Gastrointestinal Infections III Flashcards
What is the name for inflammation of the angles of the mouth?
What are te usual etilogical agents responsible?
Angular Cheilitis
Angular stomatitis or perleche
- Etiology:
- Candida albicans- usually
- Yellow crusting – Staphylococcus aureus
Angular Cheilitis is most common in which demographic?
- elderly, children who suck their digits, adn in people with riboflavin or irion deficiency
- Elderly
- sagging facial muscles adn ill filling dentures
- causes maceration of skin resultin in inflammation
- can be sign of anemia or vitamin deficiency
Angular Ceilitis Diagnosis?
Treatment?
Prevention?
- Diagnosis
- swab & culture
- S. aureus - blood plates/others
- C. albicans - sabouraud dextrose agar
- swab & culture
- Treatment
- Antigungal or antibacterial agent depending on cause
- hydrocortizone if chronic
- Prevention
- proper nutrition
- proper fitting dentures
- Oral candidiasis
Oral hairy leukoplakia usually occurs at the corners of themouth & you cannot remove it
Oral hairy leukoplakia
What is the most common cause of benign viral parotitis?
Paramyxovirus
mumps
What are the possible complicated associated with mumps?
- Aseptic meningitis (parotitis absent up to 50%)
- asymptomatic infections occur in 40-50% mumps
- symptomatic CNS infections occur in 10% clinical cases
- adults & boys at higher risk
- perminant sequelae occur in 25% – 1% die
- can result in encephalitis (fatal 1.4%)
- Oophoritis and Epididymoorchitis
- testicular swelling, tenderness, nausea, vomiting, and fever
- most common complication postpubertal males
- ovarian inflammation in 5% postpubertal females
- Deafness
- 1 in 15,000– usually unilateral
- sudden onset & damage is permanant
- During pregnancy can lead to fetal death in 1st trimeser
Incubation period for Mumps?
Symptoms?
- Incubation: 14-25 days
- Usually asymptomatic
- may present as lower respiratory tract infection– esp in preschool children
- If symptomatic
- prodrome: myalgia, headache, anorexia, malaise, low-grade fever
- parotitis: swollen and tender salivary glands with earache (30-40% patients)
- can be bilateral or unilateral
- symptoms occur w/in first 2 days, usually gone after 10 days
How is mumps transmitted?
What is the most affected demographic?
- highly contagious
- airborne transmission w/ infected droplet nuclei or saliva
- direct person-person contact
- most common in winter-spring
- infections 3 days before symptoms & 9 days after symptoms disappear
- primarily childhood infection w/ 60% cases occurring in children <15 years of age
- no carrier state is known
Mumps Pathogenesis
- Virus replicates in nasopharynx and regional lymph nodes
- viremia 12-25 days later
- multiple tissues infected durign viremia
- hemagglutinin-neuraminidase or virus binds to trisaccharids (alpha2,3-linked sialic acid) on host cells
- Tropisms for glandular tissue & CNS
- meninges, salivary glands, testes, ovaries, pancreas, kidneys, thyroid, eyes, and mammary glands
Mumps diagnosis
- clinically obvious
- jelly-like feel; NOT warm
- isolate virus from saliva, urine, and CSF
- serology EIA fro IgM and IgG
- IgM: first few days (acute)
- IgG: requies 2 samples 2 weeks apart
- if titer is rising, indication acute case
- not rising = past case/immunized
Mumps treatment and prevention
- Treatment
- treat the symptoms
- Prevention
- MMR vaccine (live attenuated)
- not given to pregnant people
- 95% develop immune response – given 12-15 months
- booster 4-6 years
- MMR vaccine (live attenuated)
What is the etilogical agent of acute bacterial parotitis?
Manifestations?
- Etilogy
- S. aureus
- Manifestations
- swellign salivary glands
- chewing increases pain
- skin- erythema, warm
- massage- purulent saliva (differentiate bacterial vs. viral)
What demographic is most commonly affected by acute bacterial parotitis?
- elderly- takign medications that affect flow of saliva
- dehydrated
- choronically ill
- postoperative patients
- patients with dry mouth
Pathogenesis of Acute bacterial parotitis
- flow of saliva affected
- bacteria enter duct
- ascend to gland
- inflammation adn pain
Diagnosis of actue parotitis?
