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Gastrointestinal OI Flashcards

1
Q

Which organism is the most common cause of oropharyngeal infection and oesophagitis?

A

Candida sp

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2
Q

What symptoms should prompt suspicion of oesophagitis?

A 
PAIN on swallowing
\+/-
reflux
or
dysphagia
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3
Q

What viral infections are causes of HIV-related oesophagitis?

A

HSV

CMV

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4
Q

What mycobacterium can present with oropharyngeal or oesophageal disease?

A

TB

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5
Q

Where does ulceration occur caused by primary syphilis?

A

ORAL
GENITAL
PERIANAL

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6
Q

What MEDICATIONS are common causes for OESOPHAGITIS?

A

DOXYCYCLINE
NSAIDS
POTASSIUM supplements
IRON tablets

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7
Q

When is ENDOSCOPY indicated in OESOPHAGITIS?

A

FAILED empirical treatment for candidiasis

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8
Q

What is the FIRST line treatment for CMV oesophagitis?

A

Intravenous GANCICLOVIR 5mg/kg
TWICE daily
2-4 weeks
until symptoms RESOLVED

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9
Q

When is it appropriate to use ORAL valganciclovir as TREATMENT for CMV oesophagitis?

A

if symptoms not SEVERE enough to interfere with SWALLOW or ABSORPTION

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10
Q

What ORAL treatment can be given for CMV oesophagitis?

A

VALGANCICLOVIR 900MG

TWICE daily

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11
Q

When is MAINTENANCE therapy for CMV disease indicated?

A

if OPHTHALMIC disease

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12
Q

What is the FIRST line treatment for HSV oesophagitis?

A 
Intravenous ACICLOVIR 5-10mg/kg
THREE times daily
then 
ORAL valaciclovir or famciclovir
14 days
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13
Q

What is the REGIMEN of oral valaciclovir following IV acyclovir for HSV oesophagitis?

A

VALACICLOVIR 1gram

TWICE daily

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14
Q

What is the alternative REGIMEN of oral famciclovir following IV acyclovir for HSV oesophagitis?

A

FAMCICLOVIR 500mg

THREE times daily

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15
Q

What is the duration of treatment in total (IV+oral) for HSV oesophagitis?

A

FOURTEEN (14) days

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16
Q

What alternative antiviral can be used for ganciclovir-RESISTANT CMV?

A

Intravenous FOSCARNET 90mg/kg

TWICE daily

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17
Q

What is the REGIMEN for FOSCARNET for ganciclovir-RESISTANT CMV?

A

Intravenous FOSCARNET 90mg/kg

TWICE daily

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18
Q

What alternative antiviral can be used for aciclovir-RESISTANT HSV?

A

Intravenous FOSCARNET 40mg/kg

TWICE or THREE times daily

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19
Q

What is the REGIMEN for FOSCARNET for aciclovir-RESISTANT HSV?

A

Intravenous FOSCARNET 40mg/kg

TWICE or THREE times daily

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20
Q

What is an alternative antiviral for both CMV or HSV disease if intolerance or resistance to acyclovir, ganciclovir or foscarnet?

A

CIDOFOVIR 5mg/kg
once WEEKLY
2 weeks

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21
Q

In addition to herpes antivirals what else is indicated as part of treatment for people with HIV?

A

ART

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22
Q

What is the prevalence of DIARRHOEA in PLW HIV on ART?

A

18%

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23
Q

What is the definition of DIARRHOEA?

A

more than TWO bowel movements per day

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24
Q

What is the definition of ACUTE diarrhoea?

A

LESS than FOUR weeks

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25
Q

What is the definition of CHRONIC diarrhoea?

A

MORE than FOUR weeks

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26
Q

In PLW HIV what is chronic diarrhoea more likely to be associated with?

A

OPPORTUNISTIC infection

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27
Q

What are the major BACTERIAL causes of HIV-related DIARRHOEA?

A 
CAMPYLOBACTER
C DIFFICILE
ECOLI
SALMONELLA
SHIGELLA
TB
NON-TB MYCOBACTERIUM (MAC or KANSAII)
CHLAMYDIA/LGV
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28
Q

What are the MYCOBACTERIAL causes of HIV-related DIARRHOEA?

A

TB
MYCOBACTERIUM AVIAN-INTRACELLULARE COMPLEX
MYCOBACTERIUM KANSAII

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29
Q

What are the major PARASITE/FUNGAL causes of HIV-related DIARRHOEA?

