Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/75

Click to flip

75 Cards in this Set

  • Front
  • Back
3 common bacteria causing gastroenteritis
Champylobacter
Salmonella
E.coli 0157
S&Ss of food poisoning/ gastroenteritis
D&V
abdo pain
malaise
?fever- salmonella, e.coli
?blood
commonest bacterial cause of food poisoning/ gastroenteritis ?
- source
- incubation
- S&Ss
CHAMPYLOBACTER- raw milk, poultry
LONG incubation 2-5days

BLOODy, abdo pain, fever
how champylobacter prevented/ treated
food hygiene
NO Rx- oral fluids

at risk Rx: ciproflaxacin/ erythromycin
salmonella:
- source
- incubation
- S&Ss
- type of bacterial infection
meat, eggs, poultry
MED incubation- 1-2d

D&V, abdo pain, fever, SEPTICAEMIA

TOXIN-producing
treatment of salmonella infection
NO Rx
at risk: ciprofloxacin
how is salmonella serogrouped
why
- antigens on flagella& body
- identify source, identify outbreaks
E.coli:
- source
- incubation
- S&Ss
- mechanism of infection
PERSON-person spread from ANIMAL contact, food (beef, raw milk) or water bourne
- 1-3d LONG incubation
- BLOOD d,
- VTEC toxin producing
which bacteria can cause outbreaks and which are toxin producing:
- champylobacter, salmonella, E.coli
salmonella and E.coli - OUTBREAKS & toxin-producing

E.coli= VTEC
what's the commonest cause of acute renal failure in children
E.coli 0157 complicated by haemolytic ureamic syndrome (HUS)
dangerous complication of E.coli 0157 infection?
- Ix's to Dx
HUS;
- thrombocytopaenia ↓plt - blood film fragmented RBCs
- ↓Hb
- ARF: ↑creatinine & ↑urea, haematuria, proteinuria
- neurological involvement
abx for e.coli 0157 may precipitate HUS, how do you treat HUS
seek expert advice
treat hypovolaemia &HTN
DIALYSIS
bacteria incubation;
- SHORT
- MED
- LONG
SHORT- staph aureus, bacillus cereus

MED- Salmonella, Cl.perfringens

LONG- Champylobacter, E.coli
q's to ask in clinical dx of gastroenteritis/ food poisoning
Hx: travel, contact, food, animals, camping
anyone else?
TIME- incubation
DIARRHOEA: blood, severity
PMH: risk comorbidities
what bacterial cause of gastroenteritis do you have to notify HPY about
suspicion of HUS
Dx of causative org
STOOL culture (48h)
management of pt's with D&V suspected gastroenteritis/ food poisoning
oral rehydration
supportive
AVOID antimotiligy agents
IMMUNOCOMPROMISED- abx's, e.g. ciprofloxacin
isolation
what's amoebic dysentery by definition (1 important symptom)
BLOODy diarrhoea
what causes pseudomembranous colitis

how is dx confirmed
overgrowth of Cl.difficile following Rx with braod-spec abx's

STOOL culture
common pathogen causing food poisoning 1-2hrs after indigestion.
abdo cramps, vomiting, watery diarrhoea.
gram +ve aerobic bacilli.
Pathogenicity due to enterotoxin, usually self-limiting.
Bacillus cereus
what pathogen is cause of diarrhoea due to broad spec abx's.
enterotoxin A&B = pseudomembranous colitis.
high mortality in elderly.

Rx?
Cl. diff

oral metranidazole/ vancomycin
Cl. diff

oral metranidazole/ vancomycin
what are coliforms:
- loc
- gram stain
- aerobes or anaerobes
- e.g
LARGE AEROBIC BACILLI 
GUT commensals
E.coli, Klebsiella, proteus
LARGE AEROBIC BACILLI
GUT commensals
E.coli, Klebsiella, proteus
what are strict/ obligate aerobes
- eg
- gram stain
REQURIE O2 for growth 
gram +ve
- bacilli: legionella, pseudomonas aeruginosa (exac bronchectasis)
REQURIE O2 for growth
gram +ve
- bacilli: legionella, pseudomonas aeruginosa (exac bronchectasis)
what are strict/ obligate anaerobes
- e.g's
- gram stain
WILL NOT grow in presence of O2
-Gram +ve: bacteroides bacilli
WILL NOT grow in presence of O2
-Gram +ve: bacteroides bacilli
normal mouth flora
Gram +ve aerobic:
- streptococci: strep viridans
- staphylococci

