Gastrointestinal Infections

Question 1

What is the second most common infection

Answer 1

GIT infections

Question 2

Mention some examples of immunocompromised patients

Answer 2

Children below 5 years
People taking cytotoxic drugs
People with diabetes
People with HIV

Question 3

GI infections usually occur in patients who don’t have which IG

Answer 3

IgA

Question 4

What is hematokesia

Answer 4

Blood in stool

Question 5

Sudden onset of bowel frequency associated with crampy abdominal pains, and a fever will point to which kind of diarrheal cause

Answer 5

An infective cause

Question 6

Bowel frequency with loose blood-stained stools is characteristic of which diarrheal cause

Answer 6

Inflammatory basis

Question 7

The passage of pale offensive stools that float, often accompanied by loss of appetite and weight loss is characteristic of what cause of diarrhea

Answer 7

Steatorrhoea

Question 8

When you eat things that are non-absorbable, it could lead to which type of diarrhea

Answer 8

Osmotic diarrhea

The gut mucosa acts as a semipermeable membrane and fluid enters the bowel if there are large quantities of non-absorbed hypertonic substances in the lumen

Question 9

Which kind of diarrhea stops when ingestion also stops

Answer 9

Osmotic diarrhea

Question 10

Diarrhea could also occur when there’s a damage to the intestinal mucosal cells so that there is a loss of fluid and blood. What kind of diarrhea is this

Answer 10

Inflammatory diarrhea

Question 11

What are some clinical features associated with acute diarrhea

Answer 11

Fever, abdominal pain and vomiting

Question 12

When should you be more serious about the diarrhea

Answer 12

If diarrhea has lasted for more than a week

Question 13

In case a stool is sent to the lab to test for diarrhea and no headway has been made, what should be done next

Answer 13

A sigmoidoscopy and rectal examination should be considered

Question 14

Do viral and bacterial infective diarrheas last long

Answer 14

No, they don’t last for more than two weeks

Question 15

What are some treatments of acute diarrhea

Answer 15

Oral fluid and electrolyte replacement (Special oral rehydration solutions (e.g. sodium chloride and glucose powder)

Question 16

What are some treatments of diarrhea

Answer 16

Oral fluid and electrolyte replacement
Antidiarrheal drugs for short term relief
Antibiotics are occasionally necessary

Question 17

Diarrhea could also be difficile associated after taking any antibiotic. Mention one antibiotic which could cause this

Answer 17

Clindamycin

Question 18

What is the causative agent of a dificile associated diarrhea

Answer 18

Clostridium difficile

Question 19

What are the three parasites which are isolated in HIV patients presenting with diarrhea

Answer 19

Cryptosporidium
Isospora belli
Microsporidia

Question 20

What are some things you see in the head and neck for patients presenting with a gastrointestinal disease

Answer 20

Pallor
Jaundice
Angular stomatitis
Glossitis
Parotid enlargement
Mouth ulcers
Lymphadenopathy

Question 21

What are some things should check for on the hands for patients presenting with a gastrointestinal disease

Answer 21

Clubbing
Koilonychia

Question 22

What are some things you should check for skin for patients presenting with a gastrointestinal disease

Answer 22

Muscle bulk
Signs of weight loss

Question 23

What is usually caused by faecal–oral transmission of bacteria or their toxins, viruses or parasite

Answer 23

Acute diarrhea

Question 24

What is the second commonest infection after respiratory tract infections

Answer 24

GIT infections

Question 25

What are the presentations of GI infections

Answer 25

Fever Chills Abdominal pain Diarrhea Vomiting

Question 26

What are some common organisms which cause GI infections

Answer 26

Cryptosporidium Giardiasis Amoebiasis Liver flukes Tapeworm Salmonellosis

Question 27

Immunodeficiency and mucosal immunity play a role in GI infections True or false

Answer 27

True

Question 28

Immunodeficiency resulting to GI infections occurs because of an antibody deficiency What antibody is this

Answer 28

IgA

Question 29

IgA deficiency is commonly associated with which pathogen

Answer 29

Giardia and campylobacter

Question 30

What occurs after ingestion of sporangiospores by malnourished patients, premature neonates or immunocompromised hosts, and is uncommon but still occurs

Answer 30

Mucormycosis

Question 31

Bowel perforation and peritonitis could occur in this condition from invasion of mucosa, sun mucosa and bowel vessels What condition is this

Answer 31

Mucormycosis

Question 32

The oesophagus is the site most frequently involved in this condition and most patients are asymptomatic Which condition is this

Answer 32

Aspergillus infection

Question 33

What are the presentation of an aspergillus infection

Answer 33

Intestinal ulcers may be with bleeding or perforation Hepatosplenic infection (30%) Liver tenderness, abdominal pain and jaundice Numerous small, radiolucent lesions scattered throughout the liver on the CT scan Elevated ALP or BIL levels