A 
CRYPTOSPORIDIUM
CYCLOSPORA
GIARDIA
ENTAMOEBA
CYSTOISOSPORA
MICROSPORIDIA
STRONGYLOIDES
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30
Q

What are the major VIRAL causes of HIV-related DIARRHOEA?

A 
CMV
HSV
ROTAVIRUS
NOROVIRUS
ADENOVIRUS
ASTROVIRUS
CORONAVIRUS
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31
Q

What are the major NON-INFECTIOUS causes of HIV-related DIARRHOEA?

A

ART
KAPOSI SARCOMA
LYMPHOMA
PANCREATIC EXOCRINE INSUFFICIENCY

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32
Q

In what specific risk group is SHIGELLA more common?

A

HIV positive MSM vs HIV negative

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33
Q

What clinical syndromes is diarrhoea associated with due to LGV?

A

PROCTOCOLITIS

ENTERITIS

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34
Q

What factors increase the likelihood of diarrhoea in PLW HIV?

A

OLDER age
LOW CD4
Travel to LOW/MIDDLE INCOME countries

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35
Q

What are risk factors for C DIFFICILE in PLW HIV?

A

HOSPITALISATION
GASTRIC ACID SUPPRESSION
LOW CD4
ANTIBIOTIC USE

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36
Q

What other clinical features may be present with BACTERIAL GASTROENTERITIS?

A

BLOODY diarrhoea
Abdominal PAIN
FEVER
SEPSIS

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37
Q

What impact does HIV have on the risk of BACTERAEMIA secondary to gastroenteritis?

A

INCREASED but LOW overall

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38
Q

Which symptoms are most common presentation of LGV in PLW HIV?

A

TENESMUS
CONSTIPATION
DIARRHOEA
ANAL DISCHARGE

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39
Q

What investigations are required for BACTERIAL diarrhoea?

A 
STOOL culture
BLOOD culture
\+/-
COLONOSCOPY 
\+/- 
BIOPSY
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40
Q

What is the TREATMENT for ACUTE bacterial DIARRHOEA?

A

No treatment if CD4 >200

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41
Q

At what CD4 count is treatment indicated for ACUTE bacterial DIARRHOEA?

A

CD4 <200

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42
Q

What ANTIMICROBIAL is indicated in treatment of CAMPYLOBACTER?

A

AZITHROMYCIN

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43
Q

What ANTIMICROBIAL is indicated in treatment of C DIFFICILE?

A

Mild - METRONIDAZOLE
Severe - VANCOMYCIN
or
FIDAXOMICIN

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44
Q

What ANTIMICROBIAL is indicated in treatment of SALMONELLA?

A

CIPROFLOXACIN
or
CEFTRIAXONE

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45
Q

What ANTIMICROBIAL is indicated in treatment of SHIGELLA?

A

CIPROFLOXACIN
or
AZITHROMYCIN

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46
Q

What ANTIMICROBIAL is indicated in treatment of CHLAMYDIA LGV?

A

DOXYCYCLINE

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47
Q

Which organisms are developing CIPROFLOXACIN-RESISTANCE?

A

CAMPYLOBACTER
SALMONELLA
SHIGELLA

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48
Q

Is antimicrobial therapy indicated in prevention of bacterial diarrhoea in PLW HIV?

A

No

ART only

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49
Q

At what stage of life can PRIMARY CMV infection occur?

A

Any stage

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50
Q

When does CMV disease occur?

A

when REACTIVATED in the IMMUNOCOMPROMISED host

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51
Q

What is the most common pathogen causing VIRAL enteritis in PLW HIV?

52
Q

What is the risk factor for developing CMV disease in PLW HIV?

53
Q

Which part of the GI tract is most commonly affected by CMV in PLW HIV?

A

OESOPHAGUS
or
COLON

54
Q

What are the complications of CMV colitis?

A 
WEIGHT LOSS
ANOREXIA
ABDOMINAL PAIN
CHRONIC DIARRHOEA
FATIGUE
55
Q

What systemic symptoms or signs may be present in CMV colitis?

A

FEVER

CYTOPENIAS

56
Q

What are the SERIOUS complications of CMV colitis?

A

TOXIC DILATATION of COLON
HAEMORRHAGE
PERFORATION

57
Q

What other system should be checked for CMV disease if there is CMV colitis?

A

EYES for RETINITIS

58
Q

If CMV retinitis is identified how does this impact on HIV and CMV treatment?

A

start CMV treatment FIRST

delay ART until 2 weeks

59
Q

Why is ART start delayed in context of CMV retinitis?

