- Type 1 – separate hard lumps, like nuts - Type 2 – sausage-shaped but lumpy - Type 3 – sausage shaped, but with cracks on the surface - Type 4 – sausage or snake like, smooth and soft - Type 5 – soft blobs with clear-cut edges (easy to pass) - Type 6 – fluffy pieces with ragged edges, mushy - Type 7 – watery, no solid pieces (entirely liquid)

Bacillus cerues: - Gram negative or gram positive? - What foods is it found in? - Describe the spores - What can it cause? - Incubation period

- Gram positive bacillus - Starchy foods - can get it from reheated rice - Spores are heat resistant - Profuse vomiting - 1-6 hours

Staph aureus: - Gram positive or gram negative? - Which foods is it found in? - What does it act on? - Incubation period

- Gram positive coccus - Foods left at food temperature e.g. milk, meat, fish - Acts on vomiting centre in brain causing vomiting and abdominal pain - 1-6 hours

Bacillus cereus: - What type of pathogen is it? - What foods can it come from? - What can it cause? - Incubation period

- Diarrhoeal toxin - Meat, stew, gravy, vanilla sauce - Abdominal cramps, watery diarrhoea, nauseua - 8-16 hours

Clostridium perfringens: - What type of pathogen is it? - What foods can it come from? - What can it cause? - Incubation period

- Toxin - Meat, poultry, gravy, dried or precooked foods, time and/or temperature-abused food - Watery diarrhoea, nausea, abdominal cramps - 8-16 hours

Gastroenterology Flashcards by Niamh Berry

Things impacting GI diseases

Poor sanitation
Commercialisation of food production
Import of food from other countries
Increase in day care/care home
International travel
Acid suppression
Healthcare associated infections of the GI tract

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GI infection risk factors

Malnutrition/deficiency, closed/semi-closed communities, exposure to contaminated food/water/travel, immunosuppression

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Diarrhoea

> 3 unformed stools a day, stools hold shape of the container

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Bristol stool chart

Type 1 – separate hard lumps, like nuts
Type 2 – sausage-shaped but lumpy
Type 3 – sausage shaped, but with cracks on the surface
Type 4 – sausage or snake like, smooth and soft
Type 5 – soft blobs with clear-cut edges (easy to pass)
Type 6 – fluffy pieces with ragged edges, mushy
Type 7 – watery, no solid pieces (entirely liquid)

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Dysentery

Inflammation of the intestine, particularly the colon, causing diarrhoea associated with blood or mucus

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Bacteria causing dysentery

Shigella, campelobacter

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Symptoms of dysentery

Fever, abdominal pain, tenesmus

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What do bacteria need to multiply?

Time
Temperature
Food source
Moisture

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Gastroenteritis

Illness caused by eating food contaminated with microorganisms, toxins, poisons etc

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Symptoms of gastroenteritis

Diarrhoea, blood, mucous, vomiting, abdominal pain

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Questions to ask when taking a history relating to gastroenteritis

Travel, contacts, food history, medication history

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Bacillus cerues:

Gram negative or gram positive?
What foods is it found in?
Describe the spores
What can it cause?
Incubation period

Gram positive bacillus
Starchy foods - can get it from reheated rice
Spores are heat resistant
Profuse vomiting
1-6 hours

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Staph aureus:

Gram positive or gram negative?
Which foods is it found in?
What does it act on?
Incubation period

Gram positive coccus
Foods left at food temperature e.g. milk, meat, fish
Acts on vomiting centre in brain causing vomiting and abdominal pain
1-6 hours

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Bacillus cereus:

What type of pathogen is it?
What foods can it come from?
What can it cause?
Incubation period

Diarrhoeal toxin
Meat, stew, gravy, vanilla sauce
Abdominal cramps, watery diarrhoea, nauseua
8-16 hours

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Clostridium perfringens:

What type of pathogen is it?
What foods can it come from?
What can it cause?
Incubation period

Toxin
Meat, poultry, gravy, dried or precooked foods, time and/or temperature-abused food
Watery diarrhoea, nausea, abdominal cramps
8-16 hours

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What is the most common bacteria?

