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Gastrointestinal > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

what are infectious diseases caused by?

A

cross contamination, undercooking, improper storage of food and reheating of food

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2
Q

what is the general pathophysiology of organisms

A

attachment to GI mucosa > cellular invasion > production of exotoxins > changes in epithelial cell physiology > loss of brush border digestive enzymes > inc intestinal motility

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3
Q

what are risk factors for pts becoming infected?

A

immunosuppression, genetics, bad hygiene, malnutrition, contamination

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4
Q

what are the 6 bacterias responsible for GI infections?

A

C.Diff, campylobacter, salmonella, listeria monocytogenes, shigella, E.Coli

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5
Q

C.diff epidemiology?

A

most common cause of diarrhoea

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6
Q

what does c.diff produce and why is it bad?

A

produce spores that may be resistant to disinfectant

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7
Q

true/false…

c.diff is transmittable

A

true

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8
Q

some strains of c.diff are _______ of toxins

A

hyperproducers

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9
Q

what are the 2 toxins that c.diff produce?

A 
toxin A (enterotoxin) 
toxin B (cytotoxin)
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10
Q

what exacerbates c.diff bacteria already in gut?

A

antibiotics that kill normal gut flora which allows c.diff to overgrow

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11
Q

symptoms of c.diff infection

A

bloody diarrhoea, abdominal pain

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12
Q

ix for c.diff?

A

GDH (if +ve then test for toxins) > if GDH +ve and toxin test -ve assess pt clinically and retest

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13
Q

2 antibiotics given for c.diff

A

metronidazole & vancomycin

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14
Q

prevention for c.diff?

A

use narrow spec antibiotics and avoid 4Cs, isolate pts

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15
Q

what are the 4Cs

A

clindamycin, ciprofloxacin, co-amoxi, clarithromycin

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16
Q

what are possible complications of C.diff?

A

pseudomembranous colitis and perforation

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17
Q

campylobacter is a gram ___ ____

A

-ve bacilli

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18
Q

how long is campylobacter’s intubation period?

A

3-10 days

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19
Q

campylobacter is most common organism that causes…?

A

gastroenteritis

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20
Q

source of campylobacter?

A

raw poultry

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21
Q

symptoms of campylobacter?

A

abdo pain, fever, bloody diarrhoea

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22
Q

what may campylobacter mimic?

A

appendicitis

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23
Q

tx for campylobacter?

A

self-limiting, antibis (erythromycin or ciprofloxacin)

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24
Q

complications of campylobacter?

A

bacteraemia, Guillain-Barre syndrome

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25
Q

what type of organism is salmonella?

A

colifrom (gram -ve)

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26
Q

is intubation for salmonella long or short?

A

short-24 to 48hr

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27
Q

why is salmonella dangerous?

A

produces toxin and is invasive

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28
Q

source of salmonella?

A

poultry, meat, raw egg

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29
Q

pathophysiology of salmonella?

A

born in animal gut and multiplies in food

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30
Q

symptoms of salmonella?

A

diarrhoea & vomit, bloody?, fever, abode pain

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31
Q

salmonella typhoic is a strain of salmonella- what is its common presentation?

A

rose spots on abdomen

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32
Q

tx for salmonella?

A

same as campylobacter ie. Antibes are erythromycin and ciprofloxacin

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33
Q

Listeria Monocytogenes is a gram __ bacterium

A

+ve

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34
Q

true/false…

intubation of LM is long

A

false..

it is short (9-48hrs)

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35
Q

listeria monocytogenes thrives in …?

A

cold e.g. fridge

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36
Q

symptoms of listeria monocytogenes?

A

fever, muscle aches, diarrhoea

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37
Q

source of Listeria Monocytogenes?

A

unpasteurised milk, deli counter

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38
Q

transmission of listeria monocytogenes?

A

food Bourne, mother to child

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39
Q

shigella is gram __?

A

-ve

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40
Q

how long is Shigella’s intubation?

A

1-9 days

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41
Q

what kind of toxin does shigella release?

A

shiga toxin

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42
Q

how does shiga toxin work?

A

binds to renal cell receptors (RBC etc) and inhibits protein synthesis causing cell death

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43
Q

which of the shiga toxins is more potent?

A

shiga toxin 2

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44
Q

who does e.coli usually affect more?

A

children

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45
Q

pathogenesis of e.coli?

A

adhere to epigastric cells and elaborate shiga toxin which inhibits proton synthesis resulting in death of enterocytes and endothelial cells > this activates inflammatory response causing fibrin deposits and clot formation > hameturia is caused

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46
Q

symptoms of e.coli?

A

bloody diarrhoea, high WBC, low Hb

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47
Q

tx for e.coli?

A

supportive

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48
Q

complications of e.coli?

A

renal failure

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49
Q

types of e.coli…

A 
e.coli 0157
enterotoxigenic 
enteropathogenic 
enteroinvasive 
enteroaggregative
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50
Q

intubation of e.coli 0157?

