GI infections Flashcards
What does inflammation do to albumin?
Inflammation drops albumin
What are differentials for watery diarrhoea?
- infectious diarrhoea: c.diff, salmonella, e.coli etc
2. non-infectious: antibiotic side effect, post-infectious IBS, IBD, microscopic colitis
What investigations should you do for watery diarrhoea?
Blood test, stool sample/culture, chest/abdo x-ray
What is management for c.diff if not severe?
- Isolate patient for infection control, stop antibiotic they are on, fluid management, nutrition.
- Antibiotic therapy with oral vancomycin or diaxomicin or metronidazole.
- Possible FMT.
What is management if severe c.diff disease or fulminant colitis?
Antibiotics, supportive care, close monitoring, early surgical consultation
what is a severe consequence of c.diff?
fulminant colitis
What is toxic megacolon?
Severe form of fulminant colitis with dilation of large bowel
What is first line treatment for toxic megacolon? What are indications for surgery?
Antibiotics + supportive. Fluid resucitation + inotropic support.
- Indications for surgery: colonic perforation, necrosis or full thickness ischemia, intra-abdominal hypertension or abdominal compartment syndrome, peritonitis, end-organ failure
What is pseudomembranous colitis? When does it usually occur? how is it confirmed?
- Occurs most often after c.diff
- severe colonic disease,
- yellow-white plaques that form pseudomembranes on mucosa.
- Confirmed on endoscopy + biopsy
What does 3 month history of diarrhoea with rectal bleeding, mucus, urgency, high WCC, CRP high, high platelets indicate?
IBD - inflammatory bowel disease
What molecule is a biomarker of active inflammation in IBD?
calprotectin
What is FIT?
- Fecal immunochemical test.
- Detects hidden blood in stool.
- Positive in IBD
Colonoscopy showing left sided inflammatory changes, chronic inflammation with no granulomas indicates what?
Ulcerative colitis
What is management for ulcerative colitis?
-Steroids, 5-ASA, immune suppressants (azathioprine, methotrexate), diet, FMT, antibiotics, probiotics, novel agents
What are different severities of ulcerative colitis?
- Mild: 4xBM/day, no systemic toxicity, normal ESR/CRP, mild symptoms.
- Moderate: >4xBM/day, mild anaemia, mild symptoms, minimal systemic toxicity, no weight loss/nutrition maintained.
- Severe: > 6xBM/day, severe symptoms and systemic toxicity, significant anaemia, increased ESR/CRP, weight loss
If ulcerative colitis flares up again what should you do?
-Repeat blood tests to see stage, manage with steroid for remission (start prednisolone) educate on side effects, immunomodulators eg. azathioprine
If flare up of UC after being put on immunomodulators again?
Rule out infection, consult, IV steroids x 3 days, start infilixab while continuing azathioprine.
What do aminosalicylates do?
Reduce inflammation in gut
What do immunosupressants like steroids/azathioprine do?
Reduce activity of immune system
What do biological therapies do?
Antibody based treatments given by injection targeting specific part of immune system
