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Clinical pathology > Clinical infections - Gastrointestinal 1 > Flashcards

Clinical infections - Gastrointestinal 1 Flashcards

1
Q

Sterile sites:

A

peritoneal space, pancreas, gall bladder, liver (wouldn’t expect bacterial growth)

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2
Q

Non-sterile sites

A

intra-luminal so from top to the bottom end: mouth, oesophagus, stomach, small/large bowel

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3
Q

Normal Flora

A
  • Enterococcus – found in the enteric tract
  • Nose: staphylococcus aureus
  • Mouth: streptococci viridans
  • Pharynx: contain haemophilus
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4
Q

Angular Cheilitis definition

A
  • Acute/chronic inflammation of skin and contiguous labial mucosa located at lateral commissures of mouth
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5
Q

Angular Cheilitis aetiology

A
  • Caused by excessive moisture [maceration] from saliva and secondary infection with C albicans or less commonly S aureus
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6
Q

Angular Cheilitis treatment

A

Topical Antifungals or Antibiotics

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7
Q

Angular Cheilitis presentation

A
  • Older people: Loss of vertical dimension of the mouth, drooling, saliva
  • Erythema, maceration, scaling, fissuring at corners of mouth
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8
Q

Hairy Leucoplakia

A
  • White plaques on the tongue seen in HIV patients who have not been treated
  • caused by Epstein Barr Virus, cause of glandular fever
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9
Q

Dentoalveolar infections

A
  • Caries - Bacterial plaques form on the tooth surface and form caries, Acid produced by Streptococcus mutans and lactobacillus spp
  • Pulpitis: Require root canal treatment
  • Periapical abscess - Streptococci and anaerobes
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10
Q

Periodontal infection

A
  • Plaque beneath the gingival margin
  • Gingivitis - requires improved oral hygiene
  • Periodontitis -Progression of gingivitis - Antibiotics required
  • Periodontal abscess - requires surgical draining
  • Acute necrotizing ulcerative gingivitis - Can lead to DNSI’s - requires antibiotics
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11
Q

Peritonsillar abscess (quinsy abscess)

A
  • Unilateral swellings of the tonsil; caused by Streptococcus pyogenes
  • Signs: muffled voice, trismus: lock jaw
  • Symptoms: dysphagia, unilateral sore throat
  • Treatment: Surgical drainage and antibiotic management
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12
Q

Acute suppurative parotitis

A
  • Non mumps; occurs in patients with poor oral hygiene and dehydration
  • Almost always caused by Staphylococcus aureus
  • Treatment: surgical drainage, antibiotics administered
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13
Q

Submandibular space infections (Ludwig’s angina)

A
  • Bilateral infection of submandibular space, potential for airway obstruction
  • Abscesses form: surgical drainage required, antibiotics administered
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14
Q

Helicobacter pylori infection definition

A
  • Bacterial urease hydrolyses gastric luminal urea to form ammonia that helps neutralise gastric acid and form a protective cloud around the organism so it can penetrate the gastric mucus layer
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15
Q

Helicobacter pylori infection diagnosis

A
  • Cause pain, bleeding, perforation, ulcers. Diagnosis:
  • Urease breath test - research
  • Faecal antigen test – Best way to diagnose
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16
Q

Helicobacter pylori infection treatment

A
  • Triple antibiotic therapy plus PPI for 7-14 days – PPIs prevent acid secretion so conditions are no longer optimal for bacteria
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17
Q

Biliary Tract Infection: Cholangitis

A
  • The classic presentation is fever, abdominal pain, and jaundice (Charcot’s triad)
  • Site: common bile duct
    Elevations in:
  • serum alkaline phosphatase (ALP)
  • gamma-glutamyl transpeptidase
  • bilirubin
  • Colonic bacteria: Enterobacteriaceae
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18
Q

Biliary Tract Infection: Cholecystitis

A
  • Abdominal pain, fever, history of fatty food ingestion
  • Elevation in the serum total bilirubin and alkaline phosphatase concentrations
  • Murphy’s signs: positive = pain on inspiration
  • Site: Gall bladder - associated with stones
  • Treatment: antibiotics +/- surgical
19
Q

Bacterial overgrowth of small intestine

A
  • Overgrowth of bacteria on small bowel is believed to be associated with malabsorption or chronic diarrhoea
  • Overgrowth of bacteria may result from achlorhydria, impaired motility, blind loops of bowel
  • Treatment: dietary changes, surgical, motility, non-absorbable antibiotics
20
Q

Whipple’s Disease aetiology

A
  • Tropheryma whipplei - found everywhere in environment
21
Q

Whipple’s Disease symptoms

A
  • Joint symptoms, chronic diarrhoea, malabsorption, and weight loss
  • joint and GI “pain”
22
Q

