisoning is rare, but can lead to morbidity and outbreaks?

E coli O157

4

What two organisms have a short incubation period of 1-6 hours?

Staph aureus and Bacillus cereus

5

What two organisms have a medium incubation period of 12-48 hours and there is invasion/toxin in gut which can often cause blood diarrhoea?

Salmonella
CI perfringens

6

What 2 organisms have a long incubation period of 2-14 days and can cause bloody diarrhoea?

Campylobacter and E coli O157

7

How long does it take for labarotory confirmation of bacteria?

48 hours for culture result

8

What two food products can campylobacter come from?

Raw milk
Poultry

9

Which organism rarely causes outbreaks, occurs in small numbers and results in pain, blood and a fever?

Campylobacter

10

What is the treatment for campylobacter?

Ciprofloxacin/erythromycin

11

What 3 food products can salmonella enteritidis come from?

Poultry, meat, raw egg

12

Where is salmonella occuring?

In animal gut

13

What is the treatment for salmonella enteritidis, which causes diarrhoea, vomiting, blood and fever?

Ciprofloxacin

14

What are the three most common groups of salmonellae?

B, C and D

15

What king of diarrhoea does E coli O157 cause?

Bloody

16

Is the infectious dose low or high for E coli O157?

Low

17

What two food products can E coli O157 come from?

Beef and raw milk/water

18

How can E coli O157 be transmitted?

Person to person

19

What toxin does E coli O157 produce?

Verotoxin (VTEC)

20

What organism can cause bloody diarrhoea nad haemorrhagic colitis?

E coli O157 VTEC

21

What syndrome can Haemolytic Uraemic Syndrome (HUS)?

E coli O157

22

`What three things does verotoxin do?

1. Binds to receptors found on renal cells, RBC and others
2. Inhibits protein synthesis
3. Causes cell death

23

What is this a presentation of: abdominal pain, fever, pallor, petechiae, blood diarrhoea and oliguria?

HUS

24

What patients are commonly infected by HUS?

Under 16 years old

25

In HUS what are the white cells like, platelets, Hb, LDH?

High WWC
Low platelets
Low Hb
LDH > 1.5 x normal

26

How is HUS investigated?

Send stool culture samples for all bloody diarrhoea samples

27

Other than U&S, FBC, film, LFT, clotting what else would you send for?

Urine (dipstick/micro)
Lactate dehydrogenase

28

What are three complications of HUS?

1. Acute renal failure
2. Thrombocytopaenia
3. Haemolytic anaemia

29

What 3 drug types are NOT given in HUS?

1. Antibiotics
2. Anti-motility agents
3. NSAIDS

30

What kind of diagnosis are these factors involved in: selective culture, sorbitol non fermenter, E coli isolated, check for O157 antigen?

Microbiological diagnosis

31

What infection is associated with contacting farm animals and private drinking water?

E coli O157

32

What two things must you notify the Health Protection Unit on?

Haemolytic Uraemic Syndrome or O157

33

What is the likely cause of blood diarrhoea in children and elderly?

E coli O157

34

What virus is the commonest cause in kids

Rotavirus

35

How is rotavirus transmitted?

Person-person and faecal oral

36

What is diarrhoea like in rotavirus?

Not bloody, mild and watery

37

Along with diarrhoea, what 2 other symptoms occur in rotavirus?

Vomiting and fever first

38

What is the infectious dose like in rota virus?

Low

39

How is rota virus diagnosed?

PCR diagnosis on faeces

40

What is management for rotavirus?

Hydration

41

What is the rota virus vaccine like?

Oral and live attenuated

42

What is the 'Winter Vomiting Disease'?

Norovirus

43

How is norovirus spread?

Faecal-oral/droplet routes spread, person to person or on contaminated food/water

44

What is the infectious dose like for norovirus?

Low

45

What is diarrhoea anad vomiting like in norovirus?

Explosive and sudden

46

What is the incubation for norovirus like?

Short

47

In what 2 ways is norovirus diagnosed?

1. PCR on stool takes 6 hours
2. PCR on vomit using red Copan viral swabs

48

What is the management for norovirus?

Hydration

49

What infection is a side effect on antibiotic treatment?

Cl difficile

50

What two toxins does Cl difficile produce?

Enterotoxin and cytotoxin

51

Does CI difficile produce spores?

Yes

52

Where can CI difficile cause symptoms?

In the colon

53

What infection is related to "mild, bloody pseudomembranous colitis"?

C diff

54

What patients are most likely affected with C diff?

