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Yr 2 - Clinical Pathology > GI Infections > Flashcards

GI Infections Flashcards

1
Q

What are the main sterile sites of the body?

A
  • Peritoneal space (ascitic fluid)
  • Pancreas
  • Gall bladder
  • Liver
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2
Q

What are the main non-sterile sites of the body?

A
  • Mouth
  • Oesophagus
  • Stomach
  • Small bowel
  • Large bowel
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3
Q

Colonisation of body sites;

A
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4
Q

What is angular cheilitis?

A

Acute or chronic inflammation of the skin and contiguous labial mucosa at the corners of the mouth.

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5
Q

How does angular cheilitis typically present?

A
  • erythema
  • maceration
  • scaling
  • fissuring
  • pain
  • lesions are often bilateral
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6
Q

What are the 2 major causes of angular cheilitis? Which organisms can be responsible?

A
  1. Excessive moisture and maceration from saliva
  2. Secondary infection with C albicans or S aureus
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7
Q

Angular cheilitis can be 2ary to infection with which organisms?

A
  • S. aureus
  • C. albicans
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8
Q

What are the risk factors for angular cheilitis?

A
  • Older age (typically seen in eldery)
  • Dentures (ill-fitting)
  • Dry mouth
  • Intraoral fungal infection
  • Poor oral hygiene
  • Thumb sucking/drooling
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9
Q

How does HSV-1 present?

A

Cold sores

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10
Q

What is hairy leukoplakia? Who is it commonly seen in? What virus is it caused by?

A
  • What –> A white patch on the side of the tongue with a corrugated or hairy appearance
  • Who –> Immunocompromised (HIV)
  • Virus –> Epstein Barrv virus
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11
Q

What are the 3 major types of dentoalveolar infections?

A
  1. Caries (cavity)
  2. Pulpitis (infection of innermost part of tooth - the pulp)
  3. Periapical abscesses (abscess at base of tooth following infection)
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12
Q

How can a tooth infection cause;

a) demineralisation of bone?
b) swelling and pain?

A

a) Acid produced by bacteria is believed to erode the enamel and bone
b) Bacteria move within the tooth and cause inflammation within the pulp, resulting in swelling and acute pain

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13
Q

Common bacteria responsible for dentoalveolar infections?

A

Oral commensals such as Streptococci and anaerobes

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14
Q

Treatment for caries?

A

Filling

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15
Q

Treatment for pulpitis?

A

Root canal

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16
Q

What can excess buildup of plaque beneath the gingivial margin lead to?

A

Peri-dontal infections

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17
Q

What is the gingival margin?

A

The terminal edge of gingiva (gums) that surrounds the teeth is known as the gingival margin (marginal gingiva).

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18
Q

What is gingivitis? How does it present?

A

Inflammation of the gums; red, swollen, painful, bleeding gums

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19
Q

How can gigivitis progress?

A
  1. Gingivitis
  2. Peridontitis
  3. Periodontal abscess
  4. Acute necrotising ulcerative gingivitis
  5. Orofacial space infections (severe)!
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20
Q

What is periodonitis?

A

Progression of gingivitis with progressive loss of dental support structure function. May require antibiotics.

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21
Q

What is a periodontal abscess?

A
  • Focal or diffuse red, fluctuant swelling of the gingiva which is extremely tender to palpation
  • Abscesses always communicate with a periodontal pocket from which pus can be readily expressed after probing
  • Requires surgical drainage
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22
Q

What is Vincent angina? What is it caused from?

A

A life-threatening infection of the oral mucosal membranes is also known as trench mouth/acute necrotising ulcerative gingivitis (ANUG).

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23
Q

How does acute necrotising ulcerative gingivitis (ANUG) present?

A

Tissue appears eroded with superficial gray-ish pseudomembranes.

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24
Q

Risk factors and treatment for peri-dontal infections?

