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Case 8: GIT diarrhoea > Dysentery > Flashcards

Dysentery Flashcards

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1
Q

Define dysentery

A

Low volume, painful bloody diarrhoea & persists despite fasting

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2
Q

How does dysentery occur

A

Due to mucosal destruction that leads to purulent exudate in stool
Purulent exudate consist of neutrophils & proliferating bacteria
Neutrophils secrete enzymes that damage mucosal lining of small & large intestine

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3
Q

What is the 3 causes of dysentery

A
  1. Infectious enterocolitis
  2. Idiopathic chronic inflammatory bowel disease
  3. Autoimmune hypersensitivity disorder
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4
Q

What is the two infectious enterocolits organisms

A
  1. Enteroinvasive bacteria
  2. Protozoal infection
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5
Q

What is the two idiopathic chronic inflammatory bowel disease

A
  1. Crohns disease
  2. Ulcerative colitis
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6
Q

What is the two enteroinvasive bacteria organisms

A
  1. Typhoid salmonella
  2. Intestinal TB
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7
Q

What areas does salmonella induced dysentery infect

A

Localised & necrosis in lymphoid tissue & reticuleoendothelial system
Diffuse enterocolitis (small & large intestine)

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8
Q

What is the appearance of typhoid salmonella ulcers

A

Large raised longitudinal oval ulcer in Peyer’s Patches of terminal ileum
Small round ulcers in MALT of colon
Enlarged mesenteric lymph nodes & spleen

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9
Q

What cells does the inflammation consist of in Salmonella Typhi

A

Lymphocytes, plasma cells & large pale macrophages
lack of neutrophils

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10
Q

Does typhoid dysentery cause B12 deficiency

A

No, as it is only an acute illness

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11
Q

What is the first 3 weeks clinical presentation of typhoid dysentery

A
  1. Bacteraemia, fever & chills
  2. Rash, abdominal pain & lethargy
  3. Intestinal bleeding & shock
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12
Q

What is the 4 complications of typhoid dysentery

A

Severe intestinal haemorrhage
Splenic rupture
Localisation of bacteria in other organs
Carrier state for prolonged period

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13
Q

What is the 2 causes of intestinal TB

A
  1. Swallow of mycobacterium tuberculosis bacilli
  2. Drinking of unpasteurised milk by mycobacterium bovis
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14
Q

What is the appearance of TB ulcers

A

Circumferential ulcers in distal ileum
Enlarged mesenteric lymph nodes w/ caseous necrosis & necrotising granulomatous inflammation

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15
Q

What is the 4 clinical presentation of intestinal TB

A

Diarrhoea
Abdominal pain
Longstanding abdominal discomfort
Vitamin B12 deficiency (macrocytic anaemia)

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16
Q

What protozoal infection caused amoebiasis

A

Entamoeba histolytica

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17
Q

What does amoebiasis cause & where

A

It secrete enzymes that digest surrounding human tissue w/ no inflammatory reaction
Predominantly in appendix, ascending colon & rectum

18
Q

What is the appearance of amoebiasis ulcers

A

Pinpoint ulcers w/ flask shaped in muscularis propria & undermined surface benign slough off

19
Q

What is the 6 complications of amoebiasis

A
  1. Haemorrhage
  2. Toxic mega colon
  3. Perforation & peritonitis
  4. Amoeboma (fibrotic mass)
  5. Amoebic liver abscess (anchovy paste)
  6. Pleuro-pulmonary amoebiasis
20
Q

What is the site of Crohn’s disease

A

The whole GIT

21
Q

What is the distribution of lesions Crohn’s disease

A

Discontinues/skipped lesions

22
Q

What is the mucosa’s appearance w/ Crohn’s disease

A

Cobblestoned

23
Q

What is the ulcers appearance w/ Crohn’s disease

A

Deep fissures

24
Q

Is strictures & fistulas common w/ Crohn’s disease

A

Yes

25
Q

What is the depth of inflammation w/ Crohn’s disease

A

Transmural

26
Q

Is lymphoid aggregates present w/ Crohn’s disease

A

Yes in deep layers

27
Q

Is fibrosis present w/ Crohn’s disease

A

Yes causing hosepipe strictures

28
Q

Is granuloma’s present w/ Crohn’s disease

A

Yes, non necrotising

29
Q

What is the 4 intestinal complications of Crohn’s disease

A

Malabsorption of B12 & bile salts
Obstruction/stricture
Perforation
Fistula

30
Q

What is the 3 extra-intestinal complications of Crohn’s disease

A

Inflammation of the skin
Uveitis
Arthritis

31
Q

What is a compensatory mechanisms w/ Crohn’s disease

A

Fat wrap to seal defect

32
Q

What is the site of Ulcerative colitis

A

Colon (whole colon is pancolitis)
Can also infect ileum- backwash ileum

33
Q

What is the distribution of ulcerative colitis

A

Continuous

34
Q

What is the mucosa’s appearance of ulcerative colitis

A

Diffuse granular

35
Q

What is the ulcers appearance of ulcerative colitis

A

Superficial coalescing ulcers

36
Q

Is ulcerative colitis malignant

A

Yes it can be

37
Q

What structures form w/ the ulcers in the inactive state

A

Pseudo-polyps

38
Q

What is the depth of inflammation of ulcerative colitis

A

Superficial

39
Q

Where is the lymphoid aggregates w/ ulcerative colitis

A

Only in the mucosa

40
Q

Is fibrosis or granulomas presents w/ ulcerative colitis

A

Fibrosis is mild & no granulomas

41
Q

What is the 3 intestinal complications of ulcerative colitis

A

Total colitis & dilation causing toxic mega colon
Haemorrhage
Colorectal adenocarcinoma

42
Q

What is the 2 extra-intestinal complications of ulcerative colitis

A

Primary sclerosis cholangitis
Arthritis

Case 8: GIT diarrhoea (11 decks)

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