1b Gastrointestinal Infections

Question 1

Rapid onset watery diarrhoea for an elderly hospital patient with high CRP, inflammatory markers, creatinine and albumin. What is the most likely diagnosis?

Answer 1

C. Diff infection

Question 2

What investigations should be done for a suspected C. Diff infection?

Answer 2

STOOL SAMPLE FOR C.DIFFICILE TOXIN
STOOL CULTURE
IMAGING AXR

Question 3

What is the management plan for a patient with suspected C. Diff infection?

Answer 3

1. Isolate the patient - move them to a side room
2. Discontinue the antibiotics which are causing the C. Diff infection
3. Management of diarrhoea, fluids and nutrition

Question 4

What are the three levels of severity with C. Diff infections?

Answer 4

1. Non-severe (WCC<15, Creat <150)
2. Severe (WCC > 15, Creat >150)
3. Fulminant Colitis

Question 5

What might patients experience if they have Fulminant Colitis?

Answer 5

Hypotension, Shock, ileus, Toxic megacolon

Question 6

What is toxic megacolon?

Answer 6

When the colon enlarges as a result of C. Diff infection - can be seen on imaging

Question 7

What is the treatment for severe C. Diff infection / Fulminant Colitis?

Answer 7

Antibiotics, supportive care, early surgical consultation

Question 8

What is the treatment for non-severe C. Diff infection?

Answer 8

Antibiotic therapy with oral vancomycin, metronidazole

Question 9

What is the treatment for fulminant colitis with toxic megacolon?

Answer 9

Medical therapy - antibiotics and supportive management

Question 10

What are the indications for surgery with fulminant colitis with toxic megacolon?

Answer 10

Colonic perforation
Necrosis or ischaemia
Clinical signs of peritonitis
End - organ failure

Question 11

What is pseudomembranous colitis?

Answer 11

Pseudomembranous colitis is inflammation (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

Question 12

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?

Answer 12

Ulcerative colitis

Question 13

What histology is seen in UC?

Answer 13

Left sided inflammatory change
Chronic inflammation with no granulomas

Question 14

What is the difference between UC and Crohns?

Answer 14

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

Question 15

What are the management options for UC?

Answer 15

• Steroids
• 5-ASA
• Immunosuppressants = Methotrexate, Aziothioprine
• Biologics

Question 16

What are the different severity classifications for UC?

Answer 16

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

Question 17

What medication is used to manage remission acutely for UC?

Answer 17

Prednisolone, if that still doesnt work then Aziothioprine, if that still not working = Infliximab

Question 18

What are some causes of non-infective diarrhoea?

Answer 18

Antibiotic side effects
IBD
IBS
Colitis
Ischaemic Colitis