A
  • Risk factors include inadequate oral hygiene
  • Treatment includes improved cleaning, antibiotics
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25
Q

What is quinsy? What is it a complication of?

A
  • Quinsy is a peritonsillar abscess –> unilateral swellings of the tonsil.
    • The abscess forms between one of your tonsils and the wall of your throat.
  • A rare and potentially serious complication of tonsillitis.
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26
Q

Causative organism of peritonsillar abscess?

A

S. pyogenes (Group B Strep)

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27
Q

Symptoms of quinsy?

A
  • Painful swallowing
  • Unilateral sore throat
  • Earache
  • Muffled voice
  • Deviation of uvula towards unaffected side
  • Oral airway may be compromised!
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28
Q

Treatment of quinsy?

A

Drainage and antibiotic management

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29
Q

What is suppurative inflammation?

A

Suppurative inflammation involves the production of large amounts of pus

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30
Q

Causative organism of acute suppurative parotitis?

A

S. aureus

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31
Q

What is parotitis?

A

Inflammation of the parotid glands

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32
Q

Risk factors for acute suppurative parotitis (non mumps)?

A

Poor oral hygiene, dehydration

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33
Q

Presentation of acute suppurative parotitis?

A

Sudden onset of swelling from cheek to angle of jaw

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34
Q

Treatment of acute suppurative parotitis?

A

Drainage and antibiotic management

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35
Q

What is Ludwig’s angina?

A
  • Bilateral infection of the submandibular space
  • Aggressive, rapidly spreading cellulitis without lymphadenopathy
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36
Q

Complications of Ludwig’s angina?

A

Airway obstruction, asphyxia, aspiration pneumonia

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37
Q

What do pretracheal space infections most commonly arise as a consequence of?

A
  • Perforation of the anterior oesophageal wall
  • Occasionally through contiguous extension from a retropharyngeal space infection
  • As a consequence of prolonged tracheostomy
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38
Q

Clinical presentation of a pretracheal space infection?

A
  • severe dyspnoea
  • hoarseness
  • dysphagia
  • regurgitation of fluids from nose
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39
Q

Where does the pretracheal space lie?

A

Immediately anterior to the trachea

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40
Q

Treatment of a pretracheal space infection?

A

drainage and antibiotic management

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41
Q

Where is the prevertebral space located?

A

In the neck

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42
Q

Where does a prevertebral space infection usually originate from?

A

Usually continuation of cervical spine infection

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43
Q

Why can parapharyngeal space infections be life threatening?

A
  • Carotid sheath involvement
  • Complications: compression on carotid sheath components, airway impingement, septicaemia
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44
Q

What is suppurative jugular thrombophlebitis? What is it also known as?

A
  • Lemierre’s syndrome
  • A venous thrombosis due to the infectious involvement of the carotid sheath vessels with bacteria and is seen in association with intravenous catheters or with certain deep neck infections
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45
Q

What is the ‘danger space’?

A

The danger space is a deep compartment of the head and neck located behind the true retropharyngeal space, extending from the skull base to the mediastinum.

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46
Q

Clinical importance of the danger space?

A

The connection of the danger space to the mediastinum allows for the spread of infections from the oral cavity to the thoracic cavity.

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47
Q

What is mucositis?

A

Inflammation of the mucous membranes of the GI tract (can be oral or intestinal or both)

48
Q

What is mucositis most commonly induced by?

A

Chemotherapy

49
Q

Risk factors for mucositis? What is required before starting chemo?

A

Caries, periodontal diseases –> dental review before chemotherapy.

50
Q

What is Boerhaave syndrome/Effort rupture? What can it be caused by?

A

A spontaneous perforation of the oesophagus that results from a sudden increase in the intraoesophageal pressure combined with negative intrathoracic pressure e.g. severe straining or vomiting

51
Q

Potential complications of an effort rupture?