A

1-14 days

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51
Q

what toxin is produced with e.coli 0157?

A

verotoxin (kidney damage > HUS)

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52
Q

symptoms of 0157?

A

blood diarrhoea, fever pain

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53
Q

main complication of e.coli 0157?

A

Haemolytic Uraemic Syndrome (HUS)

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54
Q

epidemiology for HUS?

A

<16 yo, elderly

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55
Q

ix for HUS?

A

stool sample, bloods (high WBC, low platelets & Hb)

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56
Q

why is HUS an emergency?

A

can easily progress to acute renal failure, thrombocytopenia, haemolytic anaemia

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57
Q

which 2 e.coli’s are mostly associated with travel?

A

enterotoxigenic and enteroaggregative

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58
Q

true/false…

amoebas are responsible for outbreaks on cruise ships

A

false…

usually viruses- rota & noro virus

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59
Q

rotovirus is no1 culprit for what presentation in young kids (<3)?

A

diarrhoea and vomiting

60
Q

what type of spread does rotavirus have?

A

faecal-oral

61
Q

how long does rotavirus last?

A

1 week

62
Q

true/false…

adults are affected more badly that kids by rotavirus

A

false…

kids are more badly affected

63
Q

symptoms of rotavirus?

A

diarrhoea with NO BLOOD

64
Q

source of rotavirus?

A

contaminated drinking water, food, fomites

65
Q

ix for rotavirus?

A

PCR

66
Q

tx for rotavirus?

A

self-limiting, rehydration, vaccine

67
Q

complications of rotavirus

A

post-infection malabsorption or repeat infections

68
Q

what is norovirus presentation like

A

explosive vomiting

69
Q

norovirus spread?

A

faecal-roal or droplets

70
Q

how long is norovirus incubation?

A

2-4 days

71
Q

what should be noted for fomites of norovirus?

A

asymptomatic shedding of virus for up to 48hrs post cessation of symptoms

72
Q

true/false…

like rotavirus, nor virus mainly affects kids

A

false…

affects all ages

73
Q

source of norovirus?

A

contaminated food or water

74
Q

ix for norovirus?

A

faeces or vomit for PCR

75
Q

tx for norovirus?

A

rehydration, self limiting

76
Q

how to control infection in hospital setting?

A

standard infection control precautions, contact precautions, prudent antibiotic prescribing

77
Q

spread of entamoeba histolytica?

A

faecal-oral

78
Q

symptoms of entamoeba histolytica?

A

asymptomatic, abdominal pain, fever, acute, bloody diarrhoea, tenderness peritonism

79
Q

ix for entamoeba histolytica?

A

stool for custs/ trophozoites, AXR (exclude toxic megacolon), endoscopy w biopsy

80
Q

common complication of entamoeba histolytica?

A

amoebic liver abscess

81
Q

epi for amoebic liver abscess?

A

intubation is 8-20 days, more common in men

82
Q

s/s of amoebic liver abscess?

A

sub-acute: 2-4 weeks (fever, sweats, upper ab pain, GI upset, hepatomegaly, tenderness over right lower ribs)

83
Q

ix for amoebic liver abscess

A

LFTs, CXR (opacity over right lung base), USS, CT

84
Q

tx for amoebic liver abscess?

A

metronidazole/ tinidazole

85
Q

4 types of protozoa

A
  • giardiasis
  • helminths
  • chugs disease
  • enterobius vermicularis
86
Q

what is giardiasis causing organism?

A

flagellated protozoa

87
Q

source of giardiasis?

A

contaminated water

88
Q

sites of giardiasis infection?

A

duodenum and proximal jejunum

89
Q

symptoms of giardiasis?

A

explosive watery diarrhoea, bloating, ab cramps, wt loss

90
Q

ix for giardiasis?

A

stool microscopy-cysts seen, PCR, OGD (oesophagus-gastro- duodenoscopy)

91
Q

tx for giardiasis?

A

metronidazole

92
Q

helminth infection site?

A

in gut and tissue

93
Q

signs of helminths infection?

A

eosinophilia, adult worm passed or eggs in stools

94
Q

what are 3 types of helminths?

A

nematodes, trematodes, cestodes

95
Q

nematodes are also known as?

A

intestinal roundworms

96
Q

pathogenesis of nematode infection?

A

egg ingested > hatches in small intestine > invades gut walls and reaches venous system > breaks into lung and alveoli > goes into bronchial tree and then swallowed into gut where becomes worm

97
Q

true/false…

schistosomiasis is caused by nematodes

A

false…

by trematodes

98
Q

what is a complication of schistosomiasis

A

can lead to hepatomegaly, liver fibrosis or PHTension

99
Q

where do cestodes originate in?

A

pork or beef that is undercooked and contains larval cysts

100
Q

what are cestodes also known as?

