Gastrointestinal Infections Flashcards
What is candidiasis and who is likely to get it
Thrush
Immunocompromised patients
Diabetics
Those taking antibiotics
What is candidiasis and who is likely to get it
Thrush
Immunocompromised patients
Diabetics
Those taking antibiotics
How is oral candidiasis treated
Nystatin or amphotericin
What are the common presentations of Vincent’s angina
Appalling oral hygiene deep, sloughing ulcers severe pain halitosis fever malaise
What might be needed to treat Vincent’s angina
Oral antibiotics or anaesthetic mouthwashes
What is parotitis
Viral or bacterial infections of the parotid glands causing swelling and pain
What is required for parotitis is an abscess is present
Surgical drainage
What is the differential for parotid swelling
Salivary gland stones
Sjogren’s syndrome
sarcoidosis
tumours
What is a common observation of oesophageal problems
Oesophageal candidiasis
Is H pylori usually symptomatic or asymptomatic
Asymptomatic
What can H pylori result in (2 things)
Antral gastritis (predisoposes to duodenal ulcer) Pan-gastritis (predisposes to gastric carcinoma)
What 2 things are gastric ulcers associated with
Both antral and pan gastritis
What is the most common way to test for H pylori
Urea breath test
How long do PPIs have to be stopped before the urea breath test
4 weeks
What enzyme does H pylori produce and what does it cleave to
Urease which can cleave urea to ammonia and CO2
What is the colour change for the pH indicator for a positive H pylori test
it turns to pink
WHat is the first line treatment for H pylori
1 week of triple therapy
What is triple therapy
PPI and 2 antibiotics: amoxicilin and metronidazole
What is the second line treatment for H pylori infection
Quadruple therapy
What is quadruple therapy
Bismuth-containing prearation of triple therapy incoroprated tetracycline
Why does treatment often fail in quadruple therapy
Poor compliance
What does an infection in the GI tract usually result in
Diarrhoea, abdominal pain and occasional vomiting
How long do most GI tract infections last
Investigation for the specific organisms is required in which 4 situations
Elderly patients, especially those in institutes
Immunocompromised patients
Symtoms >5days
Epidemics
What is the incubation period for Staph aureus
1-6 hours
What is the incubation for Ecoli, Campylobacter and Clostrium perfringens
8-18hours
What is the incubation for salmonella
12-36 hours
What organisms can cause bloody diarrhoea
Shigella,
enterotoxic E coli
Campylobacter
What is the most common organism for causing abdominal pain
Campylobacter
How is oral candidiasis treated
Nystatin or amphotericin
What are the common presentations of Vincent’s angina
Appalling oral hygiene deep, sloughing ulcers severe pain halitosis fever malaise
What might be needed to treat Vincent’s angina
Oral antibiotics or anaesthetic mouthwashes
What is parotitis
Viral or bacterial infections of the parotid glands causing swelling and pain
What is required for parotitis is an abscess is present
Surgical drainage
What is the differential for parotid swelling
Salivary gland stones
Sjogren’s syndrome
sarcoidosis
tumours
What is a common observation of oesophageal problems
Oesophageal candidiasis
Is H pylori usually symptomatic or asymptomatic
Asymptomatic
What can H pylori result in (2 things)
Antral gastritis (predisoposes to duodenal ulcer) Pan-gastritis (predisposes to gastric carcinoma)
What 2 things are gastric ulcers associated with
Both antral and pan gastritis
What is the most common way to test for H pylori
Urea breath test
How long do PPIs have to be stopped before the urea breath test
4 weeks
What enzyme does H pylori produce and what does it cleave to
Urease which can cleave urea to ammonia and CO2
What is the colour change for the pH indicator for a positive H pylori test
it turns to pink
WHat is the first line treatment for H pylori
1 week of triple therapy
What is triple therapy
PPI and 2 antibiotics: amoxicilin and metronidazole
What is the second line treatment for H pylori infection
Quadruple therapy
What is quadruple therapy
Bismuth-containing prearation of triple therapy incoroprated tetracycline
Why does treatment often fail in quadruple therapy
Poor compliance
What does an infection in the GI tract usually result in
Diarrhoea, abdominal pain and occasional vomiting
How long do most GI tract infections last
Investigation for the specific organisms is required in which 4 situations
Elderly patients, especially those in institutes
Immunocompromised patients
Symtoms >5days
Epidemics
What is the incubation period for Staph aureus
1-6 hours
What is the incubation for Ecoli, Campylobacter and Clostrium perfringens
8-18hours
What is the incubation for salmonella
12-36 hours
What organisms can cause bloody diarrhoea
Shigella,
enterotoxic E coli
Campylobacter
What is the most common organism for causing abdominal pain
Campylobacter
What is quadruple therapy
Bismuth-containing preparation of triple therapy incorporated tetracycline
