Deck 2 - GI Flashcards
Q. Name 2 causes of diarrhoea
A. Bacterial: e.g. E coli
B. Viral: Rotavirus, norovirus, adenovirus, astrovirus
C. Parasitic: parasites, helminths, schistosomiases, stronglyoids
Q. What should be asked when taking a history from a patient with diarrhoea?
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
Q. Who is at a higher risk of catching norovirus?
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
Q. What is a high risk (spread) profession?
1.
A. Health care professionals, food outlets etc
Q. What pathogen is resistant to alcohol gel?
A. Clostridium difficile – spores are resistant
Q. Name 3 methods to prevent C.diff spread
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
Q. Describe a classical presentation of norovirus
A. Mainly vomiting – may cause diarrhoea, nausea, cramps, headache, fever, chills, myalgia, lasts 1-3 days, (Mainly occurs in winter)
Q. Describe two WHO prevention and treatment measures for diarrhoea in children
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.
Q. Name two other control measures
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
Q. Describe the classical presentation of traveller’s diarrhoea
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
Q. What organisms may cause traveller’s diarrhoea?
A. More than 50% bacterial i.e. enterotoxigenic E.coli, SE Asia mainly Campylobacter
B. Norovirus
C. Giardia – longer term disease
Q. Which antibiotics are particularly associated pseudomembranous colitis (antibiotic associated diarrhoea, C.dif resistance)?
A. ‘Rule of C’s”: Clindamycin, ciprofloxacin, co-amoxiclav, cephalosporins
Q. What occurs in peritonitis?
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
Q. What occurs in Biliary sepsis/ascending cholangitis?
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
Q. Describe the presentation including investigations of acute or chronic hepatitis
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