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Holy Grail Docs > Michelle GI > Flashcards

Michelle GI Flashcards

1
Q

criteria for traveller’s diarrhoea?

A

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

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2
Q

most common cause of traveller’s diarrhoea?

A

E. coli

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3
Q

classic staph aureus picture?

A

vomiting 1-6 hrs after eating contaminated leftovers

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4
Q

classic bacillus cereus picture?

A

ill 1-6 hrs after eating non-refrigerated rice

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5
Q

classic E. Coli picture?

A

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

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6
Q

classic clostridium perfringens picture?

A

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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7
Q

classic salmonella enterica picture?

A

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

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8
Q

how is salmonella enterica infection treated?

A

usually self limiting

ceftriaxone or ciprofloxacin if severe

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9
Q

classic shigella picture?

A

“3 day history of dysentery”

diarrhoea for 1-9 days

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10
Q

how is shigella treated?

A

ciprofloxacin

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11
Q

classic campylobacter picture?

A

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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12
Q

complication of campylobacter infection?

A

guillian barre syndrome

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13
Q

how is campylobacter treated?

A

usually self limiting

ciprofloxacin if systemic (flu like)

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14
Q

classic giardiasis picture?

A

ill 7 days after swimming in contaminated pond/swimming pool

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15
Q

how is giardiasis treated?

A

metronidazole

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16
Q

classic salmonella typhi picture?

A

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

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17
Q

what are some complications of salmonella typhi?

A

bones
joints
encephalopathy
GI perforation

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18
Q

how is salmonella typhi treated?

A

azithromycin

ceftriaxone (if sepsis)

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19
Q

definition of intestinal failure?

A

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

  • obstruction
  • dysmobility
  • congenital defect
  • surgical resection
  • disease
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20
Q

type 1 intestinal failure?

A

days/weeks duration

can be post op or paralytic ileus

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21
Q

treatment for type 1 intestinal failure?

A

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

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22
Q

type 2 intestinal failure?

A 
< 4 weeks duration
can be due to:
- fistula
- sepsis
- abdo surgery complications
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23
Q

treatment for type 2 intestinal failure?

A

PN +/- enteral feeding

HDU or ITU

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24
Q

type 3 intestinal failure?

A

chronic but stable

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25
Q

treatment for type 3 intestinal failure?

A

home PN feeding

may need intestine transplant or bowel lengthening

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26
Q

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

A 
maltase = glucose + glucose
Sucrase = glucose + fructose
Lactase = Glucose + galactose
27
Q

what is rosving’s sign?

A

push on LLQ causes pain in RLQ

sign of appendicitis

28
Q

russel’s sign?

A

calluses on back of hands due to induced vomiting

sign of bulimia nervosa

29
Q

what can long term laxative use cause?

A

hypokalaemia

30
Q

list some retroperitoneal structures (“SAD PUCKER”)

A 
suprarenal (adrenal) gland
Aorta/IVC
Duodenum
Pancreas
Ureters
Colon (ascending and descending)
Kidneys
Oesophagus
Rectum
31
Q

what test is used for bowel screening?

A

faecal occult blood test every 2 years

32
Q

BUFALO?

A 
Bloods (cultures)
Urine output (hourly)
Fluids
Antibiotics
Lactate (> 4 = fucked)
Oxygen
33
Q

antibiotic for gram +ve cocci?

A

amoxicillin

34
Q

antibiotic for gram -ve coliforms?

A

gentamicin

35
Q

antibiotic for gram -ve anaerobes?

A

metronidazole

36
Q

pathogenesis of sepsis?

A

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

37
Q

what is SIRS?

A

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

38
Q

what diseases can cause malabsorption?

A 
Tropical sprue
disaccharide deficiency
Crohns/UC
A-Beta-lipoproteinaemia
Pancreatic insufficiency
39
Q

what causes vit B1 deficiency?

A

alcohol excess
high diuretic doses
dialysis

40
Q

what is whipple’s disease?

A

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

41
Q

how is whipples disease diagnosed?

A

PAS granules/macrophages on duodenal biopsy

42
Q

how is tropical sprue diagnosed?

A

biopsy

43
Q

how is lactose deficiency diagnosed?

A

lactose breath H2 test

oral lactose intolerance test

44
Q

is crohns TH1 or TH2 mediated?

A

TH1

45
Q

how is small bowel bacterial overgrowth diagnosed?

A

jejunum aspirate: (low vit B12, high folate)

schilling test

46
Q

whatcan cause small bowel bacterial overgrowth?

A

trauma (puncturing injury)

fistula, diverticula, stricture, crohns

47
Q

diverticulitis risk factor?

A

low fibre

48
Q

what is Meckel’s diverticulum?

A

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

49
Q

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

A

2 feet above ileocaecal valve on small intestine side

supplied by vitelline artery

50
Q

what are the symptoms of Meckel’s diverticulum?

A

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

51
Q

what is ischaemic colitis and how may it present?

A

acute transient loss of blood flow to large intestine

thumb printing on AXR, inflammation, ulceration and haemorrhage

52
Q

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

A

in flexures

people using cocaine

53
Q

what is gilbert’s disease?

A

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

54
Q

what are the symptoms of gilberts disease?

A

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

55
Q

physical complications of C. Diff?

A

pseudomembranous colitis > yellow easily disloged plaques on colonoscopy

56
Q

how is C. Diff diagnosed and treated?

A 
Dx = toxins in stool
Tx = metronidazole
57
Q

classic presentation of intussusception?

A

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

58
Q

how is intussusception diagnosed and managed?

A 
Dx = US
Tx = air insufflation (radiological)
59
Q

what causes pernicious anaemia?

A

autoimmune causes by autoantibodies against parietal cells or intrinsic factor

60
Q

what are the symptoms of pernicious anaemia?

A

Vit B12 deficiency (need intrinsic factor to absorb B12)

predisposes to gastric cancer

61
Q

how does oesophageal candidiasis present and what does it indicate?

A

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

62
Q

signs of starvation?

A
  • decreased metabolic rate
  • small increase in cortisol/GH
  • decreased insulin
  • initial loss of Na/H2O then retention
63
Q

signs of injury?

A

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

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