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A. Block C Paediatrics > Viral gastroenteritis > Flashcards

Viral gastroenteritis Flashcards

1
Q

Viral gastroenteritis is an acute inflammation of the lining of the stomach and small intestine, resulting from viral infection. What is the incidence of VG?

1 - 50 cases per 100,000
2 - 500 cases per 100,000
3 - 5000 cases per 100,000
4 - 50,000 cases per 100,000

A

3 - 5000 cases per 100,000

Affects males and females equally

The most common cause of acute diarrhoea in the general population contracted by person to person contact

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2
Q

Viral gastroenteritis (VG) can occur at any age, but what is the peak age that VG occurs?

1 - 1-4 y/o
2 - 10-20 y/o
3 - 30-40 y/o
4 - >65 y/o

A

3 - 30-40 y/o

In children most common age is 6-24 months

Most common in winter and spring

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3
Q

All of the following organisms can cause viral gastroenteritis (VG). Which of the following is the most common cause of VG in children and adults?

1 - rotavirus
2 - sapovirus
3 - novovirus
4 - adenovirus

A

3 - novovirus

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4
Q

All of the following organisms can cause viral gastroenteritis (VG). Which of the following used to be the most common cause of VG in children?

1 - rotavirus
2 - sapovirus
3 - novovirus
4 - adenovirus

A

1 - rotavirus
- causes more prolonged infection when compared to other viruses

Typically all children in the UK will have VG before their 5th birthday

Bacteria and parasites can also cause this

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5
Q

Which of the following viruses is commonly associated with outbreaks in nurseries and paediatric wards causing viral gastroenteritis?

1 - rotavirus
2 - sapovirus
3 - novovirus
4 - adenovirus

A

4 - adenovirus

Typically called enteric adenovirus

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6
Q

Which of the following is NOT a common risk factor for developing viral (VG) gastroenteritis?

1 - exposure to contaminated food and 2 2 - exposure to contaminated water
3 - close contact with an infected persons
4 - good hygiene
5 - immunocompromised

A

4 - good hygiene

Typically poor hygiene causes VG

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7
Q

Which of the following does NOT typically occur during viral gastroenteritis?

1 - ingestion of virus
2 - virus infects enterocytes throughout whole of the GIT
3 - virus replicates in enterocytes
4 - virus disrupts absorption and secretion and electrolytes (specifically chloride) flood into lumen
5 - viral enterotoxins secreted
6 - malabsorption and osmotic diarrhoea

A

2 - virus infects enterocytes throughout whole of the GIT

Typically only affects upper GI

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8
Q

Viral gastroenteritis typically self limiting. How long does it normally last for?

1 - <24h
2 - <72h
3 - <7 days
4 - <14 days

A

4 - <14 days

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9
Q

In viral gastroenteritis, is a high or low fever common?

A
  • low grade fever

Bacteria typically cause a high grade fever

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10
Q

Acute diarrhoea is a common symptom in viral gastroenteritis. How many times must an individual pass stools to be diagnosed with acute diarrhoea?

1 - >3/day
2 - >5/day
3 - >7/week
4 - >10/week

A

1 - >3/day

Typically watery in nature

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11
Q

Acute diarrhoea is a common symptom in viral gastroenteritis. Does this present rapidly or have an insidious nature?

A
  • rapid onset
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12
Q

In acute diarrhoea, if blood is present in stool in viral gastroenteritis, is this likely to be due to bacteria or a virus?

A
  • bacteria

If blood in the stool suspect Shiga-toxin producing E-coli or Campylobacter infection

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13
Q

In addition to acute diarrhoea, a common symptom in viral gastroenteritis, which of the following symptoms is NOT common?

1 - blood in stool
2 - vomiting and nausea
3 - abdominal pain
4 - mild fever
5 - mucus

A

1 - blood in stool
- typically occurs if cause is bacterial, rather than viral.

Mucus is more common in bacterial, but can also present in viral

A short viral prodrome may occur prior to any symptoms of viral gastroenteritis

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14
Q

A common clinical finding in patients with viral gastroenteritis is dehydration. Which of the following is NOT a sign of dehydration?

1 - dry mucous membranes
2 - tachycardia
3 - hypertension
4 - thin, thready pulse
5 - reduced urine output
6 - reduced skin turgor and sunken eyes

A

3 - hypertension

Typically causes hypotension

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15
Q

A common clinical finding in patients with viral gastroenteritis is dehydration. Which of the following does NOT increase the risk of dehydration?

