Gastrointestinal Infections (Complete) Flashcards

1
Q
A
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2
Q

List 4 examples of causes of infectious diarrhoea in patients who have investigation findings indicative of inflammation/infection (e.g. elevated CRP and WCC)

A

Clostridium difficile

Klebsiella oxytoca

Clostridium perfringens

Salmonella spp

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3
Q

List 6 examples of causes of non-infectious diarrhoea in patients who have investigation findings indicative of inflammation/infection (e.g. elevated CRP and WCC)

A

Antibiotics side effect

Post-infectious irritable bowel syndrome

Inflammatory bowel disease

Microscopic colitis

Ischaemic colitis

Coeliac disease

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4
Q

List 4 examples of investigations that can help determine whether the diarrhoea has an infectious or non-infectious cause

A

Stool sample for C. difficile toxin

Stool culture

Imaging (AXR, CT)

Endoscopy (e.g. Flexible sigmoidoscopy, Colonoscopy)

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5
Q

Stool sample findings show a positive for C. diff. What is the management plan for this patient?

A

Move patient to a side room (Infection control)

Discontinue any antibiotics (e.g. co-amoxiclav) the patient is on and start them on vancomycin, fidaxomicin or metronidazole.

Management of fluids, nutrition & diarrhoea

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6
Q

What two investigation parameters can be looked at to measure the severity of a c.diff infection?

A

WCC

Creatinine (Measure of kidney function)

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7
Q

What values must WCC and creatinine levels fall under to consider a c. diff infection as being non-severe?

A

WCC<15

Creatinine <150

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8
Q

What values must WCC and creatinine levels fall under to consider a c. diff infection as being severe?

A

WCC>15

Creat >150

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9
Q

What is a rare but severe consequence of a c. diff infection?

A

Fulminant colitis

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10
Q

What are some of the sypmtoms associated with fulminant colitis?

A

Toxic megacolon

Hypotension or shock

Ileus (lack of muscles contractions in intestines)

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11
Q

Define toxic megacolon

A

Non-obstructive widening of the colon due to swelling and inflammation

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12
Q

Patient has a c.diff infection with WCC 14 and creatinine 140. What is the management/treatment plan for this patient?

A

Isolate the patient in a side room

Stop any current antibiotics and place them on vancomycin, fidaxomicin or metronidazole.

Role of Faecal Microbiota Transplantation (FMT) [If its an option]

Management of fluids, nutrition & diarrhoea

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13
Q

Patient has a c.diff infection with WCC 16 and creatinine 170. What is the management/treatment plan for this patient?

A

This patient has a severe infection and potentially may have fulminant colitis.

Isolate the patient in a side room

Stop any current antibiotics and place them on vancomycin, fidaxomicin or metronidazole.

Supportive care and close monitoring

Early surgical consultation

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14
Q

What is the management plan for a patient with fulminant colitis with toxic megacolon?

A

Medical therapy with antibiotics and supportive management

ITU transfer for invasive monitoring

Potential surgery

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15
Q

What are the 5 main indications for surgery in patients with fulminant colitis?

A

Colonic perforation

Necrosis or full-thickness ischaemia

Intra-abdominal hypertension or abdominal compartment syndrome

Clinical signs of peritonitis or worsening abdominal exam despite adequate medical therapy

End-organ failure

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16
Q

What severe manifestation of colic disease is most associated with a c. diff infection?

A

Pseudomembranous colitis

N.B. This has a chance of leading to toxic megacolon and fulminant (severe) colitis

17
Q

Define pseudomanas colitis

A

Pseudomembranous colitis is an inflammatory condition of the colon characterized by elevated yellow-white plaques that coalesce to form pseudomembranes on the mucosa.

N.B. Most commonly caused by overgrowth of C.diff (which usually occurs due to AB use)

18
Q

How is pseudomonas colitis confirmed?

A

Via endoscopy +/- biopsy

19
Q

How does inflammation differ between ulcertaive colitis and crohn’s disease?

A

Ulcertaive colitis inflammation is usually continous and starts in the rectum towards the rest of the colon

Crohns disease has discontinous inflammation with and inflammation can be anywhere within the GI tract (mouth to anus)

20
Q

26F presenting with a long history of loose motions & PR bleeding who is clinically stable . Blood tests showing ↑ed WCC & CRP indicating an inflammatory/infective process with no complications.

A colonoscopy has showed continuous left sided inflammatory changes. What is the likely diagnosis?

A

Ulcerative colitis

21
Q

A patient has been diagnosed with ulcerative colitis. What are the 5 potential management options for this patient?

A

Steroids

5 ASA

Immune suppressants (e.g. Azathioprine, Methotreaxate)

Biologic therapy

Others –diet, FMT, antibiotics, probiotics, novel agents

22
Q

Give 2 examples of immune suprpesants used in treatment of ulcerative colitis?

A

Azathioprine

Methotreaxate

23
Q

What are the 3 different types of measures of severity of ulcerative coltiis (UC)?

A

Clinical Disease Activity Index (DIA)

Montreal classification

Trulov & Witt scores

24
Q

List the 4 criteria that suggest UC is mild in severity

A

4 or less bowel movements a day

No systemic toxicity

Normal ESR/CRP

Mild symptoms

25
Q

List the 4 criteria that suggest UC is moderate in severity

A

> 4x BMs/daily

Mild anaemia

Mild symptoms

Minimal systemic toxicity

Nutrition maintained and no weight loss.

26
Q

List the 6 criteria that suggest UC is severe in severity

A

•> 6 BMs/day

Severe symptoms

Systemic toxicity

Significant anaemia

Increased ESR/CRP

Weight loss

27
Q

A patient with intially mild ulcerative colitis who was placed on steroids and 5 ASA has returned to hospital as their symptoms have recurred. What is the next step of actions to be taken?

A

Repeat blood tests to establish severity

Manage with steroid (prednisolone) to establish remission acutely

Educate on side effects

Prepare for next method of treatment: Immuno-modulators e.g. Azathioprine and blood tests in preparation

28
Q

List 10 blood tests that should be ordered before deciding to place a person on immuno-suppresants such as azithioprine in treatment of ulcerative colitis.

A

FBC,

LFT (Can cause liver damage)

Renal profile (Meds can cause kidney damage)

CRP

TPMT (Enzyme which helps to break down azithioprine. Low levels may increase risk of side effects so may choose a diffrent medication instead)

Hep B/C/ HIV (Azithioprine incraeses risk of re-infection)

Chicken pox

Vaccinations

Tuberculosis

N.B. Reasons CP, TB, Hep ect are ordered is because the medication is immuno-suppresant)

29
Q

Name the enzyme responsible for breaking down immuno-modulators such as azithioprine.

A

TPMT (thiopurine methyltransferase)

30
Q

Patient with ulcerative colitis on azithioprine has returned to hospital with the following findings:

What is the management plan for this patient?

A

Rule out infection and c.diff

Order imaging to rule out complications (e.g. toxic megacolon)

If no infection, detected, put on IV steroids

If steroids ineffective, give infliximab (a biologic) alongside azithioprine and educate on side effects

31
Q

List 8 potential serious side effects of biologics

A