GI Disorders and Infection

Question 1

What could be causes of infectious diarrhoea?

Answer 1

• Clostridium difficile
• Klebsiella oxytoca
• Clostridium perfringens
• Salmonella spp

Question 2

What could be causes of non-infectious diarrhoea?

Answer 2

• Antibiotics side effect
• Post-infectious irritable bowel syndrome
• Inflammatory bowel disease
• Microscopic colitis
• Ischaemic colitis
• Coeliac disease

Question 3

What is the management of C difficle?

Answer 3

•Infection control
-The patient is moved into a side room
•Discontinue inciting antibiotic agents
-Co-amoxiclav is stopped
•Management of fluids, nutrition & diarrhoea

Question 4

When is management for severity?

Answer 4

• Non-severe infection
• WCC<15, Creat <150
• Severe infection
• WCC>15, Creat >150
• Fulminant colitis
• Hypotension or shock, ileus, toxic megacolon

Question 5

What is the treatment for c difficle in non-severe disease?

Answer 5

• Antibiotic therapy with oral vancomycin or fidaxomicin or metronidazole
• Role of Faecal Microbiota Transplantation (FMT)

Question 6

What is the treatment for c difficle in severe disease or fulminant colitis ?

Answer 6

• Antibiotic therapy, supportive care and close monitoring

* Early surgical consultation

Question 7

What are the indications for surgery?

Answer 7

1. Colonic perforation
2. Necrosis or full-thickness ischaemia
3. Intra-abdominal hypertension or abdominal compartment syndrome
4. Clinical signs of peritonitis or worsening abdominal exam despite adequate medical therapy
5. End-organ failure

Question 8

When might there be Pseudomembranous colitis?

Answer 8

• Most often associated with C. difficile infection
• Manifestation of severe colonic disease
• Characteristic yellow-white plaques that form pseudomembranes on the mucosa
• Confirmed on endoscopy +/- biopsy

Question 9

What are the management options for UC?

Answer 9

• Steroids
• 5 ASA
• Immune suppressants
• Azathioprine
• Methotreaxate
• Biologic therapy
• Others –diet, FMT, antibiotics, probiotics, novel agents

Question 10

What is mild UC?

Answer 10

•4 x BMs/day, no systemic toxicity, normal ESR/CRP, mild symptoms.

Question 11

What is moderate UC?

Answer 11

•> 4x BMs/day, mild anaemia, mild symptoms, minimal systemic toxicity, nutrition maintained and no weight loss.

Question 12

What is severe UC?

Answer 12

•> 6 BMs/day, severe symptoms, systemic toxicity, significant anaemia, increased ESR/CRP and weight loss.