Deck 2 - GI Flashcards

1
Q

Q. Name 2 causes of diarrhoea

A

A. Bacterial: e.g. E coli
B. Viral: Rotavirus, norovirus, adenovirus, astrovirus
C. Parasitic: parasites, helminths, schistosomiases, stronglyoids

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2
Q

Q. What should be asked when taking a history from a patient with diarrhoea?

A

A. Travel history – where, how long, how travelled?
B. Pets/contact with animals
C. Drinking water/tap water/food
D. Immunocompromised e.g HIV, malignancy, DM, Steroids
E. Remember malaria and sepsis can also present with diarrhoea..
F. History of contact with other cases and Norovirus
G. Small children and Rotavirus
a. Fresh water and Aeromonas
b. Puppies and Campylobacter
c. Reptiles and Salmonella enterica subsp arizonae
d. Well water and Giardiasis
e. Flooding and problems with water treatment and Cryptosporidiosis
f. Raspberries and Cycospora

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3
Q

Q. Who is at a higher risk of catching norovirus?

A

A. Young children and the elderly
B. Low-income countries, developing countries
C. Drinking water, sanitation/access to toliets, hand hygiene
D. Where? Hospitals, care homes, schools, cruise ships, families
E. Rotavirus vaccine

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4
Q

Q. What is a high risk (spread) profession?

A

1.

A. Health care professionals, food outlets etc

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5
Q

Q. What pathogen is resistant to alcohol gel?

A

A. Clostridium difficile – spores are resistant

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6
Q

Q. Name 3 methods to prevent C.diff spread

A

A. Isolate! Use gloves and aprons, Handwashing with soap and water, Test stool for toxins
B. Control antibiotic use, standard infection procedures, surveillance and case finding
C. Any patient with diarrhoea – Isolate – Enteric precautions – Test stool samples – Environmental cleaning – Treat cases with metronidazole or vancomycin

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7
Q

Q. Describe a classical presentation of norovirus

A

A. Mainly vomiting – may cause diarrhoea, nausea, cramps, headache, fever, chills, myalgia, lasts 1-3 days, (Mainly occurs in winter)

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8
Q

Q. Describe two WHO prevention and treatment measures for diarrhoea in children

A

A. Rotavirus and measles vaccinations
B. Promote early & exclusive breastfeeding + Vitamin A supplementation
C. Promote hand washing with soap
D. Improved water supply quantity & quality, including treatment & safe storage of household water
E. 5. Community-wide sanitation promotion.

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9
Q

Q. Name two other control measures

A

A. Hand-washing with soap - Ensure availability of safe drinking water • - Safe disposal of human waste • - Breastfeeding of infants & young children • - Safe handling and processing of food • - Control of flies/vectors • - Case management including exclusion • - Vaccination

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10
Q

Q. Describe the classical presentation of traveller’s diarrhoea

A

A. 3 or more unformed stool per day and at least one of abdominal pain/cramps/nausea/vomiting/dysentery
B. Occurs within 2 weeks of arrival in a new country, most often within 3 days. 30-50% of travellers are affected

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11
Q

Q. What organisms may cause traveller’s diarrhoea?

A

A. More than 50% bacterial i.e. enterotoxigenic E.coli, SE Asia mainly Campylobacter
B. Norovirus
C. Giardia – longer term disease

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12
Q

Q. Which antibiotics are particularly associated pseudomembranous colitis (antibiotic associated diarrhoea, C.dif resistance)?

A

A. ‘Rule of C’s”: Clindamycin, ciprofloxacin, co-amoxiclav, cephalosporins

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13
Q

Q. What occurs in peritonitis?

A

A. Inflammation of the peritoneum (tissue that lines inner wall of abdomen)
B. Due to: infection/perforation
C. S&S: acute abdo pain, guarding and tenderness, worse on coughing, rebound tenderness, fever, sinus tachycardia, - Generalised abdo pain, may become localized later

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14
Q

Q. What occurs in Biliary sepsis/ascending cholangitis?

A

A. Obstruction of biliary tract causing bacterial infection (usually at duodenum junction), more common if obstructed by gall stones, may be due to benign stricture of bile duct, post op damage, tumours

a. Charcot’s triad: Fever + RUQ Pain + Jaundice
b. Reynold’s pentad: Charcot’s triad, plus: Hypotension, Confusion/altered mental state (septic shock)
c. Medical emergency: Ultrasound abdo, MRCP, ERCP, IV antibiotics/fluid endoscopy to relieve obstruction /stenting/haproscopy/surgery
d. Increase risk: obesity, diabetes

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15
Q

Q. Describe the presentation including investigations of acute or chronic hepatitis

A

A. Acute: < 6 months, (asymptomatic), general malaise, myalgia, GI upset, abdo pain, +- jaundice (pale stools, dark urine), tender hepatomegaly, raised AST, ALT (GGT, ALP) +/- Bili
B. Chronic: >6 months, (asymptomatic), +/- signs of chronic liver disease: clubbing, palmar erythema, Dupuytren’s contracture, spider naevi, may be:
a. Compensated – LFTs normal
b. Decompensated – jaundice, ascites, low albumin, coagulopathy, encephalopathy
c. Complicated – hepatocellular carcinoma, portal HTN – varices, bleeding

