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Infections > infectious diarrhoea > Flashcards

infectious diarrhoea Flashcards

1
Q

Define diarrhoea

A

Fluidity and frequency of stool

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2
Q

Define gastro-enteritis

A

Three or more loose stools/day
inflammation of the small intestine

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3
Q

Define dysentry

A

Inflammation of the large bowel
Bloody stools often containing mucous

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4
Q

What stool chart is used to describe consistency and appearance of stool

A

Bristol stool chart

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5
Q

What can cause gastro-enteritis

A

Contamination of foodstuffs - e.g campylobacter

Poor storage of food

Travel related infection

Person to person spread e.g norovirus

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6
Q

What is the most common gastro-enteritis causing bacteria

A

Campylobacter

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7
Q

Which foodborne bacteria causes the most admissions in hospital

A

salmonella

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8
Q

What are the defences against enteric infections

A

Stomach acidity

Normal gut flora

immunity

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9
Q

What can cause the stomach acidity to reduce

A

Antacids and PPIs

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10
Q

What is the common opportunistic bacteria in the gut when the normal flora is dirupted

A

C difficile

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11
Q

What are non inflammatory diarrhoeal pathogen examples

A

Cholera
Enterotoxigenic E.coli

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12
Q

What are the symptoms of non-inflammatory diarrhoeal ilness

A

Frequent watery stools with little abdo pain
Usually no pain and fever due to no inflammation

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13
Q

What is usually the management of non inflammatory diarrhoeal illness

A

Rehydration therapy

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14
Q

How does cholera cause diarrhoea

A

It releases the cholera toxin which stimulates cAMP which causes increase loss of chlorine from cells - the water then follows the chlorine which leads to it being excreted

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15
Q

What are common pathogens which cause inflammatory diarrhoeal illness

A

Salmonella and campylobacter

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16
Q

What are the symptoms of inflammatory diarrhoeal illness

A

Pain and pyrexia

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17
Q

What is the treatment of inflammatory diarrhoeal illness

A

Antibiotics can be helpful but are not necessary if the patient has a healthy immune system

Rehydration therapy is the most important treatment

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18
Q

How long does infective gastro-enteritis usually last

A

2 weeks

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19
Q

What will be seen on examination and in investigations for bacteria causing diarrhoea

A

Risk of food poisoning

Assess hydration - patients usually dehydrated therefore they will have a postural drop in blood pressure when they stand up, low skin turgor and tachycardia

On bloods, may see signs of inflammation e.g CRP and raised WCC

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20
Q

What investigations are done when for patients with suspected bacterial causing gastro-enteritis

A

Stool culture
blood culture
renal function - increased fluid loss can cause harm to kidneys
blood count - raised WCC
Xray/ CT

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21
Q

What is the differential diagnosis for bacterial causing gastro-enteritis

A

Inflammatory bowel disease
Spurious diarrhoea
carcinoma
Sepsis outside the gut

22
Q

What is spurious diarrhoea

A

Patient is so constipated that they can only excrete fluid which escapes between the gaps in the constipated bowel

23
Q

What is the treatment for gastro-enteritis

A

Rehydration :
Oral rehydration with salt/sugar solution
IV saline

24
Q

How long is the incubation period of campylobacter and how long does it take to become cleared

A

7 days incubation period

Cleared within 6 weeks

25
Q

What is a complication of campylobacter

A

Post-infection sequelae - developing autoimmune condition after having an immune response to an infection

26
Q

What are the stool investigations done gastro-enteritis

A

Stool culture - can identify the bacteria and see how it reacts to different forms of bacteria

PCR - viral suspicion

Immunoassays - if bacterial invasion suspected

27
Q

What is used in culture to specifically look for capmpylobacter

A

Campylobacter specific agar

28
Q

How is salmonella transmitted

A

Eating/drinking contaminated food and water
Touching infected animals
The bacteria lives in the intestines

29
Q

What is the incubation time for salmonella

A

upto 48 hours

30
Q

What are the symptoms of salmonella gastroenteritis

A

Inflammatory diarrhoea - therefore pyrexia and abdominal pain with diarrhoea

31
Q

Who is most at risk of salmonella gastroenteritis

A

Elderly, young, immunocompromised , those taking antacids which reduce stomach acid

32
Q

What does E.coliO157 cause

A

Characterised by frequent bloody stool

Haemolytic uraemic syndrome - haemolytic anaemia, thrombocytopenia and renal failure

33
Q

How is E.coli O157 spread

A

Contaminated meat or person to perosn

34
Q

What happens in haemolytic-uraemic syndrome

A

The shigella toxin stimulates platelet aggregation which blocks vessels - the red blood cells try squeeze through which causes haemolysis where they are broken down

The uraemia is caused by renal failure when the renal arteries are affected

35
Q

How does staph aureus cause gastroenteritis

A

release of a toxin

36
Q

What is found in re-fried rice

A

Bacillus cereus - allows spores of bacillus to open up when the rice is reheated which releases the toxins to the gut

37
Q

What is found is clostridium perfringens found in

A

Undercooked/ left out meat

38
Q

When are antibiotic indicated in gastroenteritis

A

Immunocompromised
sepsis
Chronic illness such as cancer

39
Q

What are the 4 antibiotics that can disrupt the gut flora leading to C difficile invasion

A

4 C antibiotics

Cephalosporin, Co-amoxiclav, ciprofloxacin and clindamycin

40
Q

What is the treatment of C difficle

A

Metronidazole first line
Oral vancomycin

41
Q

What is given as treatment if there is severe colitis caused by C difficile

A

Oral vancomycin with IV metronidazole

42
Q

How are parasites diagnosed

A

Microscopy

43
Q

What is giardia duodenalis

A

Protozoan parasite which is a travellers parasite and is more common in men

44
Q

describe cryptposporidium

A

Causes diarrhoea, nausea and vomiting with abdo pain

Transmitted through infected animals and faeces - contaminated water and food

45
Q

What does entamoeba histolytica cause

A

Bloody diarrhoea - dysentry
Liver abscess

46
Q

How is entamoeba histolytica treated

A

Metranidazole and luminal agent to flush out the invasion

47
Q

What is rotavirus

A

Paediatric virus - children version of Norovirus

Has a vaccine for rotavirus

48
Q

When is norovirus more common

A

Winter

49
Q

What is norovirus

A

Disease which causes diarrhoea and viruses and has common outbreaks in hospital

50
Q

How is norovirus diagnosed

A

PCR

51
Q
A

Infections (13 decks)

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