infections of the upper GI tract

Question 1

what type of infections are more prevelant in soft tissue rich areas

Answer 1

anerobic

Question 2

examples of normal oropharyngeal bacteria (6)

Answer 2

1. streprococci viridans
2. strep milleri (!)
3. strep pyogenes (group A strep)
4. diphtheroids
5. staph aureus
6. moraxella

Question 3

what bacteria is implicated in appendicitis, GI abcessess and quinsey

Answer 3

streptococcus milleri

Question 4

what are aphthous ulcers (stomatitis)

Answer 4

a common ulcerative condition of the oral mucosa, presents as a painful punched-out sore on oral or genital mucous membranes

Question 5

what organisms can cause oral aphthous ulcers + mgx (2)

Answer 5

1. HSV1 (immunocomprimised pts) -> aciclovir
2. candida (HIV, immunocomprimised, diabects, oral steroid users) ->oral hygeine, Nystatin (prevention), fluconazole

Question 6

what type of disease are dental caries

Answer 6

chronic infectious disease

Question 7

what bacteria is particularly involved in dental carie formation and how

Answer 7

S.mutans -> colonised oral cavity anf produces glycosyl transferase which promotes attachment to tooth pellicle -> converts sugar from food into lactic acid -> demineralisation of tooth enamel in plaques

Question 8

what is gingivitis

Answer 8

pockets of infection affecting the gums

Question 9

what non-oral condition can S.mutans result in

Answer 9

infective endocarditis

Question 10

what is ludwig’s angina

Answer 10

suppurative infection of hypoglossal tissue -> life threatening cellulitis of the soft tissue involving the floor of the mouth and neck

Question 11

why might ludwig’s angina be life threatening

Answer 11

airway threatened -> oedema and exudate push tongue up and backwards

Question 12

ludwig’s angina presentation (5)

Answer 12

rapid onset
1. pain
2. fever
3. dysphagia
4. stridor
5. bull-neck (bilateral neck swelling)

Question 13

ludwig’s angina mgx (3)

Answer 13

1. broad spectrum abx
2. corticosteroids
3. surgical drainage

Question 14

what is vincent’s angina

Answer 14

unilateral tonsillitis due to a mixed infection by spirochetes and fusobacteria that manifests as a one-sided sore throat and difficulty swallowing

Question 15

what 2 bacteria cause vincent’s angina

Answer 15

1. borrelia vincenti (spirochaetes)
2. fusiformis (anaerobic bacteria)
   usually due to poor dental hygeine

Question 16

vincent’s angine presentation

Answer 16

1. extremely sore mouth/gums
2. offensive smell (halitosis)

Question 17

vincent’s angina mgx

Answer 17

1. metranidazole
2. ampicillin
3. improved mouth care

Question 18

what bacteria can cause streptococcal pharyngitis

Answer 18

1. group A strep beta haemolytic - strep. pyogenes (also causes scarlet fever!)
2. group C strep- S.equilisimus, S.anginosus

Question 19

streptococcal pharyngitis presentation (6)

Answer 19

1. sudden onset sore throat
2. pain when swallowing
3. fever
4. headache
5. abdominal pain
6. nausea/vomiting
7. NO cough, hoarsenss, rhinorrhoea, conjunctivitis etc.

Question 20

pharyngitis investigations (3)

Answer 20

1. throat swab for culture
2. bloods - raised WBC
3. serology - ASO titre >400

Question 21

mgx for pharyngitis

Answer 21

abx - ampicillin, amoxicillin or eythromycin (oral if mild) or IV benzylpenicillin (severe)

Question 22

complications of pharyngitis

Answer 22

1. rheumatic fever
2. poststreoptococcal glomerulonephritis
3. peritonsillar abscess (quinsy)
4. cervical lymphadenitis
5. bacteraemia

Question 23

what is lemierre’s syndrome

Answer 23

a rare complication of bacterial pharyngitis/tonsillitis and involves an extension of the infection into the lateral pharyngeal spaces of the neck with subsequent septic thrombophlebitis of the internal jugular vein -> usually immunosuppressed pts

Question 24

what bacteria is responsible for lemierre’s syndrome

Answer 24

fusobacterium necrophorum (gram -ve)

Question 25

what is actinomycosis

Answer 25

a rare subacute to chronic infection caused by the gram-positive filamentous non-acid fast anaerobic to microaerophilic bacteria -> has fungi like properties

Question 26

what bacteria are implicated in acute epiglottitis (2)

Answer 26

1. H.influenzae 2. S.pyogenes

Question 27

why should amoxicillin not be given to an EBV suspected pt

Answer 27

if EBV is present it can cause an amoxicillin induced rash

Question 28

4 organisms that cause oesophagitis

Answer 28

1. candida 2. cytomegalovirus (CMV) 3. HSV 4. varicella-zoster virus

Question 29

oesophagitis presentation (5)

Answer 29

1. dysphagia 2. odynophagia 3. retrosternal discomfort 4. anorexia 5. fever

Question 30

risk factors for oesophagitis

Answer 30

1. abx use (candidia) 2. HIV (CMV, candida) 3. leukaemia 4. lymphoma (candida, HSV) 5. corticosteroids (candida)

Question 31

oesophagitis investigations (4)

Answer 31

1. flexible endoscopy 2. x ray (barium) 3. swab/brushings 4. tissue biopsy

Question 32

endoscopic findings of CMV infection (3)

Answer 32

1. erythema 2. ulcers 3. gastric wall thickening (associated with overlying erosion)

Question 33

HSV oesophagitis appearance

Answer 33

numerous small ulcerations

Question 34

candidiasis oesophagitis appearance

Answer 34

typical white plaques/nodules

Question 35

mgx for candida oesophagitis

Answer 35

1. antifungal (fluconazole, itraconazole) 2. amphotericin B

Question 36

mgx for HSV/VZV oesophagitis

Answer 36

1. antiviral (aciclovir, famciclovir etc.) 2. foscarnet (if resistant)

Question 37

mgx for CMV oesophagitis

Answer 37

1. valganciclovir

Question 38

complications of diptheria infection

Answer 38

1. attacks cardiac muscle (early) 2. attacks myelin (late) -> leading to respiratory arrest due to diaphragm paralysis