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year 1 > GI - Large and small intestine > Flashcards

GI - Large and small intestine Flashcards

1
Q

what is intestinal failure

A

when the gut can no longer supply hydration and nutritional needs of body - failure of ability to absorb food via intestines

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2
Q

what is type 1 intestinal failure associated with

A

short term - post op, chemo

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3
Q

what qualifies as acute intestinal failure

A

lasting 2 weeks

type 1 and type 2

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4
Q

what is type 2 intestinal failure associated with

A 
sepsis
abdo fistula /Crohns
metabolic comp
ischaemia
prolonged surgery comps
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5
Q

what is the treatment of acute intestinal failure

A

parenteral nutrition if unable to tolerate food/fluid - 7 days post op but allow as much enteral feeding as possible
PPI
Octreotide (reduced bowel movements)
alpha-hydroxycholecalciferol (preserves Mg)

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6
Q

what is type 3 intestinal failure

A

chronic - SBS

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7
Q

what length of bowel qualifies as SBS

A

< 200cm functioning small bowel

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8
Q

what is the treatment of chronic SBS

A

home parenteral nutrition
PPI
if venous access lost or liver disease - transplant

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9
Q

what are some complications of parenteral nutrition

A 
pneumothorax 
arterial puncture 
misplacement
endocarditis (venous lines)
hepatitis (venous lines)
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10
Q

where is access for parenteral nutrition gained

A

via subclavian/internal jugular vein - US guided

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11
Q

what nutrient deficiencies is referring syndrome associated with

A

hypokalaemia
hypophosphataemia
hypomagnesaemia

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12
Q

what is referring syndrome

A

imbalances in fluid and electrolytes leading to cell/organ damage

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13
Q

what can refeeding syndrome result in

A

arrhythmia
CF
death

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14
Q

what are some s/s of small bowel obstruction

A 
intermittent episodes of colicky pain
absolute constipation - no flatus/burping
abdominal distension
faeculent vomiting 
high pitched/tinkling bowel sounds (like water against a boat)
obstruction may be palpable
lack of abdo tenderness
visible peristalsis
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15
Q

if copious volumes of bile stained fluid was vomited where would you suspect the obstruction was

A

upper small bowel

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16
Q

if semi-digested food eaten half a day ago was vomited where would you suspect the obstruction was

A

gastric outlet

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17
Q

how does bowel obstruction look on an investigation

A

dilation of bowel proximal to the obstruction and collapsed bowel distal

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18
Q

what are the investigations for bowel obstruction

A

supine AXR - looks for distension

CT - confirm and look for cause

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19
Q

what is the treatment of bowel obstruction

A 
NBM
cannula - take blood and IV fluids
NG tube to decompress stomach
(drip and suck)
anti embolism measures
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20
Q

what are some causes of bowel obstruction

A 
congenital
tumour
hernia - abode wall/internal
volvulus
post op comp
strictures - Crohn's, Diverticular (usually incomplete)
intususceptioin 
GS ileus
adhesions
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21
Q

what is strangulation of the bowel

A

twisting of bowel in loops around itself cutting off blood supply

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22
Q

what does strangulation of the bowel lead to

A

progresses to infarction and perforation due to arterial inflow compromise

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23
Q

what are some s/s of strangulation

A 
constant pain
"pain over hernia" - can occur in external hernia or volvulus
sepsis/shock
MSO failure
death
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24
Q

what is the treatment of strangulation

A

urgent surgery

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25
Q

how is perforation of bowel diagnosed

A

erect CXR - free subphrenic gas

CT may help find source

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26
Q

what is paralytic ileus

A

Obstruction of the intestine due to paralysis of the intestinal muscles

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27
Q

what are the s/s of paralytic ileus

A

similar to obstruction but tinkling bowel sounds and pain less common

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28
Q

what is the treatment of paralytic ileus

A

drip and suck while awaiting restoration of peristalsis

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29
Q

what is pseudo-obstruction (ogilvie’s syndrome)

A

acute dilation of colon in absence of colonic obstruction in acutely unwell patients

