GI: GI, Dental, Eye

Question 1

Diverticulitis / Diverticular disease

Answer 1

related digestive conditions that affect the large intestine

small bulges or pockets that can develop in the lining of intestine as people age - usually asymptomatic, called diverticulosis

Question 2

What are the causing symptoms of diverticulitis?

Answer 2

Pain in abdomen and becomes diverticular disease

Question 3

What does treatment of diverticulitis cover?

Answer 3

dietary manipulation, symptomatic medication and progress further to e.g. surgery

Question 4

Acute diverticulitis

Answer 4

if becomes inflammed and infcted symptoms incl;
constant, more severe abdominal pain
pyrexia
diarrhoea or constipation
mucus or blood in stools or somethimes rectal bleeding

Question 5

When to refer?

Answer 5

arrange same-day hospital assessment in IF PERSON;
uncontrollable abdominal pain

dehydrated to take or tolerate oral fluids at home

unable or at risk of dehydration is unable to take tolerate oral fluids at home

unable to take or tolerate oral antibiotics if needed at home

aged over 65 yrs

significant comorbidity or immunosuppression

Question 6

When to offer antibiotic if person with acute divertucullitis?

Answer 6

systemically unwell - and does not meet the criteria for suspected complicated acute diverticulitis

Question 7

What to prescribe if treating with oral antibiotic?

Answer 7

prescribe co-amoxiclav 500/126 mg tds for 5 days

pen allergic;
cefalexin 500mg bd pr tds for 5 days (up to 1-1.5g a day, or qds) + metronidazole or trimethoprim + metronidazole 400mg tds daily for 5 days

Question 8

Gastroenteritis

Answer 8

transiet disorder due to enteric infection with viruses, bacteria or parasites

sudden onset diarrhoea, faecal urgency, bloods/mucus in stools

nausea/sudden onset vomiting
fever or general malaise

abdominal pain/cramping

can be addovciated with; headache, myalgia, bloating, weight loss

Question 9

Gastroenteritis – key questions to ask

Answer 9

Symptoms (as above)
Onset, frequency, severity
Risk factors for dehydration – reduced fluid intake, reduced urine output
Recent food intake
Recent exposure to contaminated water
Recent foreign travel
Contact with other suspected cases
Recent antibiotic/PPI use

Occupation

Question 10

Gastroenteritis causes

Answer 10

Transmission of gastrointestinal infection from person-to-person may occur through one or more of a variety of different pathways, including faecal-oral, foodborne, environmental, and airborne routes

Most often self-limiting in a day or so and caused by a virus
However, can be bacterial or parasitic

Question 10

Bacterial causes - Gastroenteritis

Answer 10

• Campylobacter
• E.coli
• Salmonella
• shigella (resolves in 5-7 days)
• c. difficile (10 day course of antibiotics)

Question 10

Parasites

Answer 10

Cryptosporidiosis = transmitted by animal-to-human or human-to-human contact, by occupational or recreational exposure to contaminated land or water, or by consuming contaminated water or food
lasts for 1-2 weeks

Giardiasis = can be transmitted by person-to-person spread by the faecal-oral route; by contact with the faeces of infected animals; by consumption of contaminated food or drink; waterborne including swimming in contaminated water; or by sexual transmission, particularly among men who have sex with men

Question 10

Stop the DAMN drugs (where appropriate):

Answer 10

if vomiting or diarrhoea for more that a day

Diruretics
ACEi/ARB
Metformin (and other antidiabetics e.g. SGLT2i, gliclazide)
NSAIDs

Question 11

Treatments - Gastroenteritis

Answer 11

Oral re-hydration therapy, e.g. Dioralyte
first-line therapy even when referring

under 1 yr - 50ml
1-5 yrs - 100ml
6-12 yrs - 200ml
adult - 400ml

Antimotility drugs not routinely recommended and contraindicated if:
blood/pus/mucous present in stools
high fever
confirmed infection with Shigella or certain E.coli strains

Question 11

Antibiotics not routinely recommended but may be recommended in certain severe cases of confirmed bacterial infection

Answer 11

Campylobacter: clarithromycin 250–500 mg twice daily for 5–7 days, within 3 days of onset of illness
E. coli: no effective antibiotic treatment available for Shiga toxin-producing E. coli (STEC) infection
Salmonella: antibiotic treatment is not usually needed
Shigella: specialist advice needed
C. difficile: depends on infection, but vancomycin most common
Cryptosporidiosis: no specific treatment licensed in the UK
Giardiasis: tinidazole 2g as a single dose

Question 12

Red flags for ophthalmology referral

Answer 12

Reduced visual acuity.
Marked eye pain, headache or photophobia.
Red sticky eye in a neonate (within 30 days of birth).
History of trauma (mechanical, chemical or ultraviolet) or possible foreign body.
Copious rapidly progressive discharge — may indicate gonococcal infection.
Infection with a herpes virus.
Soft contact lens use with corneal symptoms (such as photophobia and watering).

Question 13

copnjunctivitis

Answer 13

symptoms =
red eye, discharge which may cause sticky coating on eyelid
blurning sensation and feeling a grif in eye

treatment = chloramphenicol 0.5% eye drops

chlopramphenicol 1% eye ointement

Question 14

Styes (hordeola)

Answer 14

acute onset - painful, localized swelling, near eyelid margin that sevelops over several days

usually unilateral

external; iusually aropund an eyelash follicle

internal; swelling tender and localised on eyelid, point outwards or inwards

Question 15

Antibiotic treatment not indicated unless:
accompanying conjunctivitis warrants it
large internal stye not clearing

Answer 15

apply warn compress, using a clean flannel that has been rinsed with hot water > closer eyelid of the affected eye for 5-10mins 2-4 times a day until stye drains or resolves

advice to NOT attempt puncture stye

avoid eye makeup of contact lenses until healed

Question 16

Blepharitis

Answer 16

Burning, itching and/or crusting of the eyelids
Symptoms are worse in the mornings
Both eyes are affected
Recurrent hordeolum
Contact lens intolerance

Question 17

What is the Treatment
for Blepharitis?

Answer 17

Education: this is a chronic, intermittent condition which requires ongoing maintenance treatment — cure is generally not possible

Symptomatic treatment: twice daily gentle cleaning with warm water (+/- 1:10 dilution baby shampoo), warm compress, avoid mascara and eye make-up

Antibiotic: for anterior blepharitis, consider topical antibiotic (such as chloramphenicol) to be rubbed into the lid margin

Question 18

Dental abscess

Answer 18

Pain – often sudden-onset over a day or two, throbbing, interfering with sleep, tooth/gum tender to touch
Unpleasant taste
Fever and malaise
Trismus in severe cases

Question 19

What is the treatment for dental abscess?

Answer 19

Emergency if airway compromised, spreading infection, significant swelling making it difficult to open the eye

Otherwise refer to dentist
analgesia
often: amoxicillin, clarithromycin, metronidazole, phenoxymethylpenicillin