1b// GI Infections Flashcards

1
Q

What are the differential diagnoses for…

A
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2
Q

What investigations would you order for suspected infections/ non-infectious diarrhoea?

A
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3
Q

How do you measure severity of C. Diff infection?

A
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4
Q

How do you manage a non severe disease?

A
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5
Q

How do you manage a severe disease/ fulminant colitis?

A
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6
Q

What is the most likely diagnosis for a large intestine distention and infection?

Toxic megacolon
Small bowel obstruction
Large bowel obstruction
Ileus

A

Toxic Megacolon

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7
Q

What is the first line treatment for a patient with fulminant colitis with toxic megacolon? And what else would you do?

A

Medical therapy with antibiotics and supportive management

  • Patient is transferred to ITU for invasive monitoring
  • IV fluid resuscitation & inotropic support
  • Discharged 10 days later on extended course of oral vancomycin
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8
Q

What are indications for surgery? (5)

A

Colonic perforation

Necrosis or full-thickness ischaemia

Intra-abdominal hypertension or abdominal compartment syndrome

Clinical signs of peritonitis or worsening abdominal examination despite adequate medical therapy

End-organ failure

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9
Q

What is this?

A

Pseudomembranous colitis:

Most often associated with C. difficile infection

Manifestation of severe colonic disease

Characteristic yellow-white plaques that form pseudomembranes on the mucosa

Confirmed on endoscopy +/- biopsy

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10
Q

What is the most likely diagnosis?
Toxic megacolon
Ulcerative colitis
Large bowel obstruction
Pseudomembranous colitis
Crohn’s disease

Extra info about patient…
26F, otherwise healthy.
3 months history of diarrhoea (4x/day) with rectal bleeding.
Associated urgency and mucous.
PMHx: Nil, no medications of note.
SHx: Ex-smoker, stopped 9 months ago.
No recent travel.
26F presenting with a long history of loose motions & PR bleeding who is clinically stable
Blood tests showing ↑ed WCC & CRP indicating an inflammatory/infective process with no complications.

A

Ulcerative Colitis

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11
Q

What are the management options for ulcerative colitis?

A

Steroids

5 ASA

Immunosuppressants
- Azathioprine
- Methotrexate

Biologic therapy

Others –diet, FMT, antibiotics, probiotics, novel agents

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12
Q

How do you classify the severity of ulcerative colitis?

A

UC severity:
Different scopes including clinical disease activity index, Montreal classification and Trulov & Witt scores.

Mild…
4 x BMs/day, no systemic toxicity, normal ESR/CRP, mild symptoms.

Moderate…
> 4x BMs/day, mild anaemia, mild symptoms, minimal systemic toxicity, nutrition maintained and no weight loss.

Severe…
> 6 BMs/day, severe symptoms, systemic toxicity, significant anaemia, increased ESR/CRP and weight loss.

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13
Q

What would you do next if this happened after treating for ulcerative colitis?

A
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14
Q

Progress update after treating the UC twice… What would you do next?

A
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