A

to reduce risk of IRIS

60
Q

Is a delay in ART start recommended in treatment of CMV colitis?

A

NO

unless eye disease also

61
Q

If a person with CMV colitis and HIV viral load does not fall appropriately after ART start what should be measured?

A

Therapeutic DRUG MONITORING

incase of malabsorption

62
Q

What are the characteristic features on histopathology of CMV disease?

A

‘Owls eyes’ INCLUSIONS

positive IMMUNOHISTOCHEMICAL stain for CMV

63
Q

In addition to histopathology what other investigations are useful to diagnose CMV?

A

characteristic mucosal ULCERATION

CMV VIRAEMIA

64
Q

Is CMV antibody a useful diagnostic test?

A

NO

but if negative makes CMV disease unlikely

65
Q

In addition to investigation for CMV what other tests are indicated for investigation of viral gastroenteritis?

A

VIRAL PCR of STOOL

66
Q

What VIRUSES is treatment indicated for GI disease?

A

CMV
HSV
ADENOVIRUS (if clinically significant)

67
Q

Which antiviral is used in clinically significant ADENOVIRUS GI disease?

68
Q

Why is ganciclovir preferred over foscarnet for CMV disease?

A

less side effects

69
Q

What is the MAINTENANCE regimen for CMV retinitis after induction?

A

VALGANCICLOVIR 900MG

ONCE daily

70
Q

When can PROPHYLACTIC antiviral therapy for CMV retinitis be stopped?

A

evidence of IMMUNE RECONSTITUTION ART 6 months

CD4 >100

71
Q

What are the THREE potential reasons for failed treatment of CMV GI disease?

A

lack of IMMUNE RECONSTITUTION
poor ABSORPTION
antiviral RESISTANCE

72
Q

What are the risk factors for antiviral RESISTANCE in CMV disease?

A

Prolonged CMV treatment >6 weeks

HIGH initial CMV viral load

73
Q

Mutations in which gene confer CMV resistance to GANCICLOVIR?

74
Q

Mutations in which gene confer CMV resistance to FOSCARNET?

75
Q

Which NEW antiviral has potential role in CMV infection in haematopoietic cell or solid organ transplant?

76
Q

Which NEW antiviral has potential role in CMV PROPHYLAXIS after transplant?

A

LETERMOVIR

77
Q

What specific features of diarrhoea are typical of a viral cause?

A

NON-BLOODY

WATERY

78
Q

What is supportive treatment indicated for viral diarrhoea?

79
Q

What investigations are indicated for diarrhoea caused by parasites?

A

STOOL MICROSCOPY, culture and PCR

80
Q

How is CRYPTOSPORIDIUM infection acquired?

A

INGESTION of contaminated WATER by human or animal FAECES
or
Sexual - FAECO-ORAL route

81
Q

Which part of the GI tract does CRYPTOSPORIDIUM predominantly affect?

A

SMALL BOWEL mucosa

82
Q

What clinical features may be present in CRYPTOSPORIDIUM GI disease?

A

PROFUSE, watery, non-bloody diarrhoea
Fever
Nause +/- vomiting
LOWER abdominal pain

83
Q

What other organ complications can occur due to CRYPTOSPORIDIUM GI disease?

A

CHOLANGITIS

PANCREATITIS

84
Q

Through what mechanism does cryptosporidium cause cholangitis or pancreatitis?

A

EPITHELIA of both pancreatic DUCT and biliary TRACT infected (communicating with small bowel)

85
Q

What are the features of SCLEROSING CHOLANGITIS associated with CRYPTOSPORIDIUM?

A

Right upper quadrant PAIN
vomiting
raised ALP

86
Q

What other organ disease has been associated with cryptosporidium in PLW HIV and advanced disease?

A

PULMONARY CRYPTOSPORIDIOSIS

87
Q

Why are more than one stool sample required for cryptosporidium?

A

INTERMITTENT oocyst secretion

88
Q

What stain is used in microscopy for cryptosporidium?

A

AURAMINE
or
ZIEHL-NEELSEN

89
Q

What is the TREATMENT for CRYPTOSPORIDIUM?

90
Q

What is SUPPORTIVE treatment for CRYPTOSPORIDIUM?

A

HYDRATION
ELECTROLYTE replacement
ANTI-MOTILITY drugs
DIETICIAN

91
Q

What methods can be used to ensure safe drinking water to avoid CRYPTOSPORIDIUM?

A

FILTER (absolute 1-um)
BOIL
(chlorination does not work)

92
Q

How is MICROSPORIDIA infection acquired?

