Gastrointestinal Infections Flashcards by Hannah Booth

List the common symptoms of acute gastroenteritis

Diarrhoea
Nausea and vomiting
Abdominal pain
Fever

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List the clinical syndromes of gastroenteritis

Acute gastroenteritis 
Dysentery (blood in diarrhoea)
Traveller’s diarrhoea 
Post antibiotic diarrhoea 
Chronic diarrhoea >2-3 weeks

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Name the bacteria normally associated with gastroenteritis, from most to least popular

Campylobacter 
Salmonella
Shigella
Escherichia coli 
E.coli 0157
Clostridium difficile

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Name the common viruses known to cause gastroenteritis

Norovirus
Rotavirus
Adenovirus

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Name the common Protozoa in gastroenteritis

Cryptosporidium
Giardia lambila
Entamoeba histolytica

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What must happen for dysentery to occurs

What pathogen does not cause dysentery

Need to damage mucosa

Virus and cryptosporidium can’t cause dysentery

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What bacteria is not relevant in travellers diarrhoea

C.diff

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The more c.diff that is found, the greater the

Damage to the mucosa

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What do you find with chronic diarrhoea

Likely to come from travellers diarrhoea from parasites

Post-infection syndromes can be irritable bowel or malabsorption

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What are the differential diagnosis with gastroenteritis

As you get older, more complications can happen so you need to determine if it is contagious

Inflammatory bowel disease
Diverticula disease
Ischaemic colitis
Colorectal carcinoma 
Malabsorption 
Pneumonia

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If someone presents with diarrhoea, what should you do?

Take a stool sample
Microscopy (cysts, parasites (OCP for particular parasite))
And culture
Check for rotavirus or c.diff

More so in hospital than in general practice if ill enough

May have to get more than one specimen if need more parasites numbers

Sometimes need to do a colonoscopy

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List the general management for diarrhoea

Oral or IV rehydrates 
Analgesia 
Antiemetics (ondansetron) 
Avoid antidiarrhoeal agents (loperamide), e.g. dysentery in children 
Isolation in hospital 
Notification to public health 
Return to work or school

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Example of giving an antibiotic in diarrhoea symptom

Suspected c.diff diarrhoea - metronidazole or vancomycin

Travellers diarrhoea <80% due to bacteria, more likely to make a difference
If due to parasites, confirm on stool, chronic symptoms and no response to ciprofloxacin

There’s controversial area for antibiotics being used for acute gastroenteritis

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Risk of using antibiotic therapy in gastroenteritis

Prolong the duration of carriage (salmonella)
Antibiotic-associated diarrhoea
Antibiotic resistance
Adverse drug events

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Is the incidence of symptomatic UTIs get older with age?

Yes because decrease of oestrogen, affects bacteria a and mucosal area, those bacteria can win the numbers in the environment

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Asymptomatic bacteriuria

Truest asymptomatic
Don’t need to do anything

Institutionalised elderly 15-50%
100% in long term in dwelling catheters

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Pathogens is I of UTIs, what is the most common route?

The ascending route

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How does the ascending route occur

Intestinal flora comes though GI tract and migrates across the skin to the urethra

Some strains are uropathogenic (can live in urine)

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What can cause uropathogenic strains more likely to cause trouble/ appear

Diarrhoea
Oestrogen deficiency
Spermicides (increase numbers and adherence)
Urodynamics (flow and structure anatomy)
Bacteria with motile flagellate and adherence, allows them to ascent

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How are these bacteria able to move? And bind

Motile flagella
Called type 1 fimbriae
.bind to mannose-containing epithelial receptors: uroplakin 1 and 2
.tamm horsfall protein which is shed in the urine to fools the e.coli to bind on to that instead and so flushed out
.IgA produced to binds to e.coli to prevent it binding

Also have p fimbriae to bind

What is P fimbriae

Produced by the bacteria which bing to Gal-Gal, on urethral epithelial cells

What other components does urobacteria like?

Urea as food

Acidic environment

What is the inflammatory response to a UTI

PMNs
Cytokines

Humoral Immune system

And the most common pathogens for UTI

Escherichia coli

Staphylococcus saprophyticus (sexually active young women)

Proteus (swarms) 
Pseudomonas
Klebsiella
Enterobacter
Enterococcus 
Staphylococcus aureus

What is the antibiotic route of UTI called?

