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Immuno mikro eng > Infectious Diseases of the GI tract > Flashcards

Infectious Diseases of the GI tract Flashcards

1
Q

What types of diarrhea are more likely to be upper abdominal vs lower abdominal?

A

Watery: Upper abdominal - affects mainly the small bowel via enterotoxins or altered absorption of villus tip

Inflammatory: Lower bowel / colon - invasion of GI mucosa and production of a cytotoxin

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2
Q

What are common day-care center related diarrhea precipitants? Pages 499-500 of the coursepack are all good review of diarrhea

A

Shigella, Rotavirus, Giardia, Cryptosporidium - all of which are fecal-oral with low inocula

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3
Q

Should you use antibiotics in EHEC?

A

No, they are not effective and may promote heolytic uremic syndrome

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4
Q

Should you give antibiotics for Salmonella?

A

Only for the enteric fever or extra-instestinal infection, otherwise they are not necessary for gastroenteritis (unless immunocompromised / high risk groups)

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5
Q

What three pathogens should always be included on routine cultures?

A

Campylobacter, Salmonella, and Shigella

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6
Q

What are the most common causes of non-infectious hepatitis?

A

Drugs / medications - i.e. Rifampin, Augmentin
Alcohol
Cholecystitis
Obstructed bile duct

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7
Q

What zone is at highest risk of becoming hypoxic in the liver?

A

The “centrilobular” zone, which is the farthest from the oxygen-rich portal triad, and the closest (radially) to the terminal hepatic vein

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8
Q

What is the main feature of chronic hepatitis on a cellular level which does not occur in acute?

A

Bridging fibrosis and necrosis + fatty changes is much more common in chronic hepatitis.

This is direct connections between the portal triad and the central veins.

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9
Q

What is acute hepatitis marked by on a cellular level?

A
  1. Lobular disarray - pattern of sinusoidal cords
  2. Ballooning and eosinophilic degeneration of hepatocytes leading to “Councilman bodies”
  3. Spotty necrosis
  4. Lymphocyte infiltration / inflammation
  5. Cholestasis (impairment of bile secretion)
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10
Q

What are the four clinical stages of viral hepatitis? What percentage of patients become jaundiced?

A
  1. Incubation
  2. Pre-icteric - where most of symptoms occur
  3. Icteric - only occurs in 20-50% of patients
  4. Convalescence - recovery
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11
Q

What are the common initial symptoms in the pre-icteric phase?

A

Malaise, anorexia, nausea / vomiting, dull RUQ pain, low grade fever (all before the jaundice). Can even have headache, myalgia and sore throat (nonspecific).

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12
Q

What usually brings viral hepatitis patients to the doctor?

A

Icteric phase - Jaundice or dark urine (from conjugated bilirubin showing up in the urine)

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13
Q

What hepatitis is a serum-sickness like syndrome associated with and what describes it?

A

Hep B - pre-icteric phase - arthralgias or arthritis, urticaria, fever

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14
Q

What color are stools in the icteric phase, and why might itching develop in severe disease?

A

Light - due to lack of unconjugated bilirubin

Itching may develop from bile salts accumulating in the skin

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15
Q

What defines fulminant viral hepatitis?

A

Lethargy, stupor, or coma, with widespread liver necrosis on biopsy. Asterixis (hand tremor) may result from ammonia accumulation in CNS.

It is uncommon

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16
Q

What labs are most elevated in viral hepatitis?

A

Aspartate and alanine aminotransferases (AST / ALT) 8-100 times normal

17
Q

What labs are only modestly elevated in viral hepatitis, except in cholestasis patients?

A
  1. Alkaline phosphatase
  2. 5’ nucleotidase
  3. Gamma-glutamyltransferase
18
Q

When is bilirubin elevated? are PT time, albumin, globulin, and hemoglobulin affected in acute disease?

A

Bilirubin elevated in icteric phase only

All other labs stay pretty normal throughout disease

19
Q

What clinically defines an inactive carrier of HepB?

A

Positive HBsAg in blood, with no anti-HBsAg in blood for greater than 6 months with normal liver function tests (AST/ALT)

20
Q

What percentage of people develop chronic hep B, and what is the most at-risk population?

A

About 10% of adults, but 90% of newborns will

21
Q

What clinically defines Chronic hepatitis B?

A

Same as inactivate carrier stage, with HBsAg in blood, no anti-HBsAg, but abnormal liver function tests.

Often “e” antigen will be positive, along with HBV DNA and DNA polymerase (P protein).

Serum aminotransferases will vary widely over the course of the infection

22
Q

What mediates the severity of Chronic hep B?

A

Immune tolerance = mild disease

Immune active = moderate or severe disease processes

23
Q

In what percentage of Chronic hep B will there be cirrhosis and hepatocellular carcinoma?

A

cirrhosis - 25-30%

hepatoma - 5%

24
Q

What percentage of people infected with Hep C will develop chronic disease? What clinically identifies this?

A

85%

Will have widely fluctuating ALT/AST levels, but not feel “sick” until very advanced stages

25
Q

In what percentage of Chronic hep C will there be cirrhosis and hepatocellular carcinoma?

A

Cirrhosis - 16% - after 20 years

Hepatoma - 5% - after 30 years

26
Q

What is the primary issue with hepatitis D infection?

A

Makes coinfection with B much more severe - leads to much high cirrhosis rates. Fulminant hepatitis will be common (widespread necrosis and high mortality)

27
Q

What type of vaccine is the hep A vaccine and how is infection acutely detected?

A

Attenuated

Diagnosed via IgM to Hepatitis A

28
Q

What is the window period?

A

Period where there is no detectable HBsAg in the blood, but also no detectable anti-HBsAg

Thus, you need to test for IgM for anti-HB core protein to always make the diagnosis

29
Q

How is hepatitis C diagnosed / tracked? How is this antibody different than hep B?

A

Via monitoring of serum hepatitis C viral RNA (qPCR) as well as anti-HCV antibodies, which are not protective (versus Hep C antibodies)

30
Q

What is one lab that is lower in alcohol hepatitis vs acute viral hepatitis?

A

Alanine aminotransferase, and even AST is not very elevated (just bilirubin).

31
Q

What is one lab that is elevated in obstructive jaundice versus other hepatitis?

A

Alkaline phosphatase

32
Q

who giv da best cuddlz

A

da memo

Immuno mikro eng (56 decks)

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