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GI > Infections and Sepsis > Flashcards

Infections and Sepsis Flashcards

1
Q

how is gut flora a supraorganism

A

A system of multiple organisms that may be considered a single organism

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2
Q

describe the normal flora of the gut- good or bad?

A

beneficial indigeous microbiota

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3
Q

do you have the same normal flora all the time

A

no, may be transient, not all colonisation is normal

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4
Q

when does colonisation of normal gut flora begin

A

at birth

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5
Q

what help prevents colonisation in the GI tract

A

stomach acidity, normal flora, peristalsis, antimicrobial compounds

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6
Q

what traits increase an invaders chance of success

A

high growth rates, dispersal capability, phenotypic plasticity, genetic diversity

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7
Q

what is a barrier to establishment of an invader after introduction

A

abiotic resistance: pH, temperature, salinity

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8
Q

what is biotic resistance

A

barrier to invasion: competition, antagonism, predation

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9
Q

what organisms are commonly in the normal flora of the large bowl

A

enterobacteriaceae, (klebsiella), enterococci, milleri group streptococci, anaerobic gram +ve bacilli (clostridium), anaerobic gram -ve bacilli (bacteroides, candida)

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10
Q

are there more bugs in the large/ small bowl?

A

small, number increases as you go towards the rectum

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11
Q

what are the steps of pathogenic adhesion

A

exposure, adhesion, invasion, colonisation, toxicity, tissue damage and disease

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12
Q

what is colonisation

A

the establishment of a microorganism on or within a host

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13
Q

what is a pathogen

A

any microorganism that has the potential to cause disease

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14
Q

what is virulence

A

the likelihood of causing disease (opportunistic or accidental pathogen)

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15
Q

what investigations should be done when diagnosing an infection

A

radiology, biochemistry, immunology, microbiology (blood, stool, urine, wound, tissue cultures), microscopy: (of stool, urine, CSF, sputum, pus) serology, antigen detection, PCR/ molecular studies

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16
Q

what are the components of inflammation

A

calor (heat), rubor (redness), tumour (swelling), dolor (pain), functio laesa (loss of function)

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17
Q

what happens in the incubation period

A

pathogen replicates in the host

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18
Q

what happens in the prodromal period

A

early signs and symptoms

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19
Q

what is the convalescent period

A

signs and symptoms recede, person returns to health

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20
Q

what immune response does bacteria usually initiat

A

phagocytes, antibody and t lymphocytes, complement

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21
Q

what immune response do viruses usually intiate

A

t lymphocytes, anti body and b lymphocytes

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22
Q

what immune response does fungi usually initiate

A

phagocytes, t lymphocytes, eosinophils

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23
Q

what immune response do protozoa usually intiate

A

t lymphocytes, eosinophils

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24
Q

what immune response do worms usually initiate

A

eosinophils, mast cells

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25
Q

what age groups are usually most susceptible to infection

A

neonates and the elderly

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26
Q

what infections of the abdomen can cause abscesses

A

hepatitis (liver abscesses)
gastroenteritis
perineal abscesses

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27
Q

what shape are enterobacteraeciae

A

bacilli

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28
Q

what shape are streptococcus and enterococcus

A

cocci

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29
Q

what shape are helicobacter pylori

A

spirochete

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30
Q

what do gram -ves have that gram +ves lack

A

lipopolysaccharide

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31
Q

what is usually the causative agent of oesophagitis

A

candida/ malfunctioning T cells

32
Q

what causes pancreatitis

A

not usually caused by infection

33
Q

what drives gram -ve sepsis

A

lipopolysaccharide

34
Q

what further step is used distinguish enterobacteriaceae

A

lactose or non lactose ferminting

35
Q

what is an abligate anaerobe

A

one that is poisoned by oxygen

36
Q

how do you tell non lactose fermenting drugs apart

A

oxidase test, urease tests

37
Q

what antibiotic do all UK E coli respond to

A

gentamycin

38
Q

are enterobacteriaceae

gram -/+ve

A

negative

39
Q

enterobacteriacae are coliforms- what is this

A

rod-shaped Gram-negative non-spore forming and motile (most) or non-motile bacteria which can ferment lactose with the production of acid and gas