What is the most common organism for causing abdominal pain
Campylobacter
What are the investigations that should be carried out if needs be
Stool culture and microscopy (for cysts and trophoziotes)
Serology for toxins (C.difficile, E coli, Shigella, Campylobacter)
Sigmoidoscopy and biopsy (if symptoms > 2 weeks)
Joint X rays and aspiration if joint is swollen and there is fever and leucocytosis
What is the general management for gastroenteritis
Resuscitation: oral hydration is preferred
Meticulous hand hygienge
antidiarrhoeal should be AVOIDED
antiemetics
What is the treatment for viral gastroenteritis
Supportive
What is the first line antibiotic used in salmonella, shigella, Ecoli , campylobacter
Ciprofloxacin
Where does Ecoli usually come from
Infected meat
What type of organism is C difficile
Gram positive anaerobe
Why is C difficile such a big problem in hospitals
It is resistant to most disinfectants
What are 3 of the main risk factors for developing C difficile
Antibiotics
Old age
Immunocompromised
What is the treatment for C difficile
Oral metronidazole for 7-10 days
Oral vancomycin for 14-28 days
What is the treatment for C difficile
Oral metronidazole for 7-10 days
Oral vancomycin for 14-28 days
How might mycobacterium tb cause intestinal infection
ingestion of infected milk
blood borne spread from the lung
direct spread from adjacent organs (rare)
Who does intestinal TB most commonly affect
Immigrant populations Saharan africa and south east asia
What are the clinical features of Intestinal TB
Ileocaecal disease - diarrhoea, abdo pain, weight loss, systemic ill health, abdombinal mass
TB adenitis - mimics appendicitis
TB peritonitis - weight loss, systemic ill health and asciteis
What are the investigations for Intestinal TB
Tissue diagnosis is key!
Ascites: exudate with increased lymphocytes supported by Ziehl-Nielsen staining and culture of acid-fast bacilli
What might be seen on an abdominal CT of a patient with Abdominal TB
indistinguishable from Crohn;’s disease (small bowel thickening, intra abdominal lymphadenopathy, peritoneal reaction
What is the management for abdominal TB
Triple therapy ( rifampicin, isoniaxid and pyrazinamide) for 2 months followed by dual therapy (rifampixin and isonizid ) for 4 months
Who is Amoebiasis most common in
Immigrant populations after ingestion of contaminated water of food
What drug might patients be on if they develop Amoebiasis
Corticosteroids
How is ameobiasis diagnosed
Entameoba histolytica antigen in stool and serum
What is the management for Amoebiasis
Metronidaxole for 5 days followed by paramyocin to eradicate luminal parasites
How is eradication of Amoebiasis confirmed
3 sequential clear stool samples
Who presents most commonly with Typhoid and paratyphoid
Returning travellers
What causes Typhoid and paratyphoid
Salmonella typhi or paratyphi
What are the symptoms of Typhoid and paratyphoid
usually systemic and non-specific Rose-spot rash constipation with diarrhoea later bradycardia hepatosplnomegaly lucopaenia
What is the management of Typhoid and paratyphoid
Cirpofloxacin or chloramphenicol to eradicate the bacterium and prednisolone for encephalopathy
How are worms consumed
Either by eating contaminated uncooked meat or through the faeco-oral route
What are the symptoms of worms
Often asymptomatic
May cause low-grade abdominal distension and nausea
Anaemia
What type of worm gives the more dramatic symptoms
Tapeworms
What symtpoms do Tapeworms cause
Fever
enterocolitis
cyst formation in brain or muscle
weight loss
What is the treatment for Tapeworms
Niclosamide as a stat dose
What is the treatment for other forms of worms
3 days of mebendazole or levamisole
What is the commonest STV
HPV
What is the characteristic appearance of anal warts
Cauliflower appearance and may extend to the dentate line
What is the treatment for anal warts
Topical antiviral (podophyllin, podofilox or imiquimod)
When might surgery be indicated for anal warts
For when there is large clusters of lesions or when there is extension into the rectum
What is the commonest STD in the developed world
Chlamydia
Men are affected by chlamydia more than women. true or false
False - women are more commonly affected
What are the symptoms of chlamydia
Urethral discharge and dysuria precede a shallow ulcer on the penis before the characteristic groin hymphadenopathy occurs
How is chlamydia diagnosed
Based on antibody and complemetn fixation testing
What is the treatment for chlamydia
Azithromycin
Doxicycline or co-trimoxazole
What parts of the GI tract can be affected by HIV infection
any part of the GI tract
What are 6 of the common symptoms suggest specific opportunistic infection
Oral ulceraltion - herpes simplex Dysphagia - cytomegalovirus Abdominal pain - TB, CMV in the gallbladder Diarrhoea - TB rectal stricture - Chlamydia Rectal bleeding - syphilis
Where can cytomegalovirus invade
The mucosa of any region of the gut
What confirms cytomegalovirus
Histology
Who can get infected with Cytomegalovirus
Anyone who is immunocompromised
flare up of UC