A

tapeworms

101
Q

a common complication of tapeworms is…

A

cysticercosis- tissue cysts in muscles and brain

102
Q

what is the organism that causes chagas disease?

A

trypanasoma cruzi

103
Q

transmission of chagas?

A

kissing bug (triatome)

104
Q

what is chagas disease?

A

causes parasympathetic denervation affecting colon and oesophagus

105
Q

what is Enterobius vermicularis?

A

threadwormss- tiny white worms in stool

106
Q

classic epidemiology of threadworms?

A

children

107
Q

s/s of threadworms?

A

perianal itch, worms in stool

108
Q

pathogenesis of threadworms?

A

eggs ingested > hatch in intestine > live in caecum/colon > adult females exit onto perianal skin and lay eggs > itchy so scratch and then fingers in mouth again

109
Q

how does enterobius vermicularis spread?

A

person to person- human only disease

110
Q

tx for threadworms (enterobius vermicularis)?

A

oral mebendazole

111
Q

what is gastroenteritis

A

infection of large intestine

112
Q

what microbiomes are responsible for gastroenteritis

A

campylobacter, shigella, e.coli, entamoeba histolytica

113
Q

what is the most common bacteria that causes gastroenteritis?

A

campylobacter

114
Q

duration of gastroenteritis?

A

< 2 weeks

115
Q

aetiology of gastroenteritis?

A

contaminated food, toxins, poisons

116
Q

symptoms of gastroenteritis?

A

diarrhoea & vomiting, abdominal pain

117
Q

important hx to take note of when pt presents with gastroenteritis?

A

travel, food hx e.g. reheating, contact tracing, antibiotics?

118
Q

ix for gastroenteritis?

A

stool sample - takes 48hrs

119
Q

complications of gastroenteritis?

A

many organisms that cause gastroenteritis invade other tissues and produce toxins

120
Q

intubation for gastroenteritis?

A

very short- 1 to 6hrs

121
Q

what type of organism thrives when reheating rice?

A

gram +ve bacillus e.g. bacillus cereus

122
Q

what is main presentation of bacillus cereus?

A

profuse vomiting

123
Q

what organisms thrive when food is left out at room temp e.g. milk, fish etc

A

gram +ve cocci e.g. staphylococcus aureus

124
Q

3 factors that allows bacteria to multiply?

A

time, temp and moisture

125
Q

what 2 micro organisms are responsible for viral gastroenteritis?

A

rotavirus & norovirus

126
Q

ix for viral gastroenteritis?

A

stool sample- PCR, antigen detection, serology, immunoassay

127
Q

if a returned traveler presents in A&E feeling unwell, what must you do straight away?

A

isolate, have a full comprehensive travel hx e.g. accommodation, since bites etc, s/s

128
Q

what are some ddx’s for returned traveler presenting with fever?

A

resp tract infection (pneumonia, influenza), traveller’s diarrhoea, malaria, enteric fever (typhoid), arboviruses (Dengue, Zika)

129
Q

what is the definition of acute traveller’s diarrhoea?

A

3 loose stools in 24 hrs

130
Q

micro organisms responsible for acute traveller’s diarrhoea?

A

enterotoxigenic E.Coli, campylobacter, salmonella, shigella, viruses?

131
Q

important acute traveler’s diarrhoea’s are…

A

cholera (watery diarrhoea, refugee camps)

dysentery (bloody diarrhoea caused by e.coli 0157)

132
Q

ix for acute traveller’s diarrhoea?

A

stool culture

133
Q

tx for acute traveller’s diarrhoea?

A

supportive, rehydration therapy, macrolide

134
Q

where is enteric fever most commonly found in?

A

india and SE asia

135
Q

incubation for enteric fever?

A

7-18 days

136
Q

types of enteric fevers?

A

typhoid and paratyphoid

137
Q

symptoms of enteric fever?

A

fever and non-specific symptoms e.g. headache

138
Q

main organism responsible for enteric fever?

A

salmonella

139
Q

ix for enteric fever?

A

blood tests, stool, urine

140
Q

tx for enteric fever?

A

ciprofloxacin, azthromycin, vaccines

141
Q

complications of enteric fever?

A

GI bleed, GI perf, encephalopathy, other infections

142
Q

main causes for pre-hepatic jaundice in returned travellers?

A

malaria, HUS, sickle cell crisis triggered by infection

143
Q

main causes for hepatic jaundice in returned travellers?

A

hep A&E, leptospirosis, malaria, enteric fever

144
Q

main causes for post- hepatic jaundice in returned travellers?

A

ascending cholangitis

145
Q

ix for fever and jaundice in returned travellers

A

USS abdomen, bloods (FBC,LFT,coags, serology)

146
Q

tx for fever and jaundice in returned travellers

A

supportive (dialysis?), liver transplant worst case scenario

Gastrointestinal (24 decks)

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