A
  • Contamination of the mediastinal cavity (leak of fluid into mediastinal space)
  • Chemical mediastinitis
  • Mediastinal emphysema and inflammation
  • Bacterial infection and mediastinal necrosis
52
Q

Risk factors for an effort rupture?

A
  • Common in alcoholics
  • History of severe retching and vomiting
53
Q

Diagnosis of an effort rupture?

A
  • Crepitus in chest (subcutaneous emphysema)
  • Mediastinal cracking (mediastinal emphysema)
54
Q

What is crepitus?

A

Crepitus is the abnormal popping or crackling sound in either a joint or the lungs

55
Q

Management for an effort rupture?

A
  • Avoid oral intake
  • Nutritional support – parenteral
  • Antibiotics
  • Intravenous PPI
  • Drainage of fluid collections/ de-bridgement of infected and necrotic tissue
56
Q

Mechanism behind H. pylori infection?

A
  • Bacterial urease hydrolyses gastric luminal urea to form ammonia
  • Gastric acid neutralised to form a protective cloud around the organism, enabling it to penetrate the gastric mucus layer
57
Q

Transmission of H. pylori?

A
  • Person-person via faecal/oral or oral/oral exposure
  • Primates and domestic cats
58
Q

Complications of H. pylori?

A
  • Peptic ulcer disease
  • Pain, bleeding, perforation
59
Q

Treatment of H. pylori?

A

Triple antibiotic treatment; 2x antibiotics and 1 PPI

60
Q

Diagnostic tests for H. pylori?

A
  • Urease breath test
  • Faecal antigen test (most effective)
  • Serology (IgG)
  • Culture and sensitivity
61
Q

What is cholangitis?

A

Cholangitis is an inflammation of the bile duct system

62
Q

Most common cause of cholangitis?

A

Enterobacteriacae infection secondary to:

  • Stone
  • Stenosis
  • Stents
  • Surgery
  • Cancer

ANYTHING THAT CAUSES OBSTRUCTION

63
Q

Triad of symptoms for cholangitis?

A

Charcot’s cholangitis triad is the combination of;

  1. jaundice
  2. fever (usually with rigors)
  3. right upper quadrant abdominal pain (RUQ pain)
64
Q

Investigations for cholangitis?

A
  • Liver test abnormalities with elevations in serum alkaline phosphatase (ALP)
  • gamma-glutamyl transpeptidase (GGT)
  • bilirubin (predominantly conjugated)
65
Q

What is cholecysitis?

A

Inflammation of the gallbladder

66
Q

What is Murphy’s sign?

A
  1. Ask the patient to take in and hold a deep breath while palpating the right subcostal area
  2. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.
67
Q

Symptoms of cholecystitis?

A
  • Abdominal pain
  • Fever
  • History of fatty food ingestion one hour or more before the initial onset of pain (as more bile is secreted after large or high fat meals)
68
Q

Investigations for cholecystitis?

A
  • Elevation in serum total bilirubin and ALP.
  • Positive Murphy’s sign.
  • Radiological, endoscopic, surgical
69
Q

Most common cause of cholecystitis?

A

Gallstones

70
Q

Associated symptoms of overgrowth of bacteria on small bowel?

A
  • Malabsorption
  • Chronic diarrhoea
71
Q

Causes of bacterial overgrowth on the small bowel?

A
  • Achlorhydria (after gastric surgery) –> absence of hydrochloric acid in the gastric secretion
  • Impaired motility
  • Blind loops of bowel
  • Surgery
  • Radiation damage
72
Q

Treatment for bacterial overgrowth in small bowel?

A
  • Dietary changes
  • Surgery
  • Motility
  • Non-absorbable antibiotics
73
Q

What is Whipple’s disease?

A

Infection causing white plaques in distal duodenum, representing engorged lymph;

  • A rare bacterial infection that most often affects your joints and digestive system
  • Interferes with normal digestion by impairing the breakdown of foods, and hampering your body’s ability to absorb nutrients, such as fats and carbohydrates
74
Q

Causative organism of Whipple’s disease?