Whipple’s Disease pathology in distal duodenum

A

White plaques representing engorged lymph vessels

23
Q

Liver abscess

A
  • Occurs if cholangitis is not treated and bacteria travel up biliary tree, into liver
  • Infection ascends biliary tract, enters the bloodstream via portal vein, Haematogenous spread
  • Commonly entamoeba histolytica
24
Q

Liver abscess investigations

A
  • Serum alkaline phosphatase is elevated in 67 to 90 percent of cases and serum bilirubin and aspartate aminotransferase concentrations are elevated in about one-half of cases
  • Protozoal infections and Viral hepatitis another cause
25
Q

Mycobacterium Tuberculosis

A
  • TB in GI tract, mainly respiratory illness
  • Ileo-caecal tuberculosis is the most common GI site
  • gastric ulcers giving gastric outflow obstruction
26
Q

Complicated Intra-Abdominal Infection definition

A

Infection of the GI tract that extends beyond the hollow viscus of origin into the peritoneal space and is associated with either abscess formation or peritonitis
- complicated need rapid surgical intervention and treatment

27
Q

Uncomplicated infections that can become complicated

A 
o Cholecystitis 
o Diverticulitis 
o Appendicitis
o Gastric/duodenal ulcer
- C diff infection
28
Q

Intra-peritoneal abscess

A
  • Anaerobes most likely cause

- Localised area of peritonitis with build-up of pus/faeces

29
Q

Intra-peritoneal abscess predisposing factors

A
  • Perforation (may be result of surgery)
  • Mesenteric ischemia/bowel infarction
  • Pancreatitis/pancreatic necrosis
  • Penetrating trauma
  • Postoperative anastomotic leak
30
Q

Intra-peritoneal abscess treatment

A
  • Generally, require
    drainage
  • Drainage: surgical or radiological; combined with antimicrobial therapy
31
Q

Swinging pyrexia

A
  • Fever (different to most infections), temperature going up and down, abscess get bigger and bigger and periodically release pus and then peak in temp
32
Q

Subphrenic abscess

A
  • between diaphragm, liver and spleen

- Pain in shoulder on affected side, persistent hiccup, intercostal tenderness, apparent hepatomegaly

33
Q

Pelvic abscess

A
  • Urinary frequency

- Tenesmus: continuation/recurrent inclination to evacuate the bowels, caused by disorder of the rectum or illness

34
Q

Post-Operative Infection

A
  • Superficial Surgical Site Infection: SSI-S
  • Deep Surgical Site Infection: SSI-D
  • Organ space SSI: SSI-O
    o Within 30 days of surgery or 1 year if prosthetic infection
35
Q

Spontaneous Bacterial Peritonitis (SBP) definition

A
  • Ascitic fluid infection without an evident intra-abdominal surgically treatable source
36
Q

Spontaneous Bacterial Peritonitis (SBP) diagnosis

A
  • Positive ascitic fluid bacterial culture
  • Elevated ascitic fluid absolute
  • Polymorphonuclear leukocyte (PMN) count.
  • Should be clear, milky appearance = infection
37
Q

Spontaneous Bacterial Peritonitis (SBP) aetiology

A
  • Bacteria within gut lumen cross intestinal wall into mesenteric lymph nodes
  • Lymphatics carrying the contaminated lymph ruptures
38
Q

Spontaneous Bacterial Peritonitis (SBP) Presentation

A
  • The vast majority of patients with SBP have advanced cirrhosis with ascites
39
Q

Spontaneous Bacterial Peritonitis (SBP) treatment

A
  • Treatment is based upon antibiotics; antibiotic prophylaxis may be given
  • Surgically treatable infections, e.g. perforated duodenal ulcer, that lead to ascitic fluid infection are called secondary bacterial peritonitis
40
Q

Antibiotic prophylaxis for SPB be given to the following patients

A

o Patients with cirrhosis and GI bleeding
o Patients who have had one+ episodes of SBP
o Patients with cirrhosis and ascites along with either impaired renal function or liver failure

41
Q

Colonic Malignancy

A
  • Patients with bowel cancer can present with a bacteraemia caused by S. gallolyticus
42
Q

Colonic Malignancy

A
  • Patients with bowel cancer can present with a bacteraemia caused by S. gallolyticus
43
Q

Abdominal conditions that require antibiotics

A
  • Appendicitis
  • Complicated diverticulitis- antibiotics and surgery
  • Pancreatitis - Antibiotics should be withheld until infection is proven with positive cultures
  • Oesophageal rupture

Clinical pathology (69 decks)

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