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GI: Gastroenteritis > Gastroenteritis - nathwani > Flashcards

Gastroenteritis - nathwani Flashcards

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1
Q

what is gastroenteritis?

A

Inflammation of stomach or intestines

Inhibits nutrient absorption and excessive H2O and electrolyte loss

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2
Q

what are the causes of gastroenteritis?

A
  • mainly infection (bacteria, parasites, viruses - majority, and microbial toxins)
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3
Q

what are the core clinical problems of gastroenteritis (3)

A
  • fever
  • abdo pain
  • diarrhoea ± blood
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4
Q

microbial toxins may be ____-____ or __ ___-

A

pre-formed or in vivo

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5
Q

which organisms pre-form toxins?

A

staph aureus, clostridium perfringens or bacillus cereus

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6
Q

which organisms form toxins in vivo

A

Vibrio, enterotoxigenic E.coli

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7
Q

what is the onset time for microbial toxin causing gastroenteritis?

A

1-6 hours

diarrhoea > few hours , abdo pain and afebrile

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8
Q

with microbial toxin causing gastroenteritis there is no ___ or ___ in the faeces

A

no blood or pus

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9
Q

how long does it take for microbial toxin causing gastroenteritis to resolve?

A

1-6 hours

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10
Q

treatment with ____ ____ has a role in the emergence of gastroenteritis

A

acid suppression

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11
Q

what are some causes of non-infectious diarrhoea? 7

A 
GI bleed
Ischemic gut
Diverticulitis
Endocrine disorders
Numerous drugs
Fish Toxins
Withdrawal
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12
Q

the approach to any clinical infection syndrome!!!

A
  1. What are the key clinical symptoms and signs that suggest the infection?
  2. Differential diagnosis
  3. Severity of Infection
  4. Site and microbiological diagnosis: investigations
  5. Antibiotic and supportive management
  6. Infection Control
  7. Public Health
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13
Q

what organism causes the most gastroenteritis

A

norovirus

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14
Q

norovirus occurs in ___ ___ or ____ and is a cause of community wide ____

A

older children, adults, outbreaks

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15
Q

what makes norovirus so infectious?

A

the virus is ejected in vomit and it has aerosol transmission

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16
Q

viruses have a ____ incubation period than bacteria

A

shorter

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17
Q

what is the incubation period for norovirus?

A

24- 48 hours

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18
Q

what are the three presenting clinical syndromes of food poisening

A
  1. Acute enteritis : fever. D&V, abdominal pain
  2. Acute colitis: fever, pain, bloody diarrhoea
  3. Enteric fever like illness : fever, rigors, pain but little diarrhoea - around 10 % of patients will have this
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19
Q

differential diagnosis of bloody diarrhoea

A

infection - usually indicates colonic inflammation

IBD

Malignancy

Ischaemia

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20
Q

which organisms cause bloody diarrhoea?

A
  1. campylobacter
  2. shigella
    E.coli 0157
  3. amoebiases
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21
Q

campylobacter infection is closely related to meals with ___

A

chicken

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22
Q

incubation period for campylobacter: __-___ days

A

2-5 days

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23
Q

what is a common misdiagnosis of campylobacter?

