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2a GI and Liver > Diarrhoea, Vaccines and Hepatitis > Flashcards

Diarrhoea, Vaccines and Hepatitis Flashcards

1
Q

What are the non-infective causes of diarrhoea?

A
  1. Neoplasm.
  2. Inflammatory.
  3. Irritable bowel.
  4. Anatomical.
  5. Chemical.
  6. Hormonal.
  7. Radiation.
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2
Q

What are the 3 infective causes of dysentery?

A

1) Shigella
2) Salmonella
3) Campylobacter
4) E. Coli

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3
Q

What are the 2 causes of non-bloody diarrhoea?

A

1) Norovirus

2) Rotavirus

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4
Q

Which 4 groups are at risk of diarrhoeal infection?

A

1) Food handlers
2) Child healthcare workers
3) Children at nursery
4) Doubtful personal hygiene

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5
Q

How would a C. Diff infection be managed?

A

1) Control antibiotic use
2) Measures for infection control
3) Isolate case
4) Case Finding
5) Test stool sample for toxin

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6
Q

What are the causes and symptoms of peptic ulcers?

A

C: Hyper-acidity, Heliobacter Pylori, Prolonged NSAID use
S: Pain, Bleeding and Perforation

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7
Q

What are the investigations and treatments for Peptic ulcers?

A

I: Barium meal, H. Pylori Test, Gastroscopy
T: H. Pylori eradication, PPI, Remove NSAID usage

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8
Q

What are the main complications and indications for OGD?

A

C: Risk of bleeding, perforation and cardiopulmonary
I: Dyspepsia, Dysphagia, Anaemia, Suspected Coeliac Disease

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9
Q

What are the main symptoms of GORD?

A

1) Dyspepsia
2) GORD
3) Acid Reflux

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10
Q

What is the PP and main symptoms of Coeliac Disease?

A

PP: Gliadin (IG), has direct toxic effects by up-regulating immune system/HLADQ2 presents to T helper cell in lamina propria –> Inflammation –> Villi atrophy –> Malabsorption

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11
Q

What are the symptoms and investigations for someone with Coeliac Disease?

A

S: Diarrhoea, Weight Loss, Irritable Bowel, Anaemia, abnormal liver function and mouth ulcers
I: Serology - autoantibodies and Gastroscopy: Duodenal biopsies

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12
Q

How is Crohn’s and ulcerative colitis different in parts of bowel affected?

A

Crohn’s: Anywhere from mouth to anus

UC: Around rectum only, can spread only to colon

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13
Q

What are the main complications of Crohn’s disease?

A

1) Malabsorption
2) Fistula
3) Obstruction
4) Perforation
5) Anal Fissure
6) Neoplasia
7) Amyloidosis (Rare)

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14
Q

What are the main complications of Ulcerative Colitis?

A
  1. Colon: blood loss and colorectal cancer.
  2. Arthritis.
  3. Iritis and episcleritis.
  4. Fatty liver and primary sclerosing cholangitis.
  5. Erythema nodosum.
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15
Q

What is the multifactorial PP of IBS?

A

The following factors can all contribute to IBS:

  • Psychological morbidity e.g. trauma in early life.
  • Abnormal gut motility.
  • Genetics.
  • Altered gut signalling (visceral hypersensitivity).
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16
Q

What are the main symptoms of IBS?

A

Abdominal pain, pain relief on defecation, bloating, change in bowel habit, mucus, fatigue

17
Q

What is an example of an IBS differential diagnosis?

A

Coeliac Disease, Lactose Intolerance, IBD, Bile acid malabsorption and colorectal cancer

18
Q

What investigations might you do in someone who you suspect has IBS?

A
  1. Bloods - FBC, U+E, LFT.
  2. CRP.
  3. Coeliac serology.
19
Q

What is the treatment for each type of IBS?

A

Mild: Education, reassurance, dietary modification e.g. FODMAP.
Moderate: Pharmacotherapy and psychological treatments:
- Antispasmodics for pain.
- Laxatives for constipation.
- Anti-motility agents for diarrhoea.
- CBT and hypnotherapy.
Severe: MDT approach, referral to specialist pain treatment centres.
- Tri-cyclic anti-depressants.