Elderly females >65

55

What 4 factors cause a high index of suspicion for C difficile?

1. Recent antibiotics
2. Surgery
3. Hospital
4. Use of stomach acid suppressants like PPIs

56

What is the diagnosing test for C diff?

Toxin/antigen sensitive screening test: 24 hour turnaround

57

On sigmoidoscopy of C diff patient, what is seen?

Membranous lesions
Pseudomembranous colitis

58

What two types of C diff are virulent strains producing 20x more toxin and lead to aggressive disease and death?

027
078

59

What is the term for inflammation of stomach or intestines - it inhibits nutrient absorption and excessive H2O and electrolyte loss?

Gastroenteritis

60

What are 3 preformed organisms that cause food poisoning?

1. Staph auresu
2. Clostridium perfringens
3. Bacillus cereus

61

What 2 organisms cause in vivo production of toxin related food posioning?

1. Vibrio
2. Enterotoxigenic E.coli

62

What are the three clinical syndromes of acute enteritis?

1. Fever
2. Diarrhoea and vomiting
3. Abdominal pain

63

What are the three clinical syndromes of enteric fever like illness?

1. Fever
2. Rigors
3. Pain

64

What 4 organisms can cause bloody diarrhoea and usually indicate colonic inflammation?

1. Campylobacter
2. Shigella
3. E coli
4. Amoebiasis

65

What is a rare, but important complication of Campylobacter?

Guillain-Barre

66

What can severe cases of campylobacter be treated with?

Clarithromycin or azithromycin

67

What condition involves tingling of the feet, leading to progressive paralysis of the legs, arms and rest of body?

Guillain-Barre Syndrome

68

What type of fever is typhoid?

Enteric fever

69

What type of enteric fever is imported from India, SE Asia, Far East, Middle East and Africa?

Typhoid

70

What two ways is typhoid transmitted?

Food and water
Carrier

71

What are the 3 features of presentation of typhoid?

1. Asymptomatic. mild
2. Bacteraemia
3. Enterocolitis

72

What is key to diagnosis of typhoid, but what can also be done to help?

Blood cultures
Stool and urine culture

73

What 4 antibiotics are used to treat Tyhpoid?

1. Chloramphenicol and Ciprofloxacin
2. Ceftriaxone or azithromycin

74

What two infections require an in depth travel history?

Giardia
Amoeba

75

What investigation would be done for Salmonella, Campylobacter and Shigella?

Stool culture

76

What two infections require toxin testing?

E Coli
C. difficle

77

What organism would you do a blood culture for?

Salmonella

78

What is creatinine like in C.diff?

>1.5 x baseline

79

What four factors are severity markers of C.diff?

1. Pseuodemembranous colitis
2. Toxic megacolon
3. Ileus
4. Colonic dilatation >6cm

80

Give 4 complications of bacterial enteritis intestinal?

1. Severe dehydration and renal failure
2. Acute colitis, toxic dilatation
3. Post infective irritable bowel (very common)
4. Transient secondary lactase intolerance

81

What are septicaemia, meningitis, aortitis, ostyeomyelitis, endocarditis, reactive arthritis, meningism, Guillian Barre Syndrome, haemolytic uraemic syndome all complications of?

Bacterial enteritis extra-intestinal

82

Name two antimotility agents?

Opiates and loperamide

83

Name tow anti-secretory agents?

Chlorpromazine, bismuth subsalycilate

84

Name two absorbents?

Kaolin, charcoal

85

What is an anaerobic gram-positive spore forming bacillus?

C. diff

86

What are four antibiotics that are risk factors for C diff?

1. Fluoroquinolones
2. Cephalosporins
3. Clindamycins
4. Broad spectrum penicillins

87

What are two medications that can be risk factors for C diff?

1. PPI
2. H2 receptor antagonists

88

What are the 4 C. dff causing antibiotics?

1. Cephalosporins
2. Clindamycin
3. Ciprofloxacin (quinolines)
4. Clarithromycin (macrolides)

89

For pseudomembranous colitis, what drugs should be stopped and what antibiotic should be given?

Stop opiates, PPIs and anti-perstaltic drugs
Give oral vancomycin or metranidazole for non-severe cases

90

What drug is used for a relapse of c diff?

Fidaxomicin

91

What are 3 travel related diarrhoea causes?

1. Amoebiasis
2. Giardiasis
3. Cryptosporidiosis

92

What is a protozoal infection spread by faeco-oral route or by an ill or asymptomatic carrier?

Amoebiasis

93

What areas is amoebiasis com mon in?