1 -year of age
2 - low birth weight infants
3 - ≥ 6 diarrhoeal stools in 24hours
4 - ≥ 3 vomiting in the last 24hours.
5 - breastfeeding infants
6 - malnutrition
7 - immunosuppression.

A

5 - breastfeeding infants

Stopping breastfeeding is a risk factor and a major concern

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16
Q

Which of the following is most effective when diagnosing viral gastroenteritis?

1 - U&Es
2 - FBC
3 - Clinical diagnosis
4 - stool culture

A

3 - Clinical diagnosis
- examination and history

Stool culture is not common, unless the following are present:

  • Persistent diarrhoea >14 days
  • Blood or pus in the stool
  • Suspicion of non-viral gastroenteritis
  • History of recent hospitalisation and antibiotic therapy
  • Recent foreign travel history
17
Q

All of the following could be a differential for viral gastroenteritis, but which is least likely?

1 - Bacterial gastroenteritis
2 - Food poisoning
3 - Clostridium difficile infection
4 - IBD
5 - Cholecystitis
6 - IBS
7 - Coeliac disease
8 - Hyperthyroidism

A

5 - Cholecystitis

18
Q

Viral gastroenteritis is typically self-limiting and lasts <14 days. Are patients normally treated at home or admitted to hospital?

A
  • managed at home

Plenty of fluids and non-fatty meals and advise on good hygiene to reduce spread

19
Q

In a patient who has been identified as not being dehydrates with viral gastroenteritis they should be advised to do all of the following except which one?

1 - drink fruit juices and carbonated drinks to help increase glucose
2 - continue breastfeeding
3 - increase overall fluid intake
4 - oral rehydration solution as supplement fluid if at risk of dehydration

A

1 - drink fruit juices and carbonated drinks to help increase glucose

These can worsen diarrhoea and therefore dehydration

Oral rehydration solution contains glucose and salts (Na+ and K+Cl-)

20
Q

In a patient who has been identified as clinically dehydrates with viral gastroenteritis they should be advised to do all of the following except which one?

1 - give fluid deficit replacement (based on 5% bodyweight)
2 - give maintenance fluids
3 - continue breastfeeding
3 - always use a nasogastric tube
4 - supplement with oral rehydration solution

A

3 - always use a nasogastric tube

May be used if child is vomitting, but not always

21
Q

If a patient goes into shock due to dehydration, how much balanced crystalloids or 0.9% saline solution should they be given?

1 - 1ml/kg boluses
2 - 10ml/kg boluses
3 - 25ml/kg boluses
4 - 50ml/kg boluses

A

2 - 10ml/kg boluses

Do not use dextrose-based solutions for volume replacement as this can cause hyponatraemia and hyperglycaemia, which may worsen neurological outcome.

22
Q

The formula for fluid maintenance is for a child weighing <10kg is:

<10kg: 100 mL/kg fluids per day

What is the fluid maintenance that would be needed for a 6.4kg child?

1 - 6.4ml/kg fluids per day
2 - 64mL/kg fluids per day
3 - 640mL/kg fluids per day
4 - 6400mL/kg fluids per day

A

3 - 650mL/kg fluids per day

Weight = 6.4kg
Fluid - 100ml per kg
6.4 x 100 = 640ml/day

So 640ml over 24h = 27ml/hour or 0.45ml/min

23
Q

The formula for fluid maintenance is for a child weighing between 10-20kg is:

10–20kg: 1000 mL + 50 mL/kg/day for each kg over 10kg

What is the fluid maintenance that would be needed for a 18.5kg child?

1 - 14.25ml/kg fluids per day
2 - 142.5mL/kg fluids per day
3 - 1425mL/kg fluids per day
4 - 14,250mL/kg fluids per day

A

3 - 1425mL/kg fluids per day

Weight = 18.5kg
Fluid - 1000ml for first 10kg and then 50ml for each kg up to 10kg.

1000ml + (8.5 x 50) = 1425ml/day

So 1425ml over 24h = 24ml/hour or 0.99ml/min

24
Q

The formula for fluid maintenance is for a child weighing >20kg is:

1500 mL + 20 mL/kg for each kg over 20 kg per day

What is the fluid maintenance that would be needed for a 33kg child?

