Michelle GI Flashcards
criteria for traveller’s diarrhoea?
at least 3 losse/watery stools in 24hrs +/- abdo cramps, fever, nausea, vomit or blood in the stool
most common cause of traveller’s diarrhoea?
E. coli
classic staph aureus picture?
vomiting 1-6 hrs after eating contaminated leftovers
classic bacillus cereus picture?
ill 1-6 hrs after eating non-refrigerated rice
classic E. Coli picture?
ill 12-48 hrs after ingesting food
Travel
Dodgy BBQ
peak diarrhoea 7-10 days after
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
classic salmonella enterica picture?
ill 12-48 hrs after poultry, egg, poor sanitation/water
how is salmonella enterica infection treated?
usually self limiting
ceftriaxone or ciprofloxacin if severe
classic shigella picture?
“3 day history of dysentery”
diarrhoea for 1-9 days
how is shigella treated?
ciprofloxacin
classic campylobacter picture?
Ill 48-72 hrs after contact
flu like symptoms first
can mimic appendicitis
farm animals, raw milk, poultry, bad food prep
complication of campylobacter infection?
guillian barre syndrome
how is campylobacter treated?
usually self limiting
ciprofloxacin if systemic (flu like)
classic giardiasis picture?
ill 7 days after swimming in contaminated pond/swimming pool
how is giardiasis treated?
metronidazole
classic salmonella typhi picture?
Flu and diarrhoea up to 3 weeks after travel to india/asia
what are some complications of salmonella typhi?
bones
joints
encephalopathy
GI perforation
how is salmonella typhi treated?
azithromycin
ceftriaxone (if sepsis)
definition of intestinal failure?
inability to maintain adequate nutrition or fluid status via intestines due to:
- obstruction
- dysmobility
- congenital defect
- surgical resection
- disease
type 1 intestinal failure?
days/weeks duration
can be post op or paralytic ileus
treatment for type 1 intestinal failure?
often self limiting
fluid and electrolytes
PN if cant oral or enteral feed
type 2 intestinal failure?
< 4 weeks duration can be due to: - fistula - sepsis - abdo surgery complications
treatment for type 2 intestinal failure?
PN +/- enteral feeding
HDU or ITU
type 3 intestinal failure?
chronic but stable
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