A

Tropheryma whipplei

75
Q

Where is Tropheryma whipplei commonly detected?

A
  • Bacteria has been detected in the sewage
  • More prevalent in faeces of sewage workers
76
Q

Risk factors for Whipple’s disease?

A
  • Caucasian
  • Male
  • European
  • Hereditary: likely rare immune defect
77
Q

Symptoms of Whipple’s disease?

A
  • Joint pain
  • Chronic diarrhoea
  • Malabsorption
  • Weight loss
  • Abdominal pain
78
Q

Investigations for Whipple’s disease?

A

Upper GI endoscopy with biopsies of the small intestine

79
Q

Which organism are liver abscesses most commonly caused by?

A

Entamoeba histolytica (parasite)

80
Q

Entamoeba histolytica is a parasite that exists in two forms, what are these?

A
  1. Cyst
  2. Trophozite
81
Q

How is the cyst form of Entamoeba histolytica acquired?

A
  • Infective form
  • Ingested via contaminated food or water but can be associated with venereal transmission through faecal-oral contact
82
Q

What is the invasive disease causing form of Entamoeba histolytica?

A

Trophozoite form

83
Q

Where are high rates of Entamoeba histolytica seen?

A
  • India, Africa, Mexico and parts of Central/South America
  • Common in travellers for more than 4 days, but more commonly if people are travelling for months
84
Q

Pathogenesis behind liver abscess?

A
  1. Ascending biliary tract infection (coliforms, streptococci, anaerobes)
  2. Portal vein after peritonitis or colonic perforation
  3. Haematogenous e.g. endocarditis
85
Q

Which organisms are responsible for ascending biliary infection causing liver abscess?

A

Coliforms, Streptococci, anaerobes

86
Q

Which organisms are responsible for haematogenous spread from endocarditis causing liver abscess?

A

S. aureus

87
Q

Investigations for liver abscess?

A
  • Serum alkaline phosphatase is elevated in 67 to 90 percent of cases and serum bilirubin
  • Aspartate aminotransferase concentrations are elevated in about one-half of cases
88
Q

What is a hydatid cyst? Causative organism?

A
  • The hydatid cyst develops in the liver, lungs, brain, or other organ.
  • Parasite –> Echinococcus tapeworm
89
Q

Transmission of hydatid cysts?

A
  • Zootrophic infection: usually confined to dogs and cattle/sheep
  • Transmission
    • Ingestion of dog faeces
90
Q

How can M. tuberculosis affect the GI tract?

A
  • Non healing oral ulcers
  • Gastric ulcers
  • Gastric outflow obstruction
  • Enterocutaneous fistulas
91
Q

Most common site of GI tract that M. tuberculosis affects? What can this be confused with?

A

Ileo-caecal TB is the most common site (may be confused with a colonic malignancy)

92
Q

Risk factors for M. tuberculosis to affect the GI tract?

A
  • Respiratory TB and aspiration
  • Chemotherapy
93
Q

Potential complications of pancreatitis?

A
  • Necrotising pancreatitis (15%)
  • Peripancreatic fluid collection
  • Pancreatic pseudocyst
  • Acute necrotic collection
  • Walled-off necrosis
94
Q

What is a complicated intra-abdominal infection?

A

Defined as infection that extends beyond the hollow viscus of origin into the peritoneal space and is associated with either abscess formation or peritonitis.

95
Q

What does complicated intra-abdominal infection commonly follow?

A

Perforation of;

  • Cholecystitis
  • Diverticulitis
  • Appendicitis
  • Gastric/duodenal ulcer
96
Q

Other causes of complicated intra-abdominal infection;

A
  • Colonic perforation after C diff infection
  • Ischaemic colon or malignancy with perforation of bowel
  • Colonic fistula communicating with peritoneal space
  • Abscess in solid organ communicating with the peritoneal space e.g. liver abscess
97
Q

What is diverticulitis?