Gram -ve aerobes:
- neisseria

Candida
flora of stomach / duodenum (low pH) & bile ducts
usually sterile
stomach/ duod.- (some Candida & Staphylocicci)
normal flora of jej & ileum (small bowel)
Gram -ve:
- aerobes: coliforms (pic)
- anaerobes
Gram -ve:
- aerobes: coliforms (pic)
- anaerobes
normal flora of colon
Gram -ve:
- aerobes (coliforms)
- anaerobes

Gram +ve: 
- aerobis: (streptococci) ENTEROCOCCUS FAECALIS (pic)
Gram -ve:
- aerobes (coliforms)
- anaerobes

Gram +ve:
- aerobes: (streptococci) ENTEROCOCCUS FAECALIS (pic)
micro-organisms that leak/ perforate into peritoneal cavity can cause abscesses (pus cells + orgs).
- why can small but not large abscesses be treated with abx's?
- how are large abscesses treated
large abscess will have NO BLOOD SUPPLY so abx's won't peneetrate it. 
- need incision & drainage
large abscess will have NO BLOOD SUPPLY so abx's won't peneetrate it.
- need incision & drainage
which empirical abx therapy for COLIFORM infection (gram -ve large baccili = e.coli & klebsiella)
gram -ve aerobes
GENTAMICIN
(>50% are amox-resistant)
gram -ve aerobes
GENTAMICIN
(>50% are amox-resistant)
which empirical abx therapy for ANAEROBE infection (bacteroides -ve and cl.diff +ve)
(generally gram -ve bacilli eg Cl.diff)
metranidazole
(generally gram +ve bacilli eg Cl.diff)
metranidazole
which empirical abx therapy for ENTEROCCOCAL (& staphylococcal) infection
aerobic gram +ve streptococci 
AMOXICILLIN
aerobic gram +ve streptococci
AMOXICILLIN
(think gram +ve = amoX...X looks like +)
what 3 empirical abx's given for INTRA-ABDOMINAL sepsis
- what do each cover
GENT..............................aerobes (coliforms)
METRANIDAZOLE......anaerobes
AMOX............................enterococcus sp. (in colon) & staphyloccus
whch prophylactic abx's for GI/HEPATO-BILIARY surgery
GENT......aerobic coliforms
MET........anaerobes (small bowel- colon)

(not amox which covers enterococcus in colon alone & staphylococcus)
what abx if penicillin allergy / MRSA (amox)
vancomycin
S&Ss of intra-abdominal sepsis
temp >38, chills/rigors
↑WCC/ CRP
↑HR, ↓BP
↑RR
N&V
malaise/ anorexia
constipation/ diarrhoea
PERITONITIS (still, no BS, board-like)
pain, tenderness, guarding
what classifies SEVERE sepsis
1+ acute organ dysfunction:
renal
resp
hepatic
clotting
CNS
metabolic acidosis (↓HCO3-)
↓BP (↓CVS)- refractory to IV fluids
Dx by Ix of intra-abdominal infection
WCC, CRP, plt, clotting, LACTATE, U/O

micro (cultures): blood, stool, urine, wound, TISSUE

microscopy: stool, urine, CSF, sputum

serology (atypicals/ Ab's)
antigen detection- PCR
management of intra-abdominal sepsis:
- empirical abx's
- supportive
ABX's: gent (aerobes), metra (anaerobes), amox (enterococcus & staphylococcus)

SUPP.: O2, IV fluids, anaelgesia, VTE prophylaxis (clotting), control electrolytes
- ?transfusion
- ?surgery
S&Ss HUS
initial follow on from E.coli 0157: diarrhoea BLOODY, vomiting, severe abdo pain, fever

HUS:abdo P, F
low U/O, renal failure, neurological involvement
- low BP, tachycardic, fever
- high urea & WCC, low plt, Hb, abnormal clotting!
2 viruses causing diarrhoea
2 viruses causing diarrhoea
ROTAvirus (front pic) & NOROvirus (pic)
ROTAvirus (front pic) & NOROvirus (pic)
which viral cause of diarrhoea is common in kids <3
how spread
time of year
infectious dose
ROTAvirus: person-person, winter
LOW infectious dose
ROTAvirus: person-person, winter
LOW infectious dose
which virus likely cause:
<3yrs
winter
Vomiting first --> watery D & fever (no blood)
post-infecitous malabsorption
ROTAvirus
ROTAvirus
which virus:
- winter
- faecal-oral/ air droplet/ direct spread
- low-infectious dose
- asymp shedding
- outbreaks
NOROvirus
NOROvirus
avg time inc for norovirus (short/med/long)
SHORT
symptoms of norovirus
symptoms of norovirus
PROFUSE vomiting
SYSTEMIC
SHORT incubation
OUTBREAKS
Ix for viral diarrhoea
PCR on STOOL
complication of Cl.diff infection (gram +ve anaerobe)
pseudomembranous colitis
pseudomembranous colitis
treatment for 1st episode of UNcomplicated Cl.diff infection (gram -ve anaerobe)
ORAL metrinidazole

stop all other abx's
review PPIs
no anti-motility agents
treatment for cl.diff if:
- poor response to SEVERE disease >1 severity marker
get help!