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16
Q

Q. Name two causes of acute hepatitis and chronic hepatitis

A

A. Acute:
a. Infectious – hep A to E, herpes virus e.g. EBV, CMV, VZV,
b. Non-infectious: alcohol, drugs, toxins, pregnancy, autoimmune, hereditary metabolic
B. Chronic:
a. Infectious – Hep B (+-D), C, E,
b. Non-infectious – Alcohol, drugs, autoimmune, hereditary metabolic

17
Q

Q. What is the common hepatitis virus? How is it transmitted?

A

A. Hep A is most common worldwide: faeco-oral transmission, contaminated food or water, shellfish, travellers, food handlers
B. Acute only! Usually self-limiting, 100% immunity after infection

18
Q

Q. Which hepatitis viruses are self-limiting?

A

A. Hep A

B. Hep E: usually self-limiting, can cause fulminant hepatitis – may cause chronic disease in immunosuppressed patients

19
Q

Q. Most hepatitis viruses are ribonucleic viruses, which is the only hepadnavirus?

A

A. Hepatitis B
B. Blood borne: Needle stick, tattoos, sexual, vertical (mother to baby)
C. 95-99% have spontaneous resolution, although there is a risk of re-activation
D. Chronic infection may lead to cirrhosis, decompensated cirrhosis and/or hepatocellular carcinoma

20
Q

Q. Which hepatitis viruses requires hepatitis B for replication?

A

A. Hepatitis D: can only occur simultaneously or as a super-infection with HBV
B. Blood borne: needles/tattoos/sexual/vertical, HBV vaccination provides immunity
C. HBV usually dominant

21
Q

Q. How is hepatitis C transmitted?

A

A. Blood borne: IVD users
B. 70% of adults will get a chronic infection (increased in HIV patients), develop fibrosis – can be reinfected
C. DAA-based triple therapy

22
Q

Q. What is the main effect of each of these substances A)Opiates B)Depressants C) Hallucinogens?

A

A. Opiates (e.g. heroin, morphine): euphoria, pain relief
B. Depressants (e.g. alcohol, benzodiazepines e.g. valium): sedation, relaxation, slow down thinking & acting Stimulants (e.g. caffeine, nicotine, cocaine): increase alertness & activity, elevate mood
C. Hallucinogens (e.g. ecstasy, ketamine, magic mushrooms): alter sensory perception & thinking patterns, loss of sense of reality

23
Q

Q. How many units (or less) should be consumed a week?

A

A. Men and women: < 14 units, spread drinking over 3 days+

24
Q

Q. What is the alcohol harm paradox?

A

A. Research suggests that low SES groups consume less alcohol than higher SES groups but experience greater alcohol-related harm

25
Q

Q. Name 5 adverse effects of binge drinking alcohol

A

A. Increased risk of HTN, CHD, pancreatitis, liver disease (fatty liver, hepatitis, cirrhosis, hepatic carcinoma), dementia
B. Direct: homelessness, poor diet

26
Q

Q. How does foetal alcohol syndrome occur? Name 3 features

A

A. When a pregnant woman drinks during pregnancy, the foetus may experience:

a. Pre and post-natal growth retardation
b. CNS abnormalities including mental retardation, irritability, incoordination, hyperactivity
c. Craniofacial abnormalities, smaller head than average, poor growth
d. Associated abnormalities including congenital defects of eyes, ears, mouth, cardiovascular system, genitourinary tract and skeleton and an increase in the incidence of birthmarks and hernias

27
Q

Q. Name 2 features of alcohol withdrawal

A

A. Tremulousness - “the shakes”
B. Activation syndrome - characterized by tremulousness, agitation, rapid heart beat and high blood pressure
C. Seizures - acute grand mal seizures can occur in alcohol withdrawal in patients who have no history of seizure or any structural brain disease
D. Hallucinations - usually visual or tactile in alcoholics
E. Delirium tremens - can be severe and often fatal

28
Q

Q. Name 3 psychosocial effects of excessive alcohol consumption

A

A. Interpersonal Relationships – Violence – Rape – Depression or anxiety
B. Problems at Work- maintaining employment
C. Criminality
D. Social Disintegration – Poverty
E. Driving offences

29
Q

Q. Name 2 population approaches to prevent harmful drinking

A

A. Price - Make alcohol less affordable
B. Availability - licensing & import allowances
C. Marketing - limit exposure, esp.to children and young people
D. Primary prevention: ‘know your limits’ binge drinking compaign, drinkaware – labelling, TV ad campaigns, “THINK!”

30
Q

Q. Name 2 screening tolls for detecting excessive alcohol consumption and to differentiate between: hazardous and harmful drinking and alcohol dependence

A

A. A Clinical Interview – a single question about heavy drinking days
B. Fast Alcohol Screening Test (FAST)
C. CAGE Questions
D. AUDIT tool – a written self-report instrument; takes about 5 minutes to complete

31
Q

Name two medical treatments and 2 psychosocial treatments for alcohol dependence

A

A. Medical treatments
a. Disulfiram (Antabuse) - Producing an acute sensitivity to alcohol
b. Naltrexone: competitive antagonist for opioid receptors – for rapid detoxification
c. Acamprosate (Campral) : - stabilize the chemical balance [More detail in next lecture]
B. Psychosocial treatments
a. Therapy – cognitive & behavioural
b. Social support – one to one or group e.g. Alcoholics Anonymous

32
Q

Q. How many units is in a standard drink in the UK? How can units be calculated?

A

A. UK unit is 8g or 10ml of pure alcohol
B. %ABV X amount of liquid in mm/1000 = units
13.5% X 250/1000 = 3.4 units in 250ml wine