INFECTIOUS DISEASE: GI and Urinary diseases Flashcards
What DDx could a patient traveller coming form aboard have if they describe Diarrhoea?
- Giardia
- Ameobiasis
- typhoid / para typhoid
- schistomiasis
- tapeworm
Definition of cystitis?
UTI that affects the bladder
Cause of cystitis?
Eschericha coli - from colon –> transurethral movement into the bladder.
Clinical features of cystitis?
Urinary frequency
Dysuria
Urgency
Foul smelling urine
Suprapubic pain
Suprapubic tenderness on palpation of region
Ddx to cystitis?
Pyelonephritis
Investigations for cystitis?
Urine dipstick - positive for leucocytes and nitrites
MSSU (especially in men, children and pregnant women) - to culture and treat accordingly
Management of cystitis?
Oral nitrofurantoin or trimethoprim
Conservative measures to reduce risk of further infections - regular fluid intake, post-coital voiding.
Definition of pyelonephritis?
UTI affecting kidneys / renal pelvis
Cause of pyelonephritis?
Escherichia coli - from colon transurethrally to kidney
Clincal features of pyelonephritis?
Fever/ rigors
Malaise
Loin/flank pain
Vomiting
Clinical exam = fever, loin and or flank tenderness
Differentials for pyelonephritis?
Cystitis - (but pts rarely have flank/loin tenderness or be pyrexial )
Lower UTI
Men - acute prostatis
Acute abdo condition - if have N&V
Women - PID, gynae conditions
Investigations for pyelonephritis?
Urine dip - positve for leucocytes and nitrites
FBC - raised WCC
U+Es - renal impairment
Blood cultures
Urine MSSU - for MC&S
Renal USS - for hydronephrosis of kidney with severe infection
Management for pyelonephritis?
Admit
IV abx - broad spec cephalosporin/quinolone/gentamicin
IV fluids if dehydrated
C.diff abc?
first-line therapy is oral vancomycin for 10 days
second-line therapy: oral fidaxomicin
third-line therapy/ life threatening: oral vancomycin +/- IV metronidazoleoral Metronidazole or vancomycin