A

The infection of diverticula (abnormal out-pouches in the colon)

98
Q

What is the most common cause of left iliac fossa pain in hospital admissions (33%)?

A

Diverticulitis

99
Q

Complicated vs uncomplicated diverticulitis?

A

Uncomplicated diverticulitis is defined as localised diverticular inflammation without complication, whereas complicated diverticulitis consists of inflammation associated with a complication such as abscess, fistula, obstruction, bleeding, or perforation.

100
Q

What is an intra-peritoneal abscess?

A

Localised area of peritonitis with build-up of pus.

Locations;

  • Sub-phrenic
  • Sub-hepatic
  • Para-colic
  • Pelvic
101
Q

Predisposing factors for intra-peritoneal abscesses?

A
  • Perforation (of peptic ulcer, appendix, diverticulum)
  • Mesenteric ischaemia/bowel infarction
  • Pancreatitis/pancreatic necrosis
  • Penetrating trauma
  • Post-operative anastomotic leak
102
Q

Treatment of Intra-peritoneal abscess?

A
  • CT/US guided drainage or surgical
  • Combined with antimicrobial therapy
103
Q

Symptoms of intra-peritoneal abscess?

A
  • Non-specific
  • Sweating, anorexia, wasting
  • Swinging pyrexia
  • Localising features e.g. subphrenic abscess will result in pain in shoulder on affected side, persistent hiccup, intercostal tenderness, apparent hepatomegaly (liver displaced downwards, ipsilateral lung collapse with pleural effusion)
  • Pelvis abscess: urinary frequency, tenesmus
104
Q

Management of complicated vs uncomplicated appendicitis?

A
  • Complicated: surgical management + antibiotics
  • Uncomplicated: surgical management plus single dose of antibiotic prophylaxis.
105
Q

What are the 3 types of post-operative infections?

A
  1. SSI-S: Superficial Surgical Site Infection
  2. SSI-D: Deep Surgical Site Infection
  3. SSI-O: Organ space infection
106
Q

When do post-operative infections occur?

A
  • Occurs within 30 days of surgery
  • Occurs within 1 year of prosthetic implantation
107
Q

What is spontaneous bacterial peritonitis?

A

Ascitic fluid infection without an evident intra-abdominal surgically treatable source.

108
Q

Diagnosis of a spontaneous bacterial peritonitis?

A
  • Positive ascitic fluid bacterial culture
  • Elevated ascitic fluid absolute polymorphonuclear leukocyte (PMN) > 250 cells/mm3
109
Q

Pathogenesis of spontaneous bacterial peritonitis?

A
  1. Bacteria in gut lumen cross the intestinal wall into mesenteric lymph nodes –> translocation
  2. Lymphatics carrying contaminated lymph rupture because of the high flow and high pressure associated with portal hypertension
  3. Seeding of ascitic fluid via the blood
110
Q

Complications of spontaneous bacterial peritonitis?

A
  • Advanced cirrhosis
  • Ascites
111
Q

Which organism is associated with colonic malignancy?

A

Streptococcus bovi/ gallolyticus (causing bacteraemia with bowel cancer)

112
Q

What else can S. bovis be associated with?

A

Endocarditis

113
Q

What does a positive Murphy’s sign indicate?

A

Acute cholecystitis

114
Q

What is a root canal treatment?

A

Root canal treatment (endodontics) is a dental procedure used to treat infection at the centre of a tooth (pulpitis)

115
Q

Parapharyngeal infections can spread to the ___ and cause ___?

A

Carotid sheath; can cause septic thrombophlebitis (Lemierre syndrome)

116
Q

Where is pain from the subphrenic region referred to?

A

Shoulder on the affected side

Yr 2 - Clinical Pathology (80 decks)

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