20
Q

What is the inflammation pattern and histological features of Crohn’s?

A

I: Patchy, granulomatous, transmural inflammation (can affect just the mucosa or go through the bowel wall).
H: Mucosa or Transmural inflammation

21
Q

What is the inflammation pattern and histological features of UC?

A

I: Continuous inflammation only affecting the mucosa
H: Mucosa

22
Q

What are the infective and non-infective causes of Acute Hepatitis?

A

Inf: Hep A-E, EBV, CMV and Toxoplasmosis

N-Inf: Alcohol, Drugs, Toxins, Autoimmune.

23
Q

What are the symptoms of Acute Hepatitis?

A
  1. General malaise.
  2. Myalgia.
  3. GI upset.
  4. Abdominal pain.
  5. Raised AST, ALT.
  6. +/- jaundice.
24
Q

What are the infective causes of Chronic Hepatitis? And complications?

A

Infective: Hep B, C, E
Complications: Uncontrolled inflammation -> fibrosis -> cirrhosis -> HCC.

25
Q

What is the background profile of Hep A?

A

Virus Type: RNA
Transmittal: Faeco-Oral Transmission
Risk: Travellers and Food handlers
Infection: Acute
Diagnosis: Viral Serology: Anti-HAV IgA then IgM
Management: Supportive, Monitor liver function to ensure no fulminant hepatic failure, Manage close contacts.
Prevention: Vaccination

26
Q

What is the background profile of Hep E?

A

Virus Type: Small RNA
Transmittal: Faeco-Oral Transmission
Infection: Acute (Chronic for Immuno-Comp)
Diagnosis: Viral Serology: Anti-HEV IgA then IgM
Management: Supportive, Monitor liver function to ensure no fulminant hepatic failure, Manage close contacts.
Prevention: Good food Hygiene and Vaccination

27
Q

What is the background profile of Hep B?

A

Virus Type: DNA (Rep. in Hepatocytes)
Transmittal: Blood-borne (V infectious)
Risk: Travellers and Food handlers
Infection: Acute but Chronic if 6 months HBV Ag still present
Diagnosis: Viral Serology: HBV surface antigen can be detected from 6w - 3m or anti-HBV core IgM after 3 months.
Management: Supportive, Monitor liver function. Manage contacts, Follow up at 6 months to see if HBV surface Ag has cleared. If present -> chronic hepatitis.
Complications: Cirrhosis, HCC, Decompensated Cirrhosis
Prevention: Vaccination (Inac. HbsAg)
Treat: a) Antivirals: Tenofovir (Inhibit viral replications) b) Alpha Interferon (boosts immune response)
(Initial immune response triggered by HBV core proteins)

28
Q

What are the main side effects of alpha interferon treatment?

A
  1. Myalgia.
  2. Malaise.
  3. Lethargy.
  4. Thyroiditis.
  5. Mental health problems
29
Q

What is the natural 4 stages of progression of Hep. B?

A
  1. Immune tolerance phase: unimpeded viral replication -> high HBV DNA levels.
  2. Immune clearance phase: the immune system ‘wakes up’. There is liver inflammation and high ALT.
  3. Inactive HBV carrier phase: HBV DNA levels are low. ALT levels are normal. There is no liver inflammation.
  4. Reactivation phase: ALT and HBV DNA levels are intermittent and inflammation is seen on the liver -> fibrosis.
30
Q

What is the background of Hep. D?

A

Virus Type: Defective RNA (HbsAG to protect)
Transmittal: Blood-borne transmission (IVDU)
Risk: Needs Hep. B to survive

31
Q

What is the background of Hep. C?

A

Virus: RNA virus
Transmission: Blood-Borne
Risk Factors: IVDU, People who have required blood products e.g. blood transfusion, Needle-stick injuries, Unprotected sexual intercourse, Materno-foetal transmission.
Diagnosis: Viral Serology: HCV RNA
anti-HCV IgM/IgG indicates that someone has either a current infection or a previous infection.
Treatment: Direct Acting Antivirals
Chronic: 70% progress
Prevention: Screen blood products, Lifestyle modification, Needle exchange.
There is currently no vaccination and previous infection does not confer immunity.

2a GI and Liver (6 decks)

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