Haematogenous route

List symptoms to lower UTI

``` Cystitis Dysuria Frequency Urgency Suprapubic pain/tenderness Can have haematuria or fever Cloudy, smelly urine ```

Lost symptoms of pyelonephritis (upper UTI of the kidneys I)

Lion pain and tenderness (where kidneys are) Fever Sometimes nausea and vomiting With/without lower tract symptoms

List the presentations in children and older adults

Children - failure to thrive due to recurrent infections Older adults - can just be confusion and ‘off legs’

Urinalysis What happens if you find nitrite Leucocyte esterase

Nitrite- don’t make it ourselves, formed by bacteria apart from enterococci ``` Others Blood Bilirubin Ascorbic acid Nitrofurantoin ``` False negatives if there’s blood, lots of bilirubin, on antibiotics

Urine microscopy to confirm diagnosis

Pyuria - >100 leukocytes/ml Culture >105 organisms /ml

List the management for asymptomatic UTI

Repeat urine culture and watch for development of symptoms Expect if pregnant, means that they have an increased likelihood of earlier delivery. You would treat. Or ureter transplant people

List the management for symptomatic

Empirical treatment or treat after urinalysis | May need imaging

List non-specific therapy for UTI

Fluid rehydration Urinary pH- low pH is antibacterial Analgesia- not recommended for treatment but may help symptom

List the useful agents for UTI (good at getting in Urine)

Nitrofurantoin Picmecillinam Fosfomycin Oral cephalosporins Co-amoxiclav IV tazocin

What is the length of treatment for cystitis and pyelonephritis

Cystitis- 3 days | Pyelonephritis 10-14 days, not all treatments get in the kidney

What is the definitions for UTIs in Cure Persistence Relapse Reinfection.

Cure - negative culture 1-2 weeks after treatment Persistence - bacteruria 48 hours after treatment Relapse - within 1-2 weeks with the same organisms Reinfection - different bug whilst on treatment or after finishing

Name the key syndromes of STIs

Genital ulcer Genital discharge Other lesions

Describe feature of herpes simplex 2 everything u know

Painful ulcers with local lymphadenopathy Recurrent Confirm diagnosis with PCR Treat with aciclovir May need long term suppression May shed virus without ulcers

``` Describe Primary chancre Latency Secondary syphilis Tertiary syphilis ```

Primary chancre - painless, May heal spontaneously, local lymphadenopathy Latency - still there Secondary syphilis - many different presentations (macular, coppery rash, May involve palms and soles), core generalised lymphadenopathy, condylomata lata (moles). Can become latent Tertiary syphilis- lots of presentations

How do we treat syphilis (early, no tertiary)

Benzathine pencilling G Procaine penicillin Doxycycline (if allergic)

How to treat tertiary syphilis | Including neurosyphilis and late latent syphilis

Benzathine penicillin or doxycycline Monitor serological response Reinfection possible

Tell me what you know about chancroid

Has ulcers similar to syphilis but the base is more necrotic with exudate (ooze) Usually single lesions caused by gram-negative organism Treat with azithromycin or ceftriaxone

Name two other ulcers not talked about in detail

Granuloma inguinale | Lymphogranuloma venereum

What should you do about urethritis/certvictis

Swan for gram stain, culture looking for diplococci- looking for gonorrhoea Urinalysis and NAAT testing

Urethritis and cervicitis is often a co-infection, with what?

Neisseria gonorrhoea Non-gonococcal .chlamydia .ureaplasma .HSV

Other than discharge, what else can gonorrhoea cause? And same for chlamydia

``` Conjunctivitis Septic arthritis Pharyngeal infection Peri-hepatitis Disseminated disease ``` Conjunctivitis for chlamydia

How to treat gonorrhoea

Ceftriaxone And Azithromycin But have found extreme resistant gonorrhoea New guidance CRO and doxycycline

Say some things about genital warts - HPV

Diffuse range of size and shape Usually asymptomatic If very large and cauliflower like called- condylomata aluminata Treatment is with scraping, cryotherapy, keratolytics, podophyllin, imiquimod