Gi Infections

Question 1

Pt presenting with watery diarrhoea and mild abdominal pain post op showing signs of infections dry mucosa and on co amoxiclav differentials?

Answer 1

Infections causes; Klebsiella oxytoca
Clostridium perfringens
Salmonella spp,clostridium difficile

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

Question 2

What would you do for p1

Answer 2

Stool sample for c diff
Stool culture
Imaging axr

Question 3

Management of c diff

Answer 3

Infection control
The patient is moved into a side room

Discontinue inciting antibiotic agents
Co-amoxiclav is stopped give metronidazole’s and vancomycin

Management of fluids, nutrition & diarrhoea

Management
Severity of C. Diff. Infection:

Non-severe infection
WCC<15, Creat <150

Severe infection
WCC>15, Creat >150

Fulminant colitis
Hypotension or shock, ileus, toxic megacolon

Question 4

What’s the treatment for non severe disease of c diff and severe

Answer 4

Non severe disease
Antibiotic therapy with oral vancomycin or fidaxomicin or metronidazole
Role of Faecal Microbiota Transplantation (FMT)
Severe disease or fulminant colitis
Antibiotic therapy, supportive care and close monitoring
Early surgical consultation

Question 5

Fulminant colitis with toxic megacolon

Answer 5

Inflammation of the colon which has worsened and becomes servely dilated

First like treatment with antibiotics and supportive management

Question 6

Indications for surgery

Answer 6

Indications for surgery
Colonic perforation

Necrosis or full-thickness ischaemia

Intra-abdominal hypertension or abdominal compartment syndrome

Clinical signs of peritonitis or worsening abdominal examination despite adequate medical therapy

End-organ failure

Question 7

Pseudomembranous colitis

Answer 7

Pseudomembranous colitis
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 8

Pt history of 3 months diarrhea with rectal bleeding and mucous bloods show high wcc and crp

Answer 8

Infectious diarrhoea
Clostridium difficile
Shigella
E. Coli
Salmonella spp
Non-infectious diarrhoea
Inflammatory bowel disease
Haemorrhoids
Post-infectious irritable bowel syndrome
Microscopic colitis
Ischaemic colitis
Coeliac disease

Question 9

Next investigation

Answer 9

Stool sample for c diff
Endoscopy (colonoscopy or flexible sigmoidoscopy)
Stool culture imaging

Question 10

Ulcerative colitis management

Answer 10

Steroids
5 ASA
Immunosuppressive such as azathioprine or methotreaxate
Biological therapy
Diet,fmt,abx,probiotics

Question 11

UC severity

Answer 11

UC severity
Different scopes including clinical disease activity index, Montreal classification and Trulov & Witt scores.
Mild
4 x BMs/day, no systemic toxicity, normal ESR/CRP, mild symptoms.
Moderate
> 4x BMs/day, mild anaemia, mild symptoms, minimal systemic toxicity, nutrition maintained and no weight loss.
Severe
> 6 BMs/day, severe symptoms, systemic toxicity, significant anaemia, increased ESR/CRP and weight loss.

Question 12

High creatinine could mean

Answer 12

Dehydrated pt this dry oral mucosa

Question 13

When do we do fmt

Answer 13

If of has recurrent c diff 2 or more times and no improvement

Question 14

Ulcerative colitis vs chrons

Answer 14

Continuous lesions and inflammation with no granulomous in UC
Chrome can affect any place from mouth to anus

Question 15

What should be done before giving immunosuppressants

Answer 15

Make sure pt is vaccinated