oral VANCOMYCIN
what's different about hand hygiene for control of Cl.diff and viral diarrhoea
HANDWASHING (no gels!)
HANDWASHING (no gels!)
4 core clinical problems in gastroenteritis
fever
abdo pain
blood PR
diarrhoea
most common cause of bloody diarrhoea
champylobacter
what bacteria causes typhoid-fever
what is it
ENTERIC FEVER: samlonella typhi / paratyphi
SYSTEMIC infection
fever, malaise, DIFFUSE abdo pain, constipation, deleriumm, haeorrhage, perforation
what infection gives profuse watery 'RICE-like' diarrhoea
CHOLERA
presentation S&Ss TYPHOID (enteric fever)
- Ix's
malaise, high Fever, bradycardia, cough, CONSTIPATION (D after 1st wk)

BLOOD cultures
stool & urine
treatment for typhoid (enteric fever)
FLUIDS & nutrition

CIPROFLOXACIN
(if resistant = chloramphenicol, ceftriaxone, azithromicin)

VACCINE (incomplete protection)
what's dysentery
intestinal infection = Pain , fever
severe diarrhoea, blood & mucus
infection with c.diff, what do you suspect if:
- high WCC & creatinine
colonic dilatation on AXR
TOXIC MEGACOLON
which empirical treatment for...
3+ unformed stool per day & 1+:
abdo pain, N&V, fever, blood in stool, tenesmus
ciprofloxacin
likely cause of diarrhoea after long stay in hospital on abxs
S&Ss
Cl.diff;
- blood D
- P

(complication: toxicmegacolon & pseudomembranous colitis)
3 causes of travellers-related diarrhoea
amoebiasis
Giardiasis
cryptosporidium
cryptosporidium
amoebiasis
giardiasis

commonly cause what
traveller's diarrhoea
treat travellers diarrhoea
self-limiting
LFUIDS
single dose CIPROFLOXACIN
short-term anti-diarrhoeals
AMOEBIASIS is a PROTAZOAL infection:
- transmission
- symp
- Dx/ test & results
- Rx
faecal-oral, poor sanitation 
acute BLOODY D
HOT stool --> ova & cysts
METRANIDAZOLE
faecal-oral, poor sanitation
acute BLOODY D
HOT stool --> ova & cysts
METRANIDAZOLE
what infection is HOT stool sampled for ova and cysts
amoebiasis (protazoal infection)
giardiasis
GIARDIASIS (protazoal infection);
- transmission
- loc of GI tract it affects
- S&Ss
contaminated WASTE
SMALL bowel
malabsorption, wt loss, fatty stool, bloating, flatulance, abdo discomfort, EXPLOSIVE diarrhoea
dx by Ix for giardiasis
stool for ova & cysts
(duodenal aspirate)
stool for ova & cysts
(duodenal aspirate)
treatment for protazoal infection with amoebiasis or giardiasis
METRANIDAOLE
treatment for cryptosporidium (1 of 3 important causes of traveller's diarrhoea)
SUPPORTIVE
anti-microbials ineffective
pathogens that can cause outbreaks of diarrhoea (5)
E.coli 0157
Norovirus
cholera
Cl. diff
Salmonella
geography of TYPHOID (enteric fever)
S&Ss
india, SE asia
- HIGH fever, malaise, low HR, headache, constipation (>1wk diarrhoea), dry cough
in a traveller, what presents with: RUQ pain, HIGH SWINGING fever & sweats, jaundice.

what Ix's would you do to confirm this?
AMOEBIC LIVER ABSCESS
LFTs
Inflam markers :WCC, CRP
serology
stool (often -ve)
USS/ CXR/ CT
what immune cell is raised in response to helminth (protazoal) infections
eosinophilia
3 types of parasites (helminth infections)
nematodes (roundworms)
tematodes (flukes)
cestodes (tapeworms)