1 - 17.60ml/kg fluids per day
2 - 176.0mL/kg fluids per day
3 - 1760mL/kg fluids per day
4 - 17,600mL/kg fluids per day

A

3 - 1760mL/kg fluids per day

Weight = 33kg
Fluid - 1500 for first 20kg and then 20ml for each kg after 20kg

1500ml + (13 x 20) = 1760ml/day

So 1760ml over 24h = 29ml/hour or 1.2ml/min

25
Q

If a patient is dehydrated in paediatrics, we need to calculate their fluid deficit. This can be performed using the following:

Fluid deficit (mL) = % dehydration x weight (kg) x 10

Step 1 = Previous weight - current weight
Step 2 = (change in weight/previous weight) x 100% = % dehydration
Step 3 = (% dehydration x current weight) x 10

If a child weighed 12kg before and now weight 11.5kg, what is their fluid deficit?

1 - 4714ml
2 - 474.1ml
3 - 47.41ml
4 - 4.742ml

A

2 - 474.1ml

Fluid deficit:
Previous weight = 12kg
Current weight = 11.5kg
Weight different = 0.5kg
- (0.5/12kg) x 100% = 4.1% dehydration
- (4.1 x 11.5) x 10 = 471.5ml

Maintenance fluid =
- 1000ml + (1.5 x 50) = 1075ml

Total fluid prescription is 1075 + 471.5 = 1547ml/day

Or 26ml/h or 1.1ml/min

26
Q

Weight is typically used for maintenance fluid and fluid deficits. However, if the weight is not available how much deficit should be presumed in a patient who is clinical dehydrated?

1 - 5%
2 - 5-10%
3 - >10%
4 - 15-20%

A

2 - 5-10%

0 no clinically detectable dehydration <5% deficit
- clinical dehydration( 5%–10% deficit)
- shock (usually >10% deficit)

27
Q

If a patient is suspected as having viral gastroenteritis, we can perform all of the following, except which one is typically not performed?

1 - echocardiogram
2 - ABG or VBG
3 - U&Es
4 - CRP
5 - FBC
6 - Stool

A

1 - echocardiogram

  • ABG or VBG would most likely show metabolic acidosis
  • U&Es would show Na+ abnormalities, hypokalaemia and raised urea
  • CRP may be raised due to infection
  • FBC may be raised due to leukocytosis
  • Stool may rule out bacterial cause
28
Q

Viral gastroenteritis is typically self-limiting and lasts <14 days. However, if the patient meets any of the following criteria, EXCEPT which one, they may need fluid resuscitation?

1 - Systolic blood pressure >100
2 - Heart rate >90
3 - Cool peripheries
4 - Respiratory rate >20
5 - PEWS score >5

A

1 - Systolic blood pressure >100
This would normally be below 100 if dehydrated

If needed consider:

  • Fluid resuscitation
  • Hospital admission
  • Enable rehydration and electrolyte replacement
  • Prevent spread of infection
29
Q

All of the following may need to be admitted to hospital, EXCEPT which one?

1 - unable to to maintain oral intake due to vomiting
2 - elderly individuals >60 years old, who are more at risk of severe dehydration
3 - Abdominal tenderness
4 - Diarrhoea lasting > 3days or more

A

4 - Diarrhoea lasting > 3days or more

Typically, it is if the diarrhoea has lasted >10 days

30
Q

Are antibiotics and anti-virals typically recommended in vial gastroenteritis?

A
  • not recommended

Zinc supplementation may help reduce severity in third world countries

31
Q

Following infection with viral gastroenteritis, when can patient be allowed back to work after vomiting and diarrhoea have stopped?

1 - 12h
2 - 48h
3 - 1 week
4 - 2 weeks

A

2 - 48h

32
Q

There are lots of complications of viral gastroenteritis. Which of the following is the least likely?

1 - dehydration and shock
2 - AKI
3 - lactose intolerance
4 - dehydration and electrolyte disturbances
5 - peptic ulcers

A

Dehydration and electrolyte disturbances

Lactose intolerance caused by inflammation to microvilli reducing reducing the expression of lactase enzymes.

Normal diet after an episode of diarrhoea results in a return of foul-smelling loose stool, excessive wind, nappy rash etc.
Management: Restart ORT/lactose free milk

May need up to 8weeks to heal

A. Block C Paediatrics (50 decks)

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