Treatment?
Prevention?
- Diagnosis
- skin erythematous, warm
- massage to express purulent material
- gram stain and culture
- Treatment
- IV antibiotic
- rehydrate patient
- may need surgery
- Prevention
- proper hydration of chronically ill, elderly and postoperative patients
Ludwig’s angina
- w/ bacterial parotitis, movement of the tongue wouldn’t cause pain– chewing will, though
Viral Parotitis
bacterial parotitis
Oral hairy leukoplakia– caused by Epstein Barr
What is the name for inflammation of the esophagus?
It is associated with what two specific symptoms?
Possible causes?
Esophagitis
- Associated with
- dysphagia (trouble swallowing)
- odynophagia (painful swallowing)
- causes
- GERD
- Infections
- Medications
Etilogical infectious agents responsible for esophagitis?
- Candida albicans
- CMV (cytomegalovirus)
- HSV (herpes simplex virus)
- HIV
- VZV (varicilla zoster virus)
Esophagitis symptoms?
What demographic is most commonly affected?
- Symptoms
- dysphagia, odynophagia, heatburn, retrosternal discomfort or pain, nausea, vomiting, fever, sepsis, abdominal pain, epigastric pain, cough
- Epidemiology
- most common in immunosuppressed
- AIDS, Leukemia,Lymphoma, diabetes, alcoholism, motility disorders, patients undergoing ratiation and chemotherapy)
- rare in general population <5%
- most common in immunosuppressed
Patogenesis of esophagitis?
–with relation to the most common causes
- C. albicans - most common all patients
- HIV- low CD4- more liekly to get fungal
- HSV and CMV- AIDS & transplant patients
- CMV more common than HSV in AIDS patients
- Transplant
- HSV early
- CMV 2-6 months after transplant
How is esophagitis diagnosed?
- odynophagia is unique to infectious esophagitis
- Esophagogastroduodenoscopy (EGD)
- to see and biopsy the esphagus
- Candida albicans
- thrush
- plaques in esophagus, creamy white or pale yellow w/ underlying raw base
- stain & look for yeast
- HSV
- abrupt onset
- early lesions- small vesicles middle to distal esophagus
- later- ulcers with raised edge (volcano lesions
- Lok for Tzanck cells
- CMV
- onset of symptoms gradual
- only in immnocompromised hosts
- large solitary shallow ulcer or multiple discrete lesions at distal end esophagus
- culture
- HIV
- multple small thrush-lie lesions
- durign priamry HIV infection
- later on giand deep uncers
- fistula, perforation, hemorrhage or superinfections
- VZV
- usually has skin lesions consisten w/ chicken pox or shingles
Treatment esophagitis?
Prevention?
- Tratment
- Antifungal or antiviral agent depending on the cause of the infection
- Steriods to lower inflammation
- Prevention
- Don’t get immuno-suppressed if you don’t have to
What is the most common etilogical cause of chronic active gastritis and peptic ulcer disease?
What are the two kinds of peptic ulcer disease?
- Etiology
- Helicobacter pylori
- Peptic ulcer disease
- gastric ulcer disease
- duodenal ulcer disease
Symptoms of Chronic active gastritis?
- often asymptomatic
- moderate
- pain or discomfort in pit of stomach
- pain in left upper abdomen
- travels to back of belly
- burning, gnawing, sore, vague discomfort
- belching w/o relief, nausea, vomiting
- critically ill
- pale and sweaty
- may have tachycardia
- severe illness- bleeding from stomach, faint or feel like fainting
- vomit blood
- blood or dark sticky, foul smelling stools
Symptoms of peptic ulcer disease
- Gnawing or burign pain inepigastrium
- bleeding that may result in anemia, weakness, and fatigue
- hematemesis, melena or hematochezia
- gastric ulcers
- pain made worse by eating
- duodenal ulcers
- pain relieved by eating or antacids
Why does eating food increase pain caused by gastric ulcers but decrease pain caused by duodenal ulcers?
- Nerves respond to protons (exposed by ulcer)
- at lower pH, more protons, more pain stimulus
- In the stomach, when you are eating acid is being made,
- increasing pain
- However, the duodenum produced bicarbonate in response to eating (b/c it does not like low pH), so it increases the pH while you are eating
- decreasing pain