Question 34

What are the presentations of CMV caused GI infections

Answer 34

Chronic or intermittent diarrhea with abdominal pain and fever Mild or severe rectal bleeding Pain may precede the development of toxic megacolon and intestinal perforation Oesophageal infection may present as dysphagia and odynophagia Involvement of the pancreatico-biliary tree may result in pancreatico-cholangiopathy or pancreatitis CMV retinitis in eye involvement

Question 35

In what terms is diarrhea defined

Answer 35

Frequency (more than 3 stools per day - relative) Stool weight or volume (should weigh > 200g per day. Varies differently and depends on diet) Consistency

Question 36

Mention the types of diarrhea

Answer 36

Osmotic Secretory Inflammatory Dysmotility

Question 37

What is acute diarrhea

Answer 37

Abrupt onset >_ 3 lose stokes per day and lasts no longer than 14 days. It could be acquired in the hospital or the community and usually self-limiting

Question 38

What are some causes of acute diarrhea

Answer 38

Infections Drug-induced Food allergies Digestive/absorptive disorders Chemotherapy/radiotherapy Surgical conditions Vitamin deficiency Heavy metal ingestion (Cu, Zn) Ingestion of herbal products (mushrooms, mistletoe)

Question 39

What is chronic diarrhea

Answer 39

Abnormal passage >_ 3 loose stools per day for more than 14 days. Daily stools weight > 200g/day. Some definitions say >_ to 4 weeks

Question 40

Mention some causes of chronic diarrhea

Answer 40

Colonic (colonic neoplasia, ulcerative and Crohn’s colitis) Small bowel (Crohn’s disease, bile acid malabsorption, Whipple disease) Pancreatic (chronic pancreatitis, pancreatic carcinoma, cystic fibrosis Endocrine (diabetes, Addison’s disease, hypothyroidism, hormone secreting hormones such as a gastrinoma) Others

Question 41

What are some things you could ask or check for in a person presenting with a GI infection

Answer 41

When and how symptoms started (abrupt, gradual onset and duration of symptoms) Stool characteristics Symptoms of volume depletion Frequency of bowel movement Presence of dysenteric symptoms Past medical Hx and social Hx Drug Hx (magnesium containing products, anti hypertensive and NSAIDs, theophyllines, anti arrhythmias) Recent antibiotic therapy and C difficile infection

Question 42

What are some physical signs you should look out for in a patient with diarrhea

Answer 42

Borborygmi (significant increases in peristaltic activity causing audible and/or palpable increase in bowel activity) Signs of malnutrition (reduced muscle/fat mass or peripheral edema) Abdominal pain, rebound tenderness or guarding (rule out bowel perforation) Perianal erhythma or excoriations

Question 43

What are some investigations to make of a patient whom you suspect of diarrhea

Answer 43

FBC RFTs LFTs ESR, serum Fe, albumin, vitamin B12, folate, Ca CRP Thyroid function test Upper and lower endoscopies (H. pylori) ERCP MCRP Stool R/E and culture sensitivity (exam of three fresh stools for ova, cysts and parasites) Enzyme immunoassay and latex agglutination assay for rotavirus IgA anti-endometrium antibodies or retuculin antibodies

Question 44

How do you manage diarrhea

Answer 44

Identify cause of disease and treat Hydration Manage patient in hypovolemic shock Prevent and manage kidney injury in severe dehydration Correct electrolyte imbalance Antimotility medications should not be given in GI infections Educate patients in preventative measures

Question 45

What is the recommended therapy for C, difficile

Answer 45

Metronidazole 500mg tid

Question 46

What is the recommended therapy for E. Coli

Answer 46

No treatment with antimicrobials or anti-motility drugs

Question 47

What is the recommended therapy for E. coli (toxigenic)

Answer 47

Azithromycin 1g stat or rifaximin

Question 48

What is the recommended therapy for Giardia

Answer 48

Tinidazole

Question 49

What is the recommended drug therapy for salmonella

Answer 49

Cipro

Question 50

What is the recommended drug therapy for shigella

Answer 50

Cipro and levo

Question 51

What is the recommended drug therapy for C. jejunum

Answer 51

Azithromycin

Question 52

What is the recommended drug therapy for E. histolytica

Answer 52

Metronidazole

Question 53

What is the recommended drug therapy for Staphylococcus aureus

Answer 53

No treatment

Question 54

What is the recommended drug therapy for vibro

Answer 54

Cipro

Question 55

What is the recommended drug therapy for yersinia enterocolitica

Answer 55

No treatment unless severe

Question 56

What are some complications of diarrhea

Answer 56

Dehydration with or without shock Hemorrhagic colitis Hemolytic uraemic syndrome Intuisusception (especially in children) Seizures Appendicitis Perforation Colonic perforation, liver abscess Chronic fat malabsorption Reuter’s syndrome