Gastroenteritis, Cellulitis, Infective Endocarditis Flashcards

1
Q

Clinical features of gastroenteritis?

A

Short history

Diarrhoea (a lot)
Vomiting
Fever
Malaise, myalgia

Dehydration: thirst, dry mucous membranes, dizziness, weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

If a patient with type 2 diabetes presents with diarrhoea and generally unwell, what should you make sure you check?

A

BMs

He could have hyperglycaemic hyperosmolar non-ketotic state

A condition that is precipitated by infection, MI etc.

Results in hyperosmolality, hypernatraemia, decreased consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is HONK?

Clinical features?
Management?

A

Hyperglycaemic hyperosmolar non-ketotic state

A condition that affects people with type 2 diabetes

Precipitated by MI, infection

Causes hyperosmolality and hypernatraemia
Decreased conscious level

Management: fluid replacement, stop metformin, insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which drugs put a dehydrated patient at more risk of AKI?

A
Metformin
PPI (lanzoprazole)
ACEi
NSAIDs
Diuretics
Aminoglycosides (gentamicin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Investigations of gastroenteritis?

A

Bedside:

  • BM
  • Obs
  • ABG, VBG

Routine:

  • Bloods: FBC, UE, LFTs, TFTs, Clotting, CRP
  • Cultures: blood, stool
  • AXR

Specialist:

  • MRI
  • CT
  • Scopes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List some pathogens that cause diarrhoea.

What would you see in the history with these pathogens?

A

Salmonella

Shigella: bloody diarrhoea

Campylobacter: commonly from chicken

E. coli: salads

Hep A: shellfish
Hep E: pork
(these usually have longer incubation period)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What should you worry about in an E. coli GI infection?

Explain it!

A

E. coli 0157

Can lead to haemolytic uraemic syndrome

Triad of:

  1. anaemia
  2. uraemia (AKI)
  3. thrombocytopenia

A toxin released by the bacteria binds to receptors in renal and CNS tissue and causes damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of gastroenteritis?

A

Supportive

Oral rehydration solution

Anti-emetics and anti-diarrhoeals

You only give antibiotics if:

  • bacteraemia
  • severe infection
  • immunocompromised
  • C. diff
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which antibiotics do you give in these situations?

A

Bacteraemia:

  • amoxicillin to cover salmonella
  • azithromycin to cover campylobacter

C. diff: metronidazole, 2nd line PO vanc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the public health rules associated with infective gastroenteritis?

A

Notify public health England

If they work in food handling, hospitals, with vulnerable people wait 48hrs after last episode

Trace back to the cause of infection, like if its a shop or restaurant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List some skin infections and say which part of the skin is involved.

A

Cellulitis: dermis and subcutaneous tissue

Erysipelas: dermis and upper subcutaneous tissues

Folliculitis: hair follicle, leading to a boil

Impetigo: superficial

Necrotising fasciitis: skin and deeper fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical features of cellulitis?

Erysipelas?

A

Cellulitis:

  • poorly demarcated
  • blisters and bullae
  • systemic unwell

Erysipelas:

  • well demarcated
  • red, tense, shiny, bullae
  • systemic unwell
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which bugs usually cause:

  • folliculitis
  • impetigo?
A

Folliculitis: s. aureus

Impetigo: s. aureus or s. pyogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Differential diagnosis of cellulitis?

A
Erysipelas
DVT
Septic arthritis or osteomyelitis
Dermatitis
Vasculitis
Gout
Chronic venous insufficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why are diabetic patients predisposed to cellulitis?

A

Type 1 diabetics have a weakened immune system

Peripheral neuropathy: may not feel an injury so high chance it could get infection

Sugary blood = good for bacterial growth

Chronic hyperglycaemia can affect activity of immune system (neutrophils, phagocytes etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some risk factors for cellulitis?

A
Previous cellulitis or erysipelas
Venous insufficiency
Diabetes
Alcohol excess
IVDU
Lymphoedema
Obesity
Pregnancy
Athletes foot
17
Q

Investigations of cellulitis?

