T11-L5: Gastrointestinal Infections I

Question 1

What organisms cause angular cheilitis?

Answer 1

These are characterised by the lesions at the closure of the mouth and associated with moistures e.g. drooling. Caused by infections of Staph. aureus and Candida.

Question 2

What condition does Hairy Leucoplakia define?

Answer 2

AIDs

Question 3

Give a continuum of dentoalveolar conditions.

Answer 3

1. Gingivitis - inflammation of the gingiva
2. Peridontitis - sere gingivitis and so may require antibiotics.
3. Peridontal abscesse
4. Acute necrotising ulcerative gingivitis
5. Orofacial space infection

Question 4

What is the aietology of quinsy?

Answer 4

Qunisy is an abscess associated the tonsils. It is caused by group A streptococcus. If severe it can cause airway obstruction.

Question 5

What is the cause of acute supprative parotitis?

Answer 5

Due to poor oral hygiene and dehydration. This can lead to reduced saliva flow and so staphylococcus aureus infection. This is treated with flucloxacillin.

Question 6

After ceasing what type of treatment, can mucositis resent?

Answer 6

Chemotherapy

• In patients who have chemotherapy, the drugs can destroy the mucosal lining, that normally protects you from the bacteria, throughout the GI tract. There is an inflammatory reaction.

Question 7

What is Boerhaave syndrome?

Answer 7

This is rupture of the oesophagus. It is a spontaneous perforation fo the oesophagus that results from sudden in intraoesophageally pressure combine with negative intrathoracic pressure e.g. sever staining or vomiting.

More commonly seen in alcoholics with a lot of vomiting.

It can lead to mediastinitis with mediastinal emphysema and inflammation and subsequent infection and necrosis.

Question 8

How is H. pylori able to cause an ulcer>?

Answer 8

H. pylori uses a urease to hydrolyse gastric gastric