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GI > Session 9: GI Infections > Flashcards

Session 9: GI Infections Flashcards

1
Q

Define microbiome.

A

All the genome within the gut environment

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2
Q

Define microbiota.

A

The organisms within the gut environment.

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3
Q

Function of the gut microbiota.

A

Pathogen inhibition

Immune protection (GALT)

Nutrient metabolism (SCFA for the cells of the colon which is produced by the fermentation of dietary fibres)

Drug metabolism

Gut brain axis

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4
Q

What are the most common presenting complaints in GI infections?

A

Diarrhoea

Vomiting

Pain

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5
Q

What is important to ask the patient about diarrhoea?

A

Onset

Duration

Frequency

Consistency

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6
Q

What is important to ask the patient about vomiting?

A

Onset

Frequency

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7
Q

What is important to ask the patient about pain in GI infections?

A

Site

Radiation

Intermittent/continuous

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8
Q

Give examples of other important questions to ask in GI infections.

A

Past medical history (Immunodeficient, other GI conditions)

Travel history (Where, when, how long, activities, food and drink, animal contact, travel companions etc…)

Drug history (recent antibiotics, PPis, Laxatives, Immunosuppressants)

Social history

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9
Q

Give examples of GI examination important to do in GI infections.

A

Volume status

Mucous membranes

Blood pressure

Pulse

JVP

Abdominal examination

Ileus

Peritonitis

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10
Q

What investigations are done in GI infections?

A

Stool culture

Enzyme immunoassay

PCR

Microscopy

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11
Q

What is gastroenteritis?

A

Inflammation of the gastrointestinal tract leading to diarrhoea, vomiting and abdominal pain.

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12
Q

Give examples of pathogens that can cause gastroenteritis.

A

E. coli

Salmonella

Shigella

Campylobacter

Cryptosporidium

Giardia

C. diff

Entamoeba histolytica

Norovirus

Rotavirus

Parasites

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13
Q

How might diarrhoea present in gastroenteritis?

A

As watery diarrhoea or inflammatory diarrhoea.

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14
Q

How is salmonella generally divided into?

A

Typhoidal salmonella (Salmonella typhi and Salmonella paratyphi)

Non-typhoidal salmonella (Salmonella enteritidis, Salmonella virchow, etc..)

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15
Q

Where might you find salmonella?

A

Eggs

Poultry

Turtles

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16
Q

What does Typhoidal salmonella generally cause?

A

Enteric fever

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17
Q

What does Non-typhoidal salmonella primarily cause?

A

Gastroenteritis

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18
Q

Incubation period of Non-typhoidal salmonella.

A

8-72 hours

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19
Q

Transmission route of Non-typhoidal salmonella.

A

Contaminated food

Faeco-oral route

Animals

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20
Q

General features of Non-typhoidal salmonella.

A

Watery diarrhoea

Nausea

Vomiting

Abdo cramps

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21
Q

Complications of Non-typhoidal salmonella.

A

Bacteraemia, endovascular infections, abscesses, osteomyelitis, septhic arthritis.

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22
Q

When might you see Non-typhoidal salmonella causing osteomyelitis and septic arthritis?

A

In patients with sickle-cell anaemia.

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23
Q

Treatment of Non-typhoidal salmonella.

A

Usually self-limiting and resolve itself within a day or two.

However in case it is persisting:

Ciprofloxacin, azithromycin, ceftriaxone.

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24
Q

Give common campylobacter pathogens.

A

Campylobacter jejuni

Campylobacter coli

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25
Q

Where might you find Campylobacter?

A

In the GI tract of animals, especially poultry.

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26
Q

Incubation period of Campylobacter.

A

Roughly 3 days

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27
Q

Transmission route of Campylobacter.

A

Food

Water

Animal contact

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28
Q

General features of Campylobacter.

A

Abdominal cramping

Watery or bloody diarrhoea

May have fever and malaise

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29
Q

Complications of Campylobacter.

A

Reactive arthritis

Guillain-Barré syndrome

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30
Q

Treatment of campylobacter.

A

Usually self-limiting.

In immunocompromised patients, elderly or severe infections:

Macrolides or fluoroquinolones can be given.

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31
Q

Give examples of Shigella.

A

Shigella dysenteriae 1

Shigella flexneri

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32
Q

What’s important to note about such Shigella?

A

They can cause dysentery (bloody diarrhoea)

33
Q

Incubation period of Shigella.

A

1-7 days

34
Q

Transmission of Shigella.

A

Faeco-oral

Food and water.

Person to person can happen due to a low infectious dose.

35
Q

General features of Shigella.

A

Fevers

Frequent low volume bloody stools

Tenesmus

Nausea and vomiting is usually absent

36
Q

Complications of Shigella.

Intestinal:

Systemic:

A

Intestinal complications are rare but include proctitis, rectal prolapse, toxic megacolon, perforation and obstruction.

Systemic complications such as bacteraemia, seizures, reactive arthritis and haemolytic uraemia syndrome (HUS)

37
Q

Treatment of Shigella.

A

Ciprofloxacin

Azithromycin

Ceftriaxone

38
Q

Give examples of E. coli.

A

ETEC

EPEC

EIEC

EAEC

STEC

39
Q

What is E. coli O157?

A

STEC (Shigella Toxin E. coli)

40
Q

Transmission of E. coli O157.

A

Faeco-oral

41
Q

What age groups are most vulnerable to E. coli O157?

A

Children under 10 years old and elderly.

42
Q

Incubation period of E. coli O157.

A

1-10 days

43
Q

General features of E. coli O157.

A

Painful and bloody diarrhoea.

Often NO fever

44
Q

Complications of E. coli O157.

A

HUS characterised by nonimmune-mediated haemolytic anaemia, thrombocytopenia and acute kidney injury.

45
Q

Treatment of E. coli O157.

A

Fluid replacement and blood pressure agents.

Do not give antibiotics as they can worsen the condition and develop HUS.

46
Q

Explain what Clostridiodes difficile is.

A

Anaerobic gram negative bacilli.

One of the most common nosocomial infections.

47
Q

Risk factors of Clostridiodes difficile.

A

Age >65

Antibiotic therapy

PPI therapy

Prolonged hospitalisation

48
Q

Explain how antibiotics can cause Clostridiodes difficile infection.

A

C. diff can be found in the normal gut flora. However as antibiotics are given the gut flora can be disrupted and C. diff can prosper and start to grow.

Colonisation of the GI tract through faecal oral route. This is exacerbated by antibiotic therapy which disrupts normal gut microbiota.

49
Q

Give an important virulence factor of Clostridiodes difficile.

A

Produces spores which are very resistant and remain in the environment for a long time.

50
Q

Complications of Clostridiodes difficile.

A

Toxic megacolon

Colitis

Perforation

51
Q

Treatment of Clostridiodes difficile.

A

Metronidazole

Oral vancomycin

Fidaxomicin

52
Q

What is norovirus more commonly called?

A

Winter vomiting virus/bug

53
Q

Clinical features of norovirus.

A

Profuse diarrhoea and vomiting

54
Q

Incubation of norovirus.

A

12-48 hours

55
Q

Transmission of norovirus.

A

Faeco-oral

Direct contact

Aerosol

It is highly infectious as the infective dose is 10-100 particles (which is very low for a virus)

56
Q

Treatment of norovirus.

A

Usually self-limiting and resolves within 1-2 days. Can excrete for longer.

57
Q

Where does norovirus cause outbreaks?

A

Hospital wards

Nursing homes

Nurseries

Schools

Cruise ships

58
Q

Incubation period of rotavirus.

A

Less than 48 hours.

59
Q

Transmission of rotavirus.

A

Faeco-oral

Highly infective

60
Q

General features of rotavirus.

A

Diarrhoea

Vomiting

Fever

Usually young children have more severe disease than adults.

61
Q

Treatment of rotavirus.

A

Usually self-limiting

62
Q

Complications of rotavirus.

A

Seizures

Encephalopathy

Acute encephalitis

They are very rare though

63
Q

Explain Cryptosporidium.

A

Intracellular protozoan parasite and associated with sporadic water associated outbreaks.

Affects all age groups but most frequently in children.

64
Q

Transmission of Cryptosporidium.

A

Water

Food

Faeco-oral

Person to person

Animals

65
Q

Incubation period of Cryptosporidium.

A

7-10 days

66
Q

Treatment of Cryptosporidium.

A

Usually self-limiting within 10-14 days.

Nitazoxanide

67
Q

Clinical features of Cryptosporidium.

A

Watery diarrhoea

Fever

Nausea

68
Q

High risk group of Giadria duodenalis.

A

A protozoan parasite that mainly affect infants, children, immunocompromised, travellers and CF patients.

69
Q

Transmission of Giardia duodenalis

A

Food

Water

Faeco-oral

70
Q

General features of Giardia duodenalis.

A

Malaise

Steatorrhoea

Abdo cramps

Bloating

Can be asymptomatic

71
Q

Treatment of Giardia duodenalis

A

For symptomatic patients

Metronidazole or nitazoxanide

72
Q

What is Entamoeba histolytica?

A

Protozoan parasite that can cause amoebic dysentery or infection at extra-intestinal sites like amoebic liver disease.

73
Q

Risk factors for severe Entamoeba histolytica disease.

A

Young age

Corticosteroid therapy

Pregnancy

Malignancy

Malnutrition

Alcoholism

74
Q

Incubation period of Entamoeba histolytica.

A

2 weeks to years

75
Q

Transmission of Entamoeba histolytica

A

Food

Water

Faeco-oral

76
Q

General features of Entamoeba histolytica.

A

Diarrhoea (can be bloody)

Abdo pain

Fulminant colitis with necrosis and perforation can occur. This means it can mimic IBD.

77
Q

Treatment of Entamoeba histolytica.

A

High dose metronidazole followed by intraluminal agent like paromomycin

78
Q

Infection and prevention control of gastroenteritis.

A

Prevent transmission

Contact precautions

Patient isolation and PPE

Hand hygiene with soap water essential in diarrhoeal illness

Terminal cleaning of patient environment.

79
Q
A

GI (30 decks)

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