A

Bedside:

  • BM
  • Obs
  • urinalysis (if they’re diabetic and unwell, high chance of DKA)

Routine:

  • Bloods: FBC, UE, LFTs, CRP, Clotting, ketones
  • Cultures: blood, swab of wound, between toes
  • XR

Specialist:

  • fine needle aspiration of leading edge of lesion
  • MRI
  • CT
18
Q

Which pathogens cause cellulitis?

A

Bugs that colonise the skin

Strep: beta-haemolytic - group A (pyogenes) and group C and G

Staph aureus

Anaerobes can too but these arrive by haematogenous spread

Others

  • Klebsiella
  • moraxella
  • psuedomonas
  • clostridium perfringens
19
Q

Management of cellulitis?

A

Flucloxacillin: covers B-haemolytic strep and s. aureus

PO or IV

Supportive: analgesia

NSAIDs and corticosteroids reduce recovery time

20
Q

When should you refer a case of cellulitis to hospital?

A
If you suspect nec fasc
Severe or rapidly worsening
Systemically unwell
Complications
Facial infection
Immunocompromised
Diabetic
Child under 1
Frail
Lymphoedema
21
Q

Clinical features of necroitising fasciitis?

Which bug?

A

Infection of skin and deep fascia

Cuts of blood supply leading to necrosis

Severe systemic toxicity

Rapidly spreading
Crepitus if organisms produce gas

S. pyogenes

22
Q

Clinical features of infective endocarditis?

A

FEVER AND NEW MURMUR

Often mitral regurgitation, early diastolic murmur

Fever and chills
Malaise
Myalgia
Anorexia
Weight loss
Abdominal pain
Nausea and vomiting

CCF: SOB, orthopnoea, PND

Splinter haemorrhages
Roth’s spots (retinal haemorrhages)

Emboli to brain, lung, spleen

23
Q

What is the most common murmur in IE patients?

A

Aortic regurgitation

Which is an early diastolic murmur

24
Q

What are some signs in the hands of IE?

A

Splinter haemorrhages

Osler’s nodes: small nodules on pulp of phalanges

Janeway’s lesions: painless erythematous macules on the thenar and hypothenar eminence

25
What might you find on examination of a patient with IE?
A new murmur: often early diastolic (A. regurg) Petechiae: conjuctiva, hands and feet, chest, abdo, oral mucosae Splinter haemorrhages Osler's nodes Janeway lesions Arthritis Splenomegaly Meningism / meningitis
26
Investigations of IE?
Bedside: - Obs - BM - ABG, VBG - Trans thoracic echo - Urinalysis Routine: - Bloods: FBC, UE, CRP, LFT, Clotting - Blood cultures - CXR Specialist: - trans-oesophageal echo - CT, MRI
27
Risk factors for IE?
Valvular heart disease Valve replacement Structural congenital heart disease Previous IE Hypertrophic cardiomyopathy IVDU Invasive vascular procedures
28
Pathogenesis of IE?
Starts off with a sterile fibrin-platelet vegetation (thrombus) Which then gets infected
29
Which valves are most commonly affected in IE?
Mitral valve Aortic valve Both
30
Which organisms cause IE?
Staph. aureus (most common) Strep: - viridans - group A, B, C, G - intermedius Psuedomonas Kingella kingae, Haemophilus species, cardiobacterium species Fungi
31
What complications can IE cause?
Meningitis Emboli in brain: middle cerebral artery, causing hemiplegia Renal infarcts - painless haematuria Nephritis AKI Splenic infarct - pain MI CCF Pericarditis Retinal artery occlusion - blindness Pulmonary emboli Synovitis Back pain: immune complex deposition in disc spaces
32
What's the antibiotic management of IE?
IV abx for 4 weeks (6 weeks if prosthetic valve) Staph confirmed: - Fluclox for non-MRSA - Vancomycin and rifampicin for MRSA Strep confirmed: - BenPen - Ceftriaxone - Gentamicin
33
Management of IE?
Antibiotic therapy - IV, 4 weeks, 6 weeks for prosthetic Surgical: if prosthetic valve or if severe IE with CCF in native valve