Michelle GI Flashcards by Joanne McEwan

criteria for traveller’s diarrhoea?

at least 3 losse/watery stools in 24hrs +/- abdo cramps, fever, nausea, vomit or blood in the stool

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most common cause of traveller’s diarrhoea?

E. coli

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classic staph aureus picture?

vomiting 1-6 hrs after eating contaminated leftovers

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classic bacillus cereus picture?

ill 1-6 hrs after eating non-refrigerated rice

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classic E. Coli picture?

ill 12-48 hrs after ingesting food
Travel
Dodgy BBQ
peak diarrhoea 7-10 days after

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classic clostridium perfringens picture?

ill 6-24 hrs (usually between 10-12) after ingesting re-heated gravy or poorly refrigerated food
only lasts 24 hrs

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classic salmonella enterica picture?

ill 12-48 hrs after poultry, egg, poor sanitation/water

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how is salmonella enterica infection treated?

usually self limiting

ceftriaxone or ciprofloxacin if severe

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classic shigella picture?

“3 day history of dysentery”

diarrhoea for 1-9 days

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how is shigella treated?

ciprofloxacin

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classic campylobacter picture?

Ill 48-72 hrs after contact
flu like symptoms first
can mimic appendicitis
farm animals, raw milk, poultry, bad food prep

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complication of campylobacter infection?

guillian barre syndrome

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how is campylobacter treated?

usually self limiting

ciprofloxacin if systemic (flu like)

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classic giardiasis picture?

ill 7 days after swimming in contaminated pond/swimming pool

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how is giardiasis treated?

metronidazole

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classic salmonella typhi picture?

Flu and diarrhoea up to 3 weeks after travel to india/asia

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what are some complications of salmonella typhi?

bones
joints
encephalopathy
GI perforation

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how is salmonella typhi treated?

azithromycin

ceftriaxone (if sepsis)

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definition of intestinal failure?

inability to maintain adequate nutrition or fluid status via intestines due to:

obstruction
dysmobility
congenital defect
surgical resection
disease

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type 1 intestinal failure?

days/weeks duration

can be post op or paralytic ileus

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treatment for type 1 intestinal failure?

often self limiting
fluid and electrolytes
PN if cant oral or enteral feed

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type 2 intestinal failure?

< 4 weeks duration
can be due to:
- fistula
- sepsis
- abdo surgery complications

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treatment for type 2 intestinal failure?

PN +/- enteral feeding

HDU or ITU

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type 3 intestinal failure?

chronic but stable

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treatment for type 3 intestinal failure?

home PN feeding | may need intestine transplant or bowel lengthening

what are the 3 brush border enzymes and what are they made of?

``` maltase = glucose + glucose Sucrase = glucose + fructose Lactase = Glucose + galactose ```

what is rosving's sign?

push on LLQ causes pain in RLQ | sign of appendicitis

russel's sign?

calluses on back of hands due to induced vomiting | sign of bulimia nervosa

what can long term laxative use cause?

hypokalaemia

list some retroperitoneal structures ("SAD PUCKER")

``` suprarenal (adrenal) gland Aorta/IVC Duodenum Pancreas Ureters Colon (ascending and descending) Kidneys Oesophagus Rectum ```

what test is used for bowel screening?

faecal occult blood test every 2 years

BUFALO?

``` Bloods (cultures) Urine output (hourly) Fluids Antibiotics Lactate (> 4 = fucked) Oxygen ```

antibiotic for gram +ve cocci?

amoxicillin

antibiotic for gram -ve coliforms?

gentamicin

antibiotic for gram -ve anaerobes?

metronidazole

pathogenesis of sepsis?

colonisation > infection > SIRS > sepsis > severe sepsis > septic shock

what is SIRS?

full body inflammation due to trauma, burns, pancreatitis, PE, surgery insults

what diseases can cause malabsorption?

``` Tropical sprue disaccharide deficiency Crohns/UC A-Beta-lipoproteinaemia Pancreatic insufficiency ```

what causes vit B1 deficiency?

alcohol excess high diuretic doses dialysis

what is whipple's disease?

infection of Tropheryma whipplei bacteria HLAB7 multi system involvement: heart, GI, joint pain, steatorrhoea, neuro, wt loss

how is whipples disease diagnosed?

PAS granules/macrophages on duodenal biopsy

how is tropical sprue diagnosed?

biopsy

how is lactose deficiency diagnosed?

lactose breath H2 test | oral lactose intolerance test

is crohns TH1 or TH2 mediated?

TH1

how is small bowel bacterial overgrowth diagnosed?

jejunum aspirate: (low vit B12, high folate) | schilling test

whatcan cause small bowel bacterial overgrowth?

trauma (puncturing injury) | fistula, diverticula, stricture, crohns

diverticulitis risk factor?

low fibre

what is Meckel's diverticulum?

remnant of omphalo-mesenteric duct (AKA vitello-intestinal duct) and can contain ileal, gastric or pancreatic mucosa

where does Meckel's diverticulum occur and what artery supplies it?

2 feet above ileocaecal valve on small intestine side | supplied by vitelline artery

what are the symptoms of Meckel's diverticulum?

malaena acute appendicitis acute abdo pain (due to increased HCl secretion)

what is ischaemic colitis and how may it present?

acute transient loss of blood flow to large intestine | thumb printing on AXR, inflammation, ulceration and haemorrhage

where is ischaemic colitis common, who is it assoc with?

in flexures | people using cocaine

what is gilbert's disease?

autosomal recessive decreased activity of UDP glucoronyl transferase (UGT) causing increased unconjugated bilirubin

what are the symptoms of gilberts disease?

intermittent jaundice brought on by physical stress (eg. exercise or fasting)

physical complications of C. Diff?

pseudomembranous colitis > yellow easily disloged plaques on colonoscopy

how is C. Diff diagnosed and treated?

``` Dx = toxins in stool Tx = metronidazole ```

classic presentation of intussusception?

2 yr old boy with RLQ pain, pulling knees up to chest during pain red currant jelly stools sausage shaped mass

how is intussusception diagnosed and managed?

``` Dx = US Tx = air insufflation (radiological) ```

what causes pernicious anaemia?

autoimmune causes by autoantibodies against parietal cells or intrinsic factor

what are the symptoms of pernicious anaemia?

Vit B12 deficiency (need intrinsic factor to absorb B12) | predisposes to gastric cancer

how does oesophageal candidiasis present and what does it indicate?

white spots in throat pain dysphagia indicates immunosuppression (HIV< chemi, steroids, broad spectrum antibiotic use)

signs of starvation?

- decreased metabolic rate - small increase in cortisol/GH - decreased insulin - initial loss of Na/H2O then retention

signs of injury?

increased metabolism increased cortisol/GH and increased insulin (but deficient) Na/H2O retention