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The Treatment and Prevention of Infection > GI infections > Flashcards

GI infections Flashcards

1
Q

Symptoms of acute gastroenteritis

A
  • Diarrhoea, > 3 loose stools per day,
  • Nausea and Vomiting
  • Abdominal pain
  • Fever
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2
Q

Define Dysentery

A

Same symptoms as acute gastroenteritis plus blood

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3
Q

When is diarrhoea considered to be chronic

A

2-3 weeks

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4
Q

Bacteria that commonly cause GI infections

A
  • Campylobacter
  • Salmonella
  • Shigella
  • Escherichia coli
  • E.coli O157
  • Clostridium difficile
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5
Q

Viruses that commonly cause GI infection

A
  • Norovirus
  • Rotavirus
  • Adenovirus
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6
Q

Protozoa that commonly cause GI infection

A
  • Cryptosporidium
  • Giardia lamblia
  • Entamoeba histolytica

Protozoa more associated with travel

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7
Q

Most common causes of acute GE in UK

A

Salmonella and campylobacter,

More viral in children

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8
Q

Pathogens that cause Dysentry

A
  • Campylobacter (Salmonella)
  • Shigella
  • Escherichia coli
  • E.coli O157
  • Clostridium difficile

Protozoa: Entamoeba histolytica

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9
Q

Causes of travelles diarrhoea.Bacterial, viral and protozoal

A

Bacterial: Campylobacter, Salmonella, Shigella, Escherichia coli

Viruses: Norovirus (e.g. cruise ships), Rotavirus, Adenovirus

Protozoa: Cryptosporidium, Giardia, Entamoeba histolytica

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10
Q

Chance of following groups being C diff positive:

AB diarrhoea

AB colitis

Pseudomembraneoud colitis

A
  • 20-30%
  • 50-75%
  • >90%
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11
Q

AB effect on microflora

A
  • Most ABs capable of killing commensal bacteria. Physioligaclly breakdown. If absent, bile damages colon
  • Macrolide (vanco, erythromycin) breakdown products bind to receptors and promote gastric motolity
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12
Q

Causes of chronis diarrhoea

A
  • Parasites in traveller’s
  • Post infection syndromes
    • Irritable bowel
    • Malabsorption

Distal illium is especially critical due to its involvement in enterohepatic recycling.

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13
Q

Non-infectious causes of GI issues

A
  • Inflammatory bowel disease
  • Diverticular disease
  • Ischaemic colitis
  • Colorectal carcinoma
  • Malabsorption
  • Extra-intestinal infection e.g. pneumonia
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14
Q

Sampling a patient with diarrhoea

A
  • Different pathogens
  • Stool
    • microscopy (ova, cysts and parasites – OCP) and culture
    • Lab can also check for rotavirus antigen
    • Clostridium difficile toxin (CDT) PCR

Aim for three specimens, especially with parasites as there are numerically fewer, so harder to pick up

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15
Q

General managment of diarrhoea

A
  1. Rehydration
  2. Analgesia e.g. paracetamol
    • NB: Condeine is anti-motility, and NSAIDS on empty stomach may cause gastritis
  3. Antiemetics e.g. ondansetron
  4. Avoid antidiarrhoeal agents e.g. loperamide Isolation (in hospital)
  5. Notification to Public Health

2-4 slows motility, so might not be ideal in acute diarrhoea

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16
Q

ABs for C. dif diarrhoes

A

Metronidazole or vancomycin

17
Q

Treating traveller diarrhoea

A
  • ~ 80% due to bacteria
  • Antibiotics are more likely to make a difference

Empirical ciprofloxacin

  • 500 mg stat or
  • 500 mg bd for 5 days
  • Reduces the duration of symptoms by 1-2 days if started early

If due to parasites

  • Confirmed on stool OCP
  • Chronic symptoms
  • No response to ciprofloxacin

Metronidazole

  • Giardia (sometimes steatorrhoea)
  • Entamoeba histolytica (dysentery)

Nitazoxanide if needed for Cryptosporidium

18
Q

ABs for acute GE?

A

Controversial area. Window of opportunity small as (see illustration)

  • Some evidence of benefit
  • May shortens duration of illness by 1-2 days if started early
  • No effect on mortality or severity of disease

Specific benefits

  • Ciprofloxacin
  • Macrolides for Campylobacter
19
Q

Rehydration therapy

A

IV or oral

  • Solution with water, salt and sugar
  • Secretory diarrhoea; pumping out Cl, Na and water follow. absorption of Na has a symporter mechanism with glucose. So ORT solutions also contain glucose
20
Q

Probiotics in treating GE/ diarrhoea

A

Poorly controlled evidence suggest benefit in preventing antibiotic associated diarrhoea

Less effect in treating established diarrhoea

21
Q
A

The Treatment and Prevention of Infection (18 decks)

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