Areas of poor sanitation

94

What is the diarrhoea like in amoebiasis?

Acute and bloody

95

How is diagnosis ofintestinal amoebiasis made?

By examination of hot stool for ova and cysts (stool M & C)

96

What is the treatment for amoebiasis?

Metronidazole. Remove from lumen by using diloxanide furate or paromomycin

97

What is the diarrhoea like in giardiasis?

Explosive, protracted and foul smelling

98

What infection is protozoan Giardia lambia trophozoites colonising the small bowel mucosa to produce diarrhoea?

Giardiasis

99

How is Giardiasis spread?

Spread by cysts found in normal drinkng water

100

How is giardiasis diagnosed?

Examine stools for ova and cysts but more accurately by duodenal aspiration.

101

How is giardiasis treated?

With metronidazole

102

What is one of the main causes of infectious diarrhoea in many parts of the world and is an important cause of travel related diarrhoea?

Cryptosporidiosis

103

How is cryptosporidiosis transmitted?

Water, food, animal contact, highly infectious and resilient

104

What patient types usually get cryptosporidiosis (C.parvum)?

West African Children

105

How is cryptosporidiosis diagnosed?

By duodenal aspirate/stool

106

How is cryptosporidiosis treated?

Supportive

107

How is diagnosis of extra-intestinal ameobiasis made?

Requires serology

108

Name two arboviruses?

Dengue
Chikungunya

109

What is the definition of acute tranveller's diarrhoea?

3 loose stools in 24 hours

110

What typically causes acute traveller's diarrhoea?

Enterotoxigenic E. coli

111

Other than E.coli, what three other causes of acute traveller's diarrhoea are there?

Campylobacter, Salmonella and Shigella

112

What is commonly caught on Cruise ships?

Noravirus or rotavirus

113

What infection is often associated with outbreaks in refugee camps?

Cholera

114

What two investigations are done for acute traveller's diarrhoea?

1. Stool culture
2. Stool wet prep on recently passed stool for amoebic trophozoites

115

What is the treatment for Acute traveller's diarrhoea?

Supportive - fluid rehydration
In travelling patients, ciprofloxaacin single dose can stop worsening

116

What is most common from travellers returning from India subcontinent or SE Asia?

Typhoid or paratyphoid fever (enteric fever)

117

Where is Salmonella typhi usually isolated from?

Blood, stool or urine

118

How is Salmonella typhi treated?

With ceftriaxone

119

What three things can be a cause of fever and pre-hepatic jaundice?

Malaria, HUS (E.coli O157/Shigella), sickle cell crisis

120

What does leptosirosis cause?

Weils disease (icteric, haemorrhagic and renal failure)

121

What is a post-hepatic cause of fever and jaundice?

Ascending cholangitis and helminths

122

How is malaria investigated?

Blood film and rapid antigen

123

What is this: incubation period 9-20 weeks, fever, cough, aching abdominal pain, hepatomegaly, sometimes a history of GI upset and usually male?

Amoebic liver abscess

124

How is amoebic liver abscess investigated?

CXR (raised right hemidiaphragm)
Abnormal LFTs, US/CT, serology,

125

What is the management for amoebic liver abscess?

Metronidazole and paramomycin/diloxanide to clear gut lumen of parasites

126

What are Helminth infections - parasites - often diagnosd by?

The adult worm passed or eggs in stool

127

What are two types of nematodes (round worms)?

Intestinal roundworms
Tissue roundworms (filariasis)

128

What are trematodes?

Flukes

129

What are cestodes?

Tapeworms

130

What is the most common helminthic infection in the world?

Ascariasis

131

What is the life-cycle of a helminth infection?

Egg ingested and hatches in small intestine. Invades gut wall into venous system and via liver and heart reaches lungs. Breaks into alveoli and ascends tracheobronchial tree then becomes swallowed. In the gut develops into adult worm where they start to produce eggs.

132

Name a trematode (fluke) and where can you get it from?

Schistosomiasis - fresh water exposure

133

What can adult worms located in portal venules lead to?

Hepatomegaly, liver fibrosis and portal hypertension

134

How can cestodes such as tapeworms Taenia solium or Saginatum, be aquired?

By eating undercooked meat containing infectious larval cysts

135

What can Taenia solium eggs cause?

Cysticercosis - tissue cysts muscle and brain

136

What protozoa is involved in Chagas disease?

Trypanasoma cruzi

137

How is Chagas disease transmitted?

By the kissing bug

138

What happens to the oesophagus in Chagas' disease?

Megaoesophagus