40
Q

how do enteronacteriaceae cause disease

A

motility- flagella

colonisation factors- fimbriae

endotoxin- cell wall component

enterotoxin- sgiga toxin

41
Q

what enterobacteriaceae are not mobile

A

shigella and klebsiella

42
Q

how does maldi-tof mass spectrometry identify bacteria

A

analyses the protein composition of bacteria cell wall, ionises the proteins, then uses a database

43
Q

how does serotyping work

A

immunoreactivity of various antigens, relates to gram -ve, helps you identify bug by antigen reactions

44
Q

what gram +ve organiams are found in the mouth

A

strep viridans

anaerobes

candida

neisseria

sthaphylococci

45
Q

what gram +ve organisms can be found in the stomach

A

usually sterile- some candda and staphylococci may survive

46
Q

name the most important enterobacteriaceae

A

e coli

47
Q

where are most anaerobic and aerobic organism in the GI tract

A

aerobic closer to mouth- upper GI tract

anaerobic closer to rectum- lower GI tract

48
Q

what is the main anaerobe to remeber

A

bacteroids and costridium

49
Q

what is the normal flora of the bowel

A

small number of coliforms and anaerobes

50
Q

what is the normal flora of the colon

A

lots of coliforms, anaerobes and enterococcus

51
Q

what is the normal flora of the bile ducts

A

usually sterile

52
Q

what antibiotic is used for anaerobes

A

metronidazole

53
Q

what is cholangitis

A

an infection in the common bile duct, usually resulting from a common bile duct stone

54
Q

what should you review after 48 hours of initial treatment

A

antibiotics, even if results from lab haven’t come back yet; change or IV/Oral switch if patient improving

55
Q

how are enterococcus in the GI tract treated

A

amoxicillin (vancomycin if penicillin allergic)

cotrimoxalzole when time to switch to oral from IV

56
Q

what are the antibiotics for an intra abdominal sepsis

A

treat as enterococcus:
amoxicillin (vancomycin if penicillin allergic)
cotrimoxalzole when time to switch to oral from IV

57
Q

how do gall stones reach the liver

A

via bile ducts

58
Q

how does malignancy spread to the liver

A

bile ducts and portal vein

59
Q

how does bacteremia spread to the liver

A

portal vein and hepatic artery

60
Q

what is sepsis

A

uncontrolled amplification of the immune response throughout the whole body- life-threatening organ dysfunction caused by a dysregulated host response to infection.

61
Q

what is septic shock

A

a subset of sepsis with circulatory and cellular/ metabolic dysfunction associated with a higher risk of mortality

62
Q

when do you know its sepsis

A

infection + news > 5

63
Q

what could lead to an unusual host response

A

age, immunosuppressed, co morbidity, drugs, genetics

64
Q

what is an occult

A

a disease of no readily discernible signs or symptoms

65
Q

what should be done to treat sepsis

A 
B-lood cultures + septic screen, U&Es
U-rine output- monitor hourly 
F-luid resuscitation
A-ntibiotics IV
L-lactate measurement 
O-xygen to correct hypoxia
66
Q

what could cause pain in the left iliac fossa on deep palpation

A

diverticular disease, inguinal hernia

67
Q

what could cause pain in the right iliac fossa

A

appendicitis, inguinal hernia

68
Q

what can cause pain in the epigastric region

A

peptic ulcer disease, cholecystitis, pancreatitis, MI

69
Q

what can cause pain in the periumbilical region

A

small or large bowl obstruction, appendicitis, abdominal aortic aneursym

70
Q

why are antibiotics not helpful in large abscesess

A

as they have no blood supply- need surgical drainage

71
Q

what is a spontaneous peritonitis

A

think ascites- is an infection of ascitic fluid that cannot be attributed to any intra-abdominal, ongoing inflammatory, or surgically correctable condition

72
Q

what is secondary peritonitis

A

an acute infection of the peritoneum due to loss of integrity of the gastrointestinal tract or other visceral organ (a burst that introduces the bacteria)

73
Q

what antibiotic for enterococcus

A

amoxicillin

74
Q

what antibiotic for enterobacteriaceae

A

gentamycin

75
Q

what is the drug of choice for sepsis and enterococci in the GI tract

A

amoxicillin

76
Q

what is the drug of choice for sepsis and coliforms

A

gentamycin

77
Q

what is the mutant selection window

A

where the wrong dose of antibiotics selects the resistant sub population of the infection

GI (64 decks)

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