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Yr3 Medicine: Infectious Diseases > GI Infections > Flashcards

GI Infections Flashcards

1
Q

What is dysentery?

A

Bloody diarrhoea due to infection of GI tract causing inflammation

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2
Q

What is meant by gastroenteritis?

A

Non-specific term used to characterise symptoms of acute diarrhoea, nausea, vomitting and abdo pain. It is often used loosely to be synonymous with infective diarrhoea.

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3
Q

State some potential causative organisms of gastroenteritis

A
  • Clostridium difficile
  • Camplylobacter jejuni
  • Salmonella spp.
  • Shigella
  • Bacillus cereus
  • E-coli (ETEC)
  • E-coli (EHEC, 0.157:H7)
  • Giardia lamblia
  • Entamoeba histolytica
  • Norovirus
  • Rotavirus
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4
Q

For campylobacter jejuni, state:

  • Source
  • Clinical features
  • Management
  • Potential complications
A
  • Contaminated water, animal droppings, unpasteurised milk
  • Clinical features:
    • Fever
    • Dysentery
  • Management:
    • Self limiting for first 7 days
    • Severe forms may respond to erythromycin
  • Complications:
    • Guillian-Barre syndrome
    • Reactive arthritis
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5
Q

For salmonella spp, state:

  • Source
  • Clinical features
  • Management
  • Potential complications
A
  • Contaminated water, foods (eggs, poultry, meat)
  • Clinical features:
    • Dysentery
    • Vomitting
    • Abdo pain
    • Fever
  • Management:
    • Usually self-limiting
    • Ciprofloxacin can be used if bacteraemia
  • Complications
    • Reactive arthritis
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6
Q

For shigella, state:

  • Source
  • Clinical features
  • Management
  • Potential complications
A
  • Contaminated food & water (spread via faecal oral route)
  • Clinical features:
    • Dysentery
    • Colicky abndo pain
    • +/- fever
  • Management:
    • Ciprofloxacin
    • Improve hand hygiene
  • Complications:
    • Reactive arthritis
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7
Q

For Bacillus cereus, state:

  • Source
  • Clinical features
  • Management
A
  • Reheated rice or sauces
  • Clinical features:
    • Watery diarrhoea
    • Vomitting
  • Management:
    • Self limiting (24-48hr)
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8
Q

For Listeria monocytogenes, state:

  • Source
  • Clinical features
  • Management
  • Potential complications
A
  • Unpasteurised milk, cheese, raw meats
  • Clinical features:
    • Watery diarrhoea
    • Colicky abdo pain
    • Vomitting
  • Management:
    • Ampicillin
  • Complications:
    • Pneumonia
    • Meningoencephalitis
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9
Q

For Escherichia coli (ETEC), state:

  • Source
  • Clinical features
  • Management
A
  • Most common cause of traveller’s diarrhoea
  • Clinical features:
    • Watery diarrhoea
    • Vomitting
  • Management:
    • Self limiting (3-5 days)
    • Ciprofloxacin may be considered
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10
Q

For Escherichia coli (EHEC, 0157:H7) state:

  • Source
  • Clinical features
  • Management
  • Potential complications
A
  • Contaminated food products (usually occurs as outbreaks)
  • Clinical features:
    • Dysentery
    • Constant abdo pain
  • Management:
    • Supportive (antibiotic therapy may worsen symptoms)
    • Haemodialysis if required
  • Complications:
    • Haemolytic uraemic syndrome
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11
Q

What is haemolytic uraemic syndrome?

A

Haemolytic uraemic syndrome is a form of thrombotic microangiopathy affecting predominantly the kidney and characterised by a triad of thrombocytopenia, mechanical haemolytic anaemia, and acute kidney injury.

Most cases of HUS occur in children and are due to infection with Shiga Toxin producing E-coli (EHEC, 0157:H7)

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12
Q

For Giardia lamblia, state:

  • Sources
  • Clinical features
  • Management
A
  • Contaminated water, common in tropics
  • Clinical features:
    • Offensive diarrhoea
    • Vomitting
    • Abdo pain
    • Distension
  • Management:
    • Tinidazole stat and metronidazole for 10 days
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13
Q

For cryptosporidiosis, state:

  • Sources
  • Who seen in
  • Clinical features
  • Management
A
  • Contaminated water
  • ONLY seen in immunocompormised pts
  • Clincial features:
    • Diarrhoea
    • Intermittent abdo pain
  • Management:
    • Usually self-limiting
    • If sever co-trimoxazole for 7 days
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14
Q

For Entamoeba histolytica, state:

  • Source
  • Clinical features
  • Management
  • Potential complications
A
  • Contaminated food (via faecal oral route)
  • Clinical features:
    • Dysentery with intermittent constipation
  • Management:
    • Acute phase: metronidazole or tinidazole
    • Paromomycin or diloxanide for up to 10 days to elimated intra-intestinal cysts
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15
Q

For norovirus, state:

  • Who it is common in
  • Clinical features
  • Management
A
  • Common in adults
  • Clinical features:
    • Profuse watery diarrhoea
    • Projectile vomitting
    • Colicky abdo pain
  • Managment:
    • Self-limiting
    • Contact precaution
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16
Q

For rotavirus, state:

  • Who it is common in
  • Clinical features
  • Management
A
  • Children
  • Clinical features:
    • Watery diarrhoea
    • Vomitting
  • Management:
    • Self limiting
    • Contact precaution
17
Q

Remind yourself of the 5 organisms that can cause dysentry

A
  • Campylobacter jejuni
  • Salmonella spp
  • Shigella
  • E.coli (EHEC, 0157:H7)
  • Entamoeba histolytica
18
Q

For Clostridium difficile, state:

  • Gram stain
  • Shape
  • Anaerobic or anaerobic
  • Whether it forms spores
  • Virulence factors
A
  • Gram positive
  • Rod
  • Obligate anaerobe
  • Spore forming
  • Virulence:
    • Enterotoxin A: hypersecretion of fluid & induces cytokine production which stimulates inflammatory response
    • Cytotoxin B: disrupts protein synthesis and causes disorganisation of cytoskeleton
    • Spores
19
Q

What can cause C.diff (pseudomembranous) colitis?

A

C.diff is present in ~3-5% adult population- remaining dormant in presensce of normal gut flora. However, natural balance can be disrupted by use of antibiotics resulting in infection.

20
Q

State some antibiotics which are commonly/hugely associated with C.diff colitis

A
  • Co-amoxiclav
  • Cephalosporins
  • Ciprofloxacin
  • Clindamycin
21
Q

How long, following antibiotic use, do symptoms of C.diff colitis usually manifest?

A

5-10 days afer antibiotic therapy

22
Q

Discuss the pathophysiology of C.diff colitis

A
  • C.diff produces enterotoxins A & B
  • Toxins trigger inflammatory response in colonic membrane
  • Subsequently leads to increase in vascular permeability and pseudomembrane formation. Accumulation of inflammatory cells, fibrin & necrotic debris contribute to pseudomembrane
23
Q

State some risk factors for developing C.diff (pseudomembranous) colitis

A
  • Antibiotics
  • PPIs (any acid supressing drugs)
  • Advanced age
  • IBD
  • HIV
  • CKD
24
Q

State the signs & symptoms of C.diff colitis

A
  • Profuse watery diarrhoea
  • Colicky abdo pain
  • Fevers & rigors (in some cases)
25
Q

Discuss what investigations you would do if you suspect a pt has C.diff (pseudomembranous) colitis, include:

  • Bedside
  • Bloods
  • Imaging
A

Bedside

  • Stool sample for MC&S (including C.diff toxin analysis): check for C.diff and toxins

Bloods

  • FBC: leucocytosis
  • CRP: raised
  • U&Es: may be deranged due to dehydration
  • Serum albumin: may be decreased

Imaging

  • ?AXR: may show colonic dilation
  • ?colonscopy/flexi sig: not routinely done but may be useful if diangosis uncertain; see pseudomembranous colitis on colonscopy
26
Q

Discuss the management of C.diff colitis

A

Management involves assessing severity, infection control, supportive therapy & antibiotic therapy:

  1. Infection control: isolate in side room & barrier nurse, do not use alcohol hand gel
  2. Medication review: stop all causative agents- particularly antibiotics & PPI
  3. Supportive therpay: fluids, analgesia etc.
  4. Antibiotic therapy:
  • Non-severe: 10-14 days of oral metronidazole, vancomycin or fidaxomicin
  • Severe: IV metronidazole + oral vancomycin
  1. Surgery may be considered in fulminant disease
27
Q

State some potential complications of C.diff colitis

A
  • Ileus
  • Toxic megacolon
  • Perforation & peritonitis

Yr3 Medicine: Infectious Diseases (9 decks)

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