Diarrhoea, Vaccines and Hepatitis Flashcards
What are the non-infective causes of diarrhoea?
- Neoplasm.
- Inflammatory.
- Irritable bowel.
- Anatomical.
- Chemical.
- Hormonal.
- Radiation.
What are the 3 infective causes of dysentery?
1) Shigella
2) Salmonella
3) Campylobacter
4) E. Coli
What are the 2 causes of non-bloody diarrhoea?
1) Norovirus
2) Rotavirus
Which 4 groups are at risk of diarrhoeal infection?
1) Food handlers
2) Child healthcare workers
3) Children at nursery
4) Doubtful personal hygiene
How would a C. Diff infection be managed?
1) Control antibiotic use
2) Measures for infection control
3) Isolate case
4) Case Finding
5) Test stool sample for toxin
What are the causes and symptoms of peptic ulcers?
C: Hyper-acidity, Heliobacter Pylori, Prolonged NSAID use
S: Pain, Bleeding and Perforation
What are the investigations and treatments for Peptic ulcers?
I: Barium meal, H. Pylori Test, Gastroscopy
T: H. Pylori eradication, PPI, Remove NSAID usage
What are the main complications and indications for OGD?
C: Risk of bleeding, perforation and cardiopulmonary
I: Dyspepsia, Dysphagia, Anaemia, Suspected Coeliac Disease
What are the main symptoms of GORD?
1) Dyspepsia
2) GORD
3) Acid Reflux
What is the PP and main symptoms of Coeliac Disease?
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
What are the symptoms and investigations for someone with Coeliac Disease?
S: Diarrhoea, Weight Loss, Irritable Bowel, Anaemia, abnormal liver function and mouth ulcers
I: Serology - autoantibodies and Gastroscopy: Duodenal biopsies
How is Crohn’s and ulcerative colitis different in parts of bowel affected?
Crohn’s: Anywhere from mouth to anus
UC: Around rectum only, can spread only to colon
What are the main complications of Crohn’s disease?
1) Malabsorption
2) Fistula
3) Obstruction
4) Perforation
5) Anal Fissure
6) Neoplasia
7) Amyloidosis (Rare)
What are the main complications of Ulcerative Colitis?
- Colon: blood loss and colorectal cancer.
- Arthritis.
- Iritis and episcleritis.
- Fatty liver and primary sclerosing cholangitis.
- Erythema nodosum.
What is the multifactorial PP of IBS?
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).
What are the main symptoms of IBS?
Abdominal pain, pain relief on defecation, bloating, change in bowel habit, mucus, fatigue
What is an example of an IBS differential diagnosis?
Coeliac Disease, Lactose Intolerance, IBD, Bile acid malabsorption and colorectal cancer
What investigations might you do in someone who you suspect has IBS?
- Bloods - FBC, U+E, LFT.
- CRP.
- Coeliac serology.
What is the treatment for each type of IBS?
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.
What is the inflammation pattern and histological features of Crohn’s?
I: Patchy, granulomatous, transmural inflammation (can affect just the mucosa or go through the bowel wall).
H: Mucosa or Transmural inflammation
What is the inflammation pattern and histological features of UC?
I: Continuous inflammation only affecting the mucosa
H: Mucosa
What are the infective and non-infective causes of Acute Hepatitis?
Inf: Hep A-E, EBV, CMV and Toxoplasmosis
N-Inf: Alcohol, Drugs, Toxins, Autoimmune.
What are the symptoms of Acute Hepatitis?
- General malaise.
- Myalgia.
- GI upset.
- Abdominal pain.
- Raised AST, ALT.
- +/- jaundice.
What are the infective causes of Chronic Hepatitis? And complications?
Infective: Hep B, C, E
Complications: Uncontrolled inflammation -> fibrosis -> cirrhosis -> HCC.
What is the background profile of Hep 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
What is the background profile of Hep E?
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
What is the background profile of Hep B?
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)
What are the main side effects of alpha interferon treatment?
- Myalgia.
- Malaise.
- Lethargy.
- Thyroiditis.
- Mental health problems
What is the natural 4 stages of progression of Hep. B?
- Immune tolerance phase: unimpeded viral replication -> high HBV DNA levels.
- Immune clearance phase: the immune system ‘wakes up’. There is liver inflammation and high ALT.
- Inactive HBV carrier phase: HBV DNA levels are low. ALT levels are normal. There is no liver inflammation.
- Reactivation phase: ALT and HBV DNA levels are intermittent and inflammation is seen on the liver -> fibrosis.
What is the background of Hep. D?
Virus Type: Defective RNA (HbsAG to protect)
Transmittal: Blood-borne transmission (IVDU)
Risk: Needs Hep. B to survive
What is the background of Hep. C?
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.