A

appendicitis

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24
Q

____ ___ is a rare but IMPORTANT COMPLICATION of camplyobacter

A

guillian barr

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25
how long does campylobacter last
5-14 days
26
treatment for campylobacter is ____ however in severe cases may be treated with _____ or ____
supportive, clarithromycin or azithromycin
27
what is guilllian barr syndrome symptoms?
Tingling of the feet leads to progressive paralysis of the legs, arms and rest of the body
28
the stool exam for leukocytes -erythrocytes is ____ for campylobacter
positive
29
what may you see on X-ray with gastritis?
thumbprinting - usually caused by oedema, related to an infective or inflammatory process (colitis)
30
what happens in thumbprinting?
the normal haustra become thickened at regular intervals appearing like thumbprints projecting into the aerated lumen
31
someone presents with fever, they are systemically unwell and have rigors and abdo pain. They had short history of diarrhoea 1 month ago, what is this?
enteric fever like illness
32
____ ___ is an enteric fever
typhoid fever
33
_____ is Almost always imported (Indian subcontinent, SE Asia, Far East, Middle East, Africa, Central/ South America)
typhoid
34
what are the carriers of typhoid?
primarily food but can be water
35
what are the symptoms of typhoid? 4
Asymptomatic, mild, bacteraemia, enterocolitis
36
what is the key to diagnosis with typhoid?
blood cultures, then stool and urine cultures
37
what antibiotics are given for typhoid?
chloramphenicol and ciprofloxacin, ceftriaxone or azithromycin
38
there is a vaccine for ___ but it is only __% effective and is not effective against ______ strains
typhoid, 70%, paratyphoid
39
what are the key features in the history
diarrhoea associated symptoms: abdo pain, vomiting, fever, urgency, incontinence anyone in family or work with similar symptoms occupation pets and ANIMAL CONTACT Travel Drug history - particularly PPI or antibiotics
40
what do you want to know about the diarrhoea?
1. frequency 2. nocturnal - generally pathological 3. colour and consistency 4. presence of blood
41
what are the key features of examination?
- fever - skin rashes - dehydration: BP, postural drop, pulse - abdominal tenderness, distension - rectal examination: stool, blood, tenderness
42
what rashes may appear?
rose spots, erythema nodosum
43
what are signs of dehydration
pulse, mental state, dry tongue, skin turgor
44
what are the options for tests? 6
STOOL: - microscopy - culture - toxin BLOOD CULTURES PCR FBC Us and Es AXR
45
when do you do microscopy?
if parasite e.g history of travel for giardia, amoeba etc
46
when would you do a culture?
Salmonella, Campylobacter, Shigella suspected
47
when would you do a toxin?
c.diff
48
_____ test for E.coli 0157
cytotoxin
49
why do renal tests?
need to know if they are dehydrated
50
factors in assessment of severity?
there are lots but: Colonic dilatation- from AXR laboratory : WCC, renal function these are important, were bold in the lecture
51
Severity of C.diff : one or more of the following severity markers for treatment to be classed as severe not mild (note treatment options differ for mild and severe) 1. Suspicion of ________ _____ (PMC) or ___ -___ or ____or ___ ____ in CT/AXR >6cm 2. WCC >__ cells/mm3 3. Creatinine >___ x baseline 4. Persisting symptomatic CDI despite __ treatments
1. Suspicion of Pseudomembranous colitis (PMC) or toxic megacolon or ileus or colonic dilatation in CT/AXR >6cm 2. WCC >15 cells/mm3 3. Creatinine >1.5 x baseline 4. Persisting symptomatic CDI despite 2 treatments
52
what are the complications of Bacterial Enteritis? Intestinal - 4
1. severe dehydration and renal failure 2. acute colitis, toxic dilatation 3. post infective irritable bowel (very common) 4. transient secondary lactase intolerance
53
what are the complications of Bacterial Enteritis? extra-intestinal - 6
- Bacteriaemia leading to sepsis - Reactive arthritis - Meningism - Neurological [Guillian Barre syndrome] - Haemolytic uraemic syndrome
54
what metastatic infections can you get if you are bacteraemic? and what else can occur in sepsis?
metastatic infection: meningitis, aortitis. Ostyeomyelitis, endocarditis
55
______ from ____ causes the haemolytic uraemic syndrome
toxin from e.coli 0157
56
why do we give antibiotics therapy ? 3 reasons
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 in the community
57
how is gastritis generally treated?
supportive therapy : Oral rehydration Intravenous fluids (saline important) if very unwell may need antibiotics - only in specific situations though
58
what are the indications for antibiotics? which bugs? 8
- Enteric fever [TYPHOID] - Shigellosis [non sonnei species] - Enterotoxigenic E coli [SOMETIMES] - Cholera - Clostridium difficile diarrhoea - Giardiasis - Amoediasis - Invasive salmonellosis
59
Does the patient need admitted to ID unit? (eg ____, ____)
Does the patient need admitted to ID unit? (eg Salmonella, E coli O157)
60
which bugs have a low infectious dose?
viruses, E.coi
61
what are some other infections spread by faecal-oral route?
hep A and E Resistant bacteria that are carried in the GI tract, e.g vancomycin-resistant enterococci, highly resistant Gram negative organisms (CPEs)

GI: Gastroenteritis (10 decks)

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