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30
Q 
what bowel obstruction is associated with
hip replacement
CABG
spinal anaesthesia 
pneumonia
frail/eldering
A

pseudo-obstruction

ogilvie’s syndrome

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31
Q

how is pseudo-obstruction diagnosed

A

AXR +/- CT

confirms gaseous distension proximal to distal rectum

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32
Q

what may be required in pseudo-obstruction

A

colon may require colonscopic decompression

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33
Q

when is surgery done early in SBO

A

strangulation
ischaemia
perforation
to prevent dead guts

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34
Q

what does acute mesenteric ischaemia usually affect

A

small bowel

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35
Q

why is the large bowel less commonly affected by acute mesenteric ischaemia

A

marginal artery of drummond

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36
Q

what are some s/s of acute mesenteric ischaemia

A 
elderly
acute severe abdominal pain
poorly localised
cramping
rapid hypovolaemia --> shock
reduced bowel sounds
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37
Q

true/false

acute mesenteric ischaemia is associated with AF

A

true

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38
Q

what are some causes of acute mesenteric ischaemia

A

volvulus
SMA thrombosis/embolism
mesenteric vein thrombus - affects smaller lengths of bowel
low flow states - poor CO, post cardiac surgery, renal failure

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39
Q

what are some complications of acute mesenteric ischaemia

A

gangrene
translocated bacteria across dying gut wall
septic peritonitis
MODS

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40
Q

what is the treatment of sepsis caused by acute mesenteric ischaemia

A

fluids

gentamicin + metronidazole + heparin

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41
Q

what is the treatment of acute mesenteric ischaemia

A

surgery to remove dead bowel

revascularisation - arteriography + thrombolysis

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42
Q

what are some tests for acute mesenteric ischaemia

A 
increased Hb
increased WCC
increased plasma amylase
AXR - gasless abdomen
CT/MRI angiography
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43
Q

what gut layer is most sensitive to ischaemia

A

mucosa - most metabolically active

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44
Q

what is chronic mesenteric ischaemia also known as

A

intestinal angina

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45
Q

what are some s/s of chronic mesenteric ischaemia

A 
severe, colicky post prandial abdominal pain
weight loss
upper abdominal bruit
\+/- PR bleeding
malabsorption 
N+V

often Hx vascular disease

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46
Q

how is chronic mesenteric ischaemia diagnosed

A

CT/MR angiography

Doppler US

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47
Q

what is the treatment of chronic mesenteric ischaemia

A

surgery
percutaneous transluminal angioplasty
stent (palliative)

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48
Q

what are some complications of chronic mesenteric ischaemia

A

scarring and fibrosis –> stricture
gangrene
perforation

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49
Q

what is ischaemic colitis

A

chronic colonic ischaemia

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50
Q

where does ischaemic colitis most commonly affect

A

sigmoid colon

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51
Q

who does ischaemic colitis affect

A

elderly

those at risk of atherosclerosis

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52
Q

what are some s/s of ischaemic colitis

A

lower left sided abdominal pain

+/- bloody diarrhoea

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53
Q

what does ischaemic colitis look like on a barium enema

A

THUMB PRINTING OF SUBMUCOSAL SWELLING AT SPLENIC FLEXURE

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54
Q

what are some investigations for ischaemic colitis

A

colonoscopy + biopsy - gold standard
CT
barium enema

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55
Q

what is the histological appearance of ischaemic colitis

A

withering of crypts
pink smudgy lamina propria
fewer chronic inflammatory cells

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56
Q

how is ischaemic colitis caused and what can is progress to

A

low flow in IMA
mild ischaemia
gangrenous colitis
peritonitis/hypovolaemia shock

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57
Q

what is the treatment for ischaemic colitis

A

fluids and antibiotics

resection of affected bowel (gangrenous colitis) + stoma

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58
Q

true/false

strictures are common in ischaemic colitis

A

true

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59
Q

what is volvulus and what does it cause

A

twisting of bowel along mesentery - cause of acute mesenteric ischaemia
obstruction and disruption of blood flow –> infarction –> gangrene

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60
Q

where does volvulus affect elderly

A

sigmoid

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61
Q

where does volvulus affect young adults

A

caecum

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62
Q

how is volvulus diagnosed

A

AXR

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63
Q

what is the treatment of volvulus

A

flatus tube + sigmoidoscope (removes flatus and fixes volvulus)
surgical resection

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64
Q

what is intussusception

A

part of intestine invaginate into another section of intestine
often causing obstruction

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65
Q

what is the most common cause of intussusception in children (emergency)

A

lymphoid hyperplasia due to rotavirus in terminal ileum

leads to intussusception in caecum (ileocaecal junction)