A

contaminated WATER
or
contact with infected FAECES or URINE

93
Q

What groups of people gets clinical disease with MICROSPORIDIA?

A

IMMUNOSUPPRESSED

94
Q

At what CD4 count does clinical disease with MICROSPORIDIA occur?

A

<100 cells

95
Q

What STAIN is required to identify MICROSPORIDIA on microscopy?

A

CHROMOTROPE
&
CHEMOFLUORESCENT

96
Q

What is the TREATMENT for MICROSPORIDIA?

97
Q

ENCEPHALITOZOON INTESTINALIS is a microsporidia for which specific treatment is indicated - what is it?

A

ALBENDAZOLE 400mg
TWICE daily
21 days

98
Q

What are the CLINICAL features of GIARDIA?

A 
NAUSEA
BLOATING
CRAMP-LIKE abdominal pain
INDIGESTION
BELCHING
chronic DIARRHOEA
99
Q

What is the TREATMENT for GIARDIA?

A 
METRONIDAZOLE 400mg 
THREE times daily
7 days
or
1gram ONCE daily
3 days
100
Q

Other than metronidazole what is an alternative treatment for giardiasis?

A 
TINIDAZOLE 500mg 
TWICE daily
7 days
or
2gram
SINGLE dose
101
Q

If a person is re-infected by GIARDIA what should be considered?

A

TEST house hold or sexual CONTACTS

102
Q

How is ENTAMOEBA infection acquired?

A

INGESTION of CYSTS in contaminated human faeces

103
Q

How does ENTAMOEBA cause GI disease?

A

TROPHOZOITE (active stage of life cycle) adheres to colonic EPITHELIAL cells
INVADES through mucosa into SUBMUCOSAL tissue causing COLITIS

104
Q

What complication can occur with ENTAMOEBA infection?

A 
HAEMATOGENOUS spread
extra-intestinal disease
liver ABSCESS (& other sites)
105
Q

Which is the most common site for extra-intestinal disease from entamoeba?

A

LIVER abscess

106
Q

What proportion of people with entamoeba infection develop clinical DISEASE?

107
Q

Within what time frame will people develop clinical disease from point of entamoeba infection?

A

within ONE year

108
Q

What is the typical presentation of liver ABSCESS from entamoeba infection?

A

FEVER
RIGHT UPPER QUADRANT PAIN
TENDERNESS

109
Q

What is the gold standard investigation for ENTAMOEBA?

110
Q

What is the REGIMEN of choice for AMOEBIC COLITIS or liver ABSCESS?

A

METRONIDAZOLE 800mg
THREE times daily
5-10 days
followed by PAROMYCIN

111
Q

Why is PAROMYCIN indicated after treatment for ENTAMOEBA?

A

to clear CYSTS from gut

112
Q

What treatment is indicated for CYCLOSPORIASIS and CYSTOISOSPORIASIS?

A

CO-TRIMOXAZOLE

113
Q

What is STRONGYLOIDES?

A

gut NEMATODE

114
Q

What is the implication of STRONGYLOIDES infection in IMMUNOCOMPROMISED people?

A

LIFE-THREATENING hyper infection syndrome

115
Q

What commonly used drug may induce a STRONGYLOIDES hyper infection syndrome?

A

CORTICOSTEROID

116
Q

What is abnormal in a full blood count in STRONGYLOIDES infection?

A

EOSINOPHILIA

117
Q

How is STRONGYLOIDES diagnosed?

A

Stool culture identifies LARVAE

118
Q

What is the FIRST line treatment of STRONGYLOIDES?

A

IVERMECTIN 200microgram/kg
DAILY
TWO days

119
Q

Following treatment for STRONGYLOIDES what investigation must be done to check for cleared infection?

A

repeat STOOL CULTURE

120
Q

What is SCHISTOSOMIASIS caused by?

A

Parasitic BLOOD FLUKE

121
Q

How is SCHISTOSOMIASIS investigated?

A

examination of FAECES and URINE

122
Q

What is the treatment for SCHISTOSOMIASIS?

A

PRAZIQUANTEL

123
Q

Which FUNGAL infections have been reported RARELY in LOWER GI tract disease?

A 
candidiasis
histoplasmosis
cryptococcosis
aspergillosis
paracoccidioidomycosis
pneumocystis
talaromycosis
124
Q

What type of organism is CRYPTOSPORIDIUM?

A

protozoan parasite

125
Q

Treatment for entamoeba or giardia?

A

metronidazole

DipHIV (14 decks)

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