1b Gastrointestinal Infections Flashcards
Rapid onset watery diarrhoea for an elderly hospital patient with high CRP, inflammatory markers, creatinine and albumin. What is the most likely diagnosis?
C. Diff infection
What investigations should be done for a suspected C. Diff infection?
STOOL SAMPLE FOR C.DIFFICILE TOXIN
STOOL CULTURE
IMAGING AXR
What is the management plan for a patient with suspected C. Diff infection?
- Isolate the patient - move them to a side room
- Discontinue the antibiotics which are causing the C. Diff infection
- Management of diarrhoea, fluids and nutrition
What are the three levels of severity with C. Diff infections?
- Non-severe (WCC<15, Creat <150)
- Severe (WCC > 15, Creat >150)
- Fulminant Colitis - Hypotension or shock, ileus, toxic megacolon
What might patients experience if they have Fulminant Colitis?
Hypotension, Shock, ileus, Toxic megacolon
What is toxic megacolon?
When the colon enlarges as a result of C. Diff infection - can be seen on imaging
What is the treatment for severe C. Diff infection / Fulminant Colitis?
Antibiotics, supportive care, early surgical consultation
What is the treatment for non-severe C. Diff infection?
Antibiotic therapy with oral vancomycin, metronidazole
What is the treatment for fulminant colitis with toxic megacolon?
Medical therapy - antibiotics and supportive management
What are the indications for surgery with fulminant colitis with toxic megacolon?
Colonic perforation
Necrosis or ischaemia
Clinical signs of peritonitis
End - organ failure
What is pseudomembranous colitis?
Pseudomembranous colitis isinflammation (swelling, irritation) of the large intestine.
Often associated with C Diff infection
Manifestation of severe colitis disease
Characteristic white-yellow plaques form pseudomembranes on the mucosa
26 Female with long history of loose motions and PR bleeding and minimal tenderness in the left iliac fossa. Increased WCC and CRP indicating inflammatory process. What is most likely diagnosis?
Ulcerative colitis
What histology is seen in UC?
Left sided inflammatory change
Chronic inflammation with no granulomas
What is the difference between UC and Crohns?
UC: Limited to the mucosa, limited to the colon, pseudopolyps, bloody diarrhoea with mucus
Crohns: All layers of the gut wall, Entire GI Tract, Patchy lesions, Cobblestone appearance, non-caseating granulomas, bloody diarrhoea
What are the management options for UC?
Steroids
5-ASA
Immunosuppressants = Methotrexate, Aziothioprine
Biologics
What are the different severity classifications for UC?
MILD - 4 x BMs, no systemic involvement and normal inflammatory markers
MODERATE - >4BM’s a day, mild symptoms, no weight loss
SEVERE - > 6BM’s a day, severe symptoms, system toxicity, severe anaemia, increased CRP and ESR, weight loss
What medication is used to manage remission acutely for UC?
Prednisolone, if that still doesnt work then Aziothioprine, if that still not working = Infliximab
What are some causes of non-infective diarrhoea?
Antibiotic side effects
IBD
IBS
Colitis
Ischaemic Colitis
List the four main bacteria which can cause diarrhoea?
- Clostridium difficile
- Klebsiella oxytoca
- Clostridium perfringens
- Salmonella spp
What are the two most common antibiotics to cause C.diff infection?
Co-amoxiclav
Ciproflaxin
List non-infectious causes of diarrhoea.
Antibiotics side effect
Post-infectious irritable bowel syndrome
Inflammatory bowel disease
Microscopic colitis
Ischaemic colitis
Coeliac disease
When would you offer a faecal microbiota transplantation?
Only for recurrent infection or resistant or prolonged infection
Or if Abx therapy failed
What is meant by Abdominal Compartment syndrome?
Significant abdominal distension and no space for fluid to expand so pressure on organs compromising blood supply leading to organ failure
How does Pseudomembranous colitis present on endoscopy?
Characteristic yellow-white plaques that form pseudomembranes on the mucosa
What are some of the endoscopic findings in Ulcerative colitis?
Continuous
Left-sided colitis
No granulomas
Why can steroids not be used as long-term management?
Lose effect after a while
Usually given acutely or short term to induce remission
E.g. Prednisolone
What diseases can Azathioprine cause reactivation of? And How can you reduce the risk of this happening?
HepB/C/HIV
Chicken pox
Blood tests to check risk of reactivation of these diseases
Ensure vaccinations have been given
What are the side effects of infliximab?
Anti-TNF-Alpha = Infliximab
Autoimmunity, immunogenicity
Demyelination disease
Infection
Bone marrow suppression
Infusion reactions, injection-site reactions
Congestive heart failure
Hepatotoxicity
Malignancy/Lymphoma