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Campylobacter jejuni

What tests do all stool cultures get?

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Salmonella/shigella/campylobacter/O 157 and cryptosporidium, all >4 years old get C.difficile

Types of Shigella

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Shigella dysenteriae (group A)
Shigella flexneri (group B)
Shigella boydii (group C)
Shigella sonnei (group D)

What does the shiga toxin in shigella bind to?

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Receptors found on renal cells, RBC and inhibits protein synthesis causing cell death

What does E.coli do?

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Adhere to intestinal epithelial cells and elaborate shiga toxin

How does shiga toxin cause disease in E.coli?

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Bind to absorptive enterocytes on the luminal surface of the small and large intestines, enter the cell and irreversibly inhibit protein synthesis causing cell death

How do shiga toxins cause death of vascular endothelial cells?

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Shiga toxins enter bloodstream via damaged intestinal epithelium and cause death of vascular endothelial cells by inhibiting protein synthesis

E.coli 0157:

When should it be suspected?
What can it cause?
Infectious dose
Which food is it found in?
How is it spread?
Incubation period
What toxin does it produce?

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In bloody diarrhoea or blood per rectum
Haemorrhagic colitis
Very low infectious dose
Found in beef mostly, but wide range
Spread person-to-person or animal contact
1-14 days
Verotoxin

Presentation of haemolytic uraemic syndrome

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Abdominal pain, fever, pallor, petechiae, oliguria
Most cases in <16 years old
Patients will have high white cells, low platelets, low haemoglobin, red cell fragments, LDH>1.5 x normal

Investigations for haemolytic uraemic syndrome

- Send stool culture samples - Send U&E, FBC, film, LFT, clotting, urine, lactate dehydrogenase - Close monitoring - Admission is usually needed - Check for acute renal failure, thrombocytopaenia, haemolytic anaemia

How is haemolytic uraemic syndrome diagnosed?

Microbiologically

Pathotypes of E.coli

Enterotoxigenic, enteropathogenic, enteroinvasive, enteroaggrative

Enterotoxigenic E.coli: - What type of toxin does it produce? - What is it related to?

- Heat labile and heat stable toxin | - Travel

Enteropathogenic E.coli: - What does it do? - Who does it occur in?

- Synthesises, secretes and inserts its own receptor into membranes - Non-breastfed children

Enteroinvasive: - What symptoms does it cause? - What test can be done to diagnose this?

- Watery diarrhoea, rare dysentery | - Sereny test

Campylobacter: - Incubation period - Which foods is it present in? - Symptoms

- 16-48 hours - Poultry and raw milk - Pain, blood, fever

Salmonella enteriditis: - Incubation period - Where is it found? - Symptoms

- 12-48 hours - Animal guts and multiplies in food, e.g. poultry, meat, raw egg - Diarrhoea and vomiting, blood in stool or vomit, fever

Most common groups of salmonella

B, C, D

Listeria monocytogenes: - Incubation period - Symptoms - Where is it found?

- 9-48 hours - Fever, muscle aches, diarrhoea - Unpasteurised milk products, deli counter

Diagnosis of listeria monocytogenes

Easier from sterile site, gram positive rod

Rotavirus: - Who does it affect? - How does it spread? - Clinical presentation - Infectious dose - How long does it last? - Diagnosis - Management

- Children, most common <3 years old - Person-to-person, faecal oral - Fever, vomiting, diarrhoea (watery but not bloody) - Low infectious dose - About a week - PCR on faeces - Supportive care - hydration is key

Rotavirus vaccine: - How is it given? - What type of vaccine is it? - How is it secreted? - Who gets it?

- Orally - Live attenuated - Faeces - 2 doses at 2 and 3 months old, not >24 weeks

Norovirus: - How is it spread? - Infectious dose - Symptoms - Incubation - Diagnosis - Management

- Faecal-oral, droplets, person-to-person or contaminated food/water - Low infectious dose - Explosive and sudden diarrhoea and vomiting - <24 hours, lasts 2-4 days - PCR on stool takes 6 hours, PCR on vomit using red copan viral swabs - Supportive - hydration

Gastroenterology Flashcards

(38 cards)