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Gastroenteritis (Specific
causes (C difficile (Clinical presentation
…
Gastroenteritis
Specific
causes
Typhoid
Pathophysiology
Salmonella typhi or paratyphi, incubation 3-21d
Faceal-oral spread
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Diagnosis
Bloods - cultures
Stool sample - MCS, PCR
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Shigella
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Pathophysiology
Faecal-oral transmission; incubation 1-7d
Invasion of mucosa, may secrete toxins
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Traveller's
diarrhoea
Pathophysiology
Commonly bacterial e.g. E Coli, shigella, salmonella
Also viruses, protozoa etc.
Clinical presentation
Diarrhoea, N+V, abdo pain, fever
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Management
Conservative: hydration
Medical: antimotility (loperamide), abx (if severe)
Cholera
Pathophysiology
Faecal-oral transmission, incubation hrs-days
Water contaminated with human waste
Toxin affects Na/Cl absorption, causing watery diarrhoea
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Epidemiology
Tropics and subtropics, poor hygeine
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C difficile
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Pathophysiology
Most colonised pts asymptomatic, but abx alters normal flora
C diff proliferates, may release toxins causing mucosal damage
Ulceration and inflammatory exudate - pseudomembranous colitis
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Management
Conservative: isolation, PPE, stop offending abx
Medical: abx (metronidazole/vancomycin)
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Giardiasis
Pathophysiology
Flagellated protozoan, faecal oral spread
Insidious onset (1-4 weeks)
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Diagnosis
Stool sample - MCS, PCR, cysts
Duodenal aspirate/biopsy - parasites
Management
Abx - metronidazole, tinidazole
Amoebiasis
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Management
Abx - metronidazole _ diloxanide
If liver abscess, I+D
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Complications
Fulminant colitis (toxic megacol, perf, peritonitis)
Liver abscesses
Pathophysiology
Cysts in food/water/ person-person
Invasion of mucosa and bloody diarrhoea
Can progress to fulminant colitis, toxic megacolon,
perforation, peritonitis, liver abscesses
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Clinical
presentation
Bloody diarrhoea
Bacteria - C. difficile, shigella, campylobacter, salmonella
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Watery diarrhoea
Viruses - enterics
Bacteria - clostridium, Yersinia, cholera, E coli
Protozoa - cryptosporidia, cyclospora
Vomiting
Bacterial - S aureus, bacillus, salmonella, C botulinum
Viral - norovirus (projectile), rotavirus
Abdo pain
Bacterial - S aureus, salmonella, C perfringens, C difficile. V parahaemolyticus, campylobacter Yersinia, shigella
Viruses - norovirus
Fever
Bacterial - salmonella, campylobacter, Yersinia, shigella
Viruses - norovirus, rotavirus
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Pathophysiology
Infection with bacteria, virus, protozoa,
worms/helminths
Sources
Food
Any - shigella
Red meat - S. aureus, C. perfrigens,
Poultry - salmonella
Seafood - V. parahaemolyticus
Pate - Listeria
Diary - salmonella, Listeria, Yersinia
Rice - bacillus
Processed food - C. botulinum
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Bacteria
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Toxin production
Endotoxins - disrupt cell junctions, watery diarrhoea)
Exotoxins - damage and death of cells, bloody diarrhoea)
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Viruses
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Norovirus (faecal oral), enteroviruses, rotavirus
Protozoa
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Giardia (cats/dogs), entamoeba histolytica,
cryptosporidia (water), cyclosporidia (immunocompromised)
Diagnosis
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History
E+D, food and water sources, recent travel,
onset of symptoms, type of diarrhoea, other symptoms
Investigations
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Bloods
FBC (high WCC), CRP (high)
Blood cultures
U+Es, LFTs
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Management
Definitive
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Medical
Antmotility agents
Indication: severe symptoms
e.g. loperamide, codeine
CI: bloody diarrhoea (dysentry), fever
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Abx
Indication: severe symptoms,
bloody diarrhoea, elderly, immunosuppressed
E.g. ciprofloxacin + metronidazole
CI: enterohaemorrhagic E. Coli
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Definition
Gastrointestinal disorder of acute
diarrhoeal illness with/without vomiting
due to ingestion of a parasite