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66
Q

what are the s/s of intussusception

A

current jelly stool/red currant stool

bullseye appearance on US

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67
Q

what is the most common cause of intussusception in adults

A

tumour

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68
Q

what is a diverticulum

A

mucosal herniation through muscle coat usually at sites of arterial perforation - out pouching of gut wall

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69
Q

what is a true diverticulum

A

involves all layers of the gut wall

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70
Q

what is a false diverticulum

A

just mucosa and serosa

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71
Q

where are diverticula most commonly found

A

sigmoid colon

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72
Q

how is diverticulosis diagnosed

A

incidental finding on endoscopy

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73
Q

what is diverticulitis

A

inflammation of diverticulum e.g. from blockage - food, seeds

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74
Q

what is the cause of diverticulum

A

low fibre diet - high intraluminal pressures and stool more liquid so higher pressure contractions needed

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75
Q

what classification is used for acute diverticulitis

A

hichney

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76
Q

what are some s/s of diverticular disease

A 
LIF pain/tenderness
relieved by defecation
nausea 
flatulence
if diverticulitis - pyrexia, increased WCC CRP and ESR
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77
Q

what are some investigations for diverticular disease

A

sigmoidoscopy
Ba enema
CT - first line for diverticulitis

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78
Q

what are some complications of diverticular disease

A 
fistula
stricture
pericolic abscess
haemorrhage - rectal bleeding
perforation - shock
sepsis
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79
Q

what is the most common fistula associated with diverticular disease

A

colovesical - bladder

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80
Q

what is the treatment of diverticular disease

A

fluids/rest/oral ABs
if complicated:
Percutaneous drainage
Hartmann’s procedure

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81
Q

what is Hartmann’s procedure

A

remove sigmoid colon and attach colostomy bag to descending colon

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82
Q

is meckel diverticulum true or false

A

true

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83
Q

what is meckel diverticulum

A

distal ileum contains embryonic remnants of gastric and pancreatic tissue due to the incomplete regression of the vitello-intestinal duct - gastric acid secretion

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84
Q

where does meckel diverticulum occur

A

60cm from ileocaecal valve

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85
Q

what are some s/s meckel diverticulum

A

pain
rectal/faecal bleeding
can mimic appendicitis

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86
Q

when does meckel diverticulum usually present

A

1st 2 years of life

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87
Q

how is meckel diverticulum diagnosed

A

Technicium Tc 99M scan

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88
Q

what kind of inflammation if crohn’s

A

transmural

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89
Q

where does crohn’s affect

A

any part of GI tract from mouth to anus

90
Q

where is Crohn’s most commonly seen

A

terminal ileum

proximal colon

91
Q

how do strictures form in Crohn’s

A

omentum (fat) wrapping around bowel

92
Q

is Crohn’s inflammation continuous

A

no - skip lesions

93
Q

what is the appearance of Crohn’s

A

cobblestone mucosa

deep fissuring ulcers

94
Q

what happens to the colon walls in Crohn’s

A

thickened

95
Q

are granulomas seen in Crohn’s

A

yes

non-caseating granulomas

96
Q

what are some causes of Crohn’s

A

smoking
infection
NSAIDs

97
Q

what gene is mutated in Crohn’s

A

NOD2 (IBD-1) - on C16 - encodes protein involved in bacterial recognition
CARD15

98
Q

what immune cells mediate Crohn’s

A

TH1

- ILN, TNF, macrophages

99
Q

who does Crohn’s affect

A

20 - 40 yos

100
Q

does Crohn’s affect men or women more

A

men

101
Q

what is the treatment of Crohn’s

A

Steroids - short course, high dose
Immunosuppressants - maintenance
Anti-TNF

102
Q

name 3 steroids used in Crohn’s

A

prednisolone (oral)
budesonide (oral)
hydrocortisone

103
Q

name 2 immunosuppressant used in Crohn’s

A

azathioprine

methotrexate

104
Q

name 2 anti-TNF therapies used in Crohn’s

antibodies to TNF

A

infliximab - IV - chimeric

adalimumab - SC - humanised

105
Q

what are some complications of Crohn’s

A 
bowel obstruction
abscess
Fistula
Malabsorption
Stricture
Perforation
SBS
osteomalacia
malnutrition
amyloidosis
106
Q

are extra GI symptoms common or rare in Crohn’s

A

rare

107
Q

what extra GI symptoms might be seen in Crohn’s

A

clubbing

skin/joint/eye problems

108
Q

what is the risk of developing CRC from Crohn’s

A

moderate

109
Q

true/false

there may be a RIF mass in Crohn’s

A

true

110
Q

how is Crohn’s diagnosed

A

endoscopy + barium imaging of SB
CT, MRI, Colonoscopy
Technetium labelled white cell scan

111
Q

what would the bloods of Crohn’s look like

A

raised CRP, albumin, platelets, B12, ferritin

112
Q

is surgery for Crohn’s curative

A

no

113
Q

what are the s/s Crohn’s in the SB

A

periumbilical abdominal cramps
diarrhoea
weight loss

114
Q

what are the s/s Crohn’s in the colon

A

lower abdominal cramps

diarrhoea + blood

115
Q

what are the s/s Crohn’s in the mouth

A

ulcers
angular chelitis
swollen lips

116
Q

what are the s/s Crohn’s in the anus

A

peri-anal disease - recurrent abscess formation leading to fistula with persistent leakage and damaged spinchters
pain

117
Q

what is a technetium labelled white cell scan

A

a means of detecting infection in bone joints and soft tissue as well as inflammation due to other causes such as IBD

118
Q

what does elevated ESR indicate

A

presence of inflammation

119
Q

what is ESR

A

rate at which red blood cells settle out in a tube of unclotted blood mm/hr

120
Q

what is intermediate colitis

A

overlap of Crohn’s and UC

121
Q

what is Rigler’s sign

A

air on both luminal and peritoneal side of bowel wall - perforated ulcer

122
Q

what are the side effects of corticosteroids

A 
avascular necrosis
osteoporosis/growth failure
acne
thinning of skin
weight gain/increased appetite 
diabetes
hypertension
cataracts
123
Q

why does budesonide not have many systemic side effects

A

undergoes 1st pass metabolism in liver

124
Q

what are some side effects of azathioprine

A

hepatitis
pancreatitis
skin cancer
leukopenia (FBR)

125
Q

what drug should be avoided with azathioprine

A

allopurinol

126
Q

what is the onset of azathioprine like

A

slow

127
Q

what do the letters in SNAP stand for

A

Sepsis
Nutrition
Anatomy
Plan

128
Q

what is measured before azathioprine is prescribed and why

A

TMPT levels - people with TMPT enzyme problems are more susceptible to infections as azathioprine lowers the WCC - TMPT is responsible for converting some of 6-MP into 6-MMP - if not working/not present higher levels of ^-TGN (active form of azathioprine) - more likely to reduce WCC

129
Q

how does Anti-TNF work

A

promotes apoptosis of activated T-lymphocytes

130
Q

what type of inflammation is seen in UC

A

mucosal inflammation

131
Q

is UC inflammation continous

A

yes

132
Q

where is UC seen

A

rectum and extends proximally to colon

133
Q

who does UC affect

A

non-smokers

20-30 yos and elderly

134
Q

does UC affect men or women more

A

men

135
Q

what immune cells mediate UC

A

Th1 and Th2

136
Q

how is severe US classified

A 
> 6 bloody stools in 24 hours 
\+1 of 
Fever
Anaemia
Tachycardia
Elevated ESR

Truelove + Witt Criteria

137
Q

what kind of things aggravate UC

A

NSAIDs
infection
ABs

138
Q

is the risk of CRC greater in Crohn’s or UC

A

UC

139
Q

are there granulomas in UC

A

no

140
Q

what are some characteristics of UC

A 
Cryptitis / Crypt abscesses
loss of haustra
thin walled
granular mucosa
absence of goblet cells
superficial ulceration
141
Q

what is the disease extent of proctitis

A

rectum - no more proximal than sigmoid colon

142
Q

what is the disease extent of left sided colitis

A

rectum and left colon - no more proximal than splenic flexure

143
Q

what is the disease extent of pancolitis

A

rectum and entire colon

144
Q

what is seen in the bloods of UC

A

CRP

Albumin

145
Q

what is seen in an AXR of UC

A

stool absent from inflamed colon

toxic megacolon

146
Q

how is UC diagnosed

A

Endoscopy + biopsy

147
Q

what is seen on endoscopy of UC

A

loss of vessel pattern
contact bleeding
pseudopolyps

148
Q

what is the treatment of UC

A

5ASA (mesalazine)
steroids
immunosuppressants
Anti-TNF

149
Q

is surgery of UC curative

A

yes

150
Q

what are 2 options of surgery in UC

A

permanent ileostomy

restorative proctocoloectomy + pouch

151
Q

what are some s/s UC

A 
diarrhoea + bleeding
increased bowel frequency
urgency
tenesmus
incontinence
night rising
lower abdominal pain (LIF)
152
Q

what are some complications of UC

A 
CRC
cholangiocarcinoma
anaemia
shock (bleeding)
toxic megacolon
153
Q

how does UC lead to CRC

A

chronic inflammation –> dysplasia –> carcinoma

154
Q

is UC or Crohn’s associated with PSC

A

UC

155
Q

what is the surgical treatment of duodenal or pyloric stenosis

A

gastrojejunostomy

156
Q

what is amyloidosis

A

deposition of abnormally folded protein

157
Q

are extra-GI symptoms common in UC

A

yes

158
Q

what are some extra-GI symptoms of UC

A 
erythema nodosom
joint/eye/skin problems
ankylosing spondylitis
steatosis
gall stones
episcleritis
iritis
sacriolitis
malnutrition
clubbing
pyoderma
159
Q

true/false

5ASA reduces risk of CRC

A

true

160
Q

what are some side effects of 5ASA

A

diarrhoea

idiosyncratic nephritis

161
Q

how can 5ASA be administered

A

topical
enema
suppositorie (oral) - drug coated to delay release of drug until in bowel

162
Q

why are topical 5ASAs inserted up rectum

A
  • to avoid systemic side effects - 1st pass metabolism in liver meaning very little of drug exits into systemic circulation
163
Q

what has better mucosal adherence

suppositorie or enema

A

suppositorie

164
Q

what is better at reaching sigmoid colon

suppositorie or enema

A

enema

165
Q

what is the Rome III criteria for IBS

A 
recurrent abdominal pain for atleast 3 days / month for 3 months
\+2 of
- improvement on defecation
- change in stool frequency
- change in stool form
166
Q

what are some triggers of IBS

A 
bread/fibre
infection
drugs e.g. opiates
menstruation
physiological factors
167
Q

what are some s/s of IBS

A 
abdo pain
change in stool frequency
change in stool form
improvement of pain on defecation
urgency
tenesmus
bloating/distension
mucus PR
worsened by stress
exaggerated gastro-colic reflex
168
Q

what is IBS associated with

A

visceral hypersensitivity

fibromyalgia, chronic fatigue syndrome/depression, TMS dysfunction, chronic pelvic pain

169
Q

is IBS worse in men or women

A

women - oestrogen driven disease

170
Q

when should a person with suspected IBS get an endoscopy

A

> 55
Fhmx CRC
red flags e.g. waking up with need to dedicate, recent onset, rectal bleeding, weight loss, anaemia

171
Q

what are some investigations done in IBS

A

FBC (anaemia)

ESR/plasma viscosity/CRP/TTG

172
Q

what is the treatment of IBS

A 
reduce fibre/dairy/gluten
stop opiates e.g. codeine
antidiarrhoeals - loperamide
antispasmodics - buscopan, mebeverine, hyoscine
antidepressants - amitryphylline
173
Q

what is a SE of amitryphylline

A

drowsiness - take at night, resets nerves in bowel

174
Q

what is the treatment for constipation in IBS

A

movicol

175
Q

what genes trigger coeliac disease

A

HLA-DQ2 and HLA-DQ8

176
Q

what antibodies are present in coeliac disease

A

antiendomesial anti-gliadin Abs

IgA anti-tissue transglutaminase Abs

177
Q

what type of hypersensitivity reaction is coeliac disease

A

type IV

178
Q

what immune cells are responsible for coeliac disease

A

Helper T cell mediated - mediate tissue damage following presentation by antigen presenting cells via MHC class II

179
Q

what happens in coeliac disease

A 
immune reaction (T cells) to gliadin in wheat fluid/gluten in small intestine (proximal)
gluten specific T cells produce IFN-Y which triggers intraepithelial lymphocytes and kills epithelial cells 
damages enterocytes and reduces absorptive capacity
180
Q

what is seen in the histology of coeliac disease

A

flat duodenal mucosa (villous atrophy)

181
Q

what does loss of villous structure in coeliac disease cause

A

loss of absorptive SA
reduction in absorption
- malabsorption

182
Q

what nutrients are malabsorbed in coeliac disease

A 
CHOs
fats
AAs
water
electrolytes
vitamins
Fe, B12, folate
183
Q

what are some s/s coeliac disease

A 
abdominal distension
diarrhoea
failure to thrive (children)
bloating
dermatitis herpetiformis
flatulence
anaemia
steatorrhoea
184
Q

what childhood disorder is coeliac disease associated with

A

childhood diabetes

- think of MH

185
Q

what is the treatment of coeliac disease

A

gluten free diet - damage is reversible

186
Q

how is coeliac disease diagnosed

A

duodenal biopsy after a positive tTGA test (patient still eating gluten)

187
Q

what are some complications of coeliac disease

A

T cell lymphoma
Small bowel carcinoma
gallstones

188
Q

what causes lactose intolerance

A

decreased function of lactase enzyme

189
Q

where is lactase enzyme found

A

brush border of enterocytes

190
Q

what does lactase normally break down

A

lactose into glucose and galactose

191
Q

what are some s/s of lactose intolerance

A

flatulence
distension
diarrhoea

following lactose consumption

192
Q

what causes the s/s of lactose intolerance

A

presence of lactose in colon –> colonic flora produce CO2, H2 and methane

193
Q

what is a test for lactose intolerance

A

H2 breath test

194
Q

what inheritance in congenital lactose intolerance

A

rare AR disorder

195
Q

why can small bowel infection cause lactose intolerance

A

lactase susceptible to injury

196
Q

what is colonic angiodysplasia

A

submucosal lakes of blood

197
Q

what causes colonic angiodysplasia

A

vascular malformation

198
Q

where is colonic angiodysplasia usually seen

A

right colon

199
Q

how is colonic angiodysplasia diagnosed

A

CT angiography

colonoscopy

200
Q

how is colonic angiodysplasia treated

A

embolisation
endoscopic ablation - cauterising bleeding BVs
surgical resection

201
Q

what is a complication of cauterising bleeding blood vessels

A

ischaemia

202
Q

what are 5 types of colitis

A 
ischaemic
collagenous
lymphocytic
radiation
pseudomembranous
203
Q

how is colitis diagnosed

A

AXR
stool culture
sigmoidoscopy
Ba enema

204
Q

how is colitis treated if the cause is IBD

A

IV fluids
IV steroids
GI rest

205
Q

what are some s/s colitis

A 
diarrhoea +/- blood
abdo cramps
dehydration
sepsis
weight loss
anaemia
206
Q

what causes collagenous colitis

A

NSAIDs

207
Q

is collagenous colitis seen grossly

A

no - microscopic

208
Q

what is seen in the histology of collagenous colitis

A

thickened basement membrane (basal lamina of epithelial cells)
intraepithelial inflammatory cells

209
Q

what are some s/s of collagenous colitis

A

watery diarrhoea

normal endoscopy

210
Q

is lymphocytic colitis seen grossly

A

no - microscopic

211
Q

is there thickening of BM in lymphocytic colitis

A

no

212
Q

are there architectural changes in either of the microscopic colitis’

A

no

213
Q

what is seen in lymphocytic colitis

A

increased intraepithelial lymphocytes

- possibly linked to coeliac

214
Q

what causes radiation colitis

A

cancer treatment

215
Q

what is seen in radiation colitis

A

telangectasia - thread like read lines on skin

216
Q

what is seen histologically in radiation colitis

A

Bizarre stroll cells

bizarre vessels - thick walled

217
Q

what causes pseudomembranous colitis

A

broad spectrum antibiotics that clear normal flora in colon causing subsequent C. Diff attack

218
Q

what toxins are produced by C diff

A

toxin A and B

219
Q

what is the treatment of pseudomembranous colitis

A 
asymptomatic - none
metronidazole
\+ vancomycin if severe
may need colectomy
may be fatal
220
Q

what are the s/s of pseudomembranous colitis

A

diarrhoea + bleeding

221
Q

what is seen in pseudomembranous colitis

A

patchy membranes stick to mucosa throughout colonic wall
volcano like fibrinopurulent exudate lesions
flame thrower like

222
Q

what are the 4 Cs associated with C diff infection

A

ciprofloxacin
clindamycin
co-amoxiclav
cephalosporins e.g. ceftriaxone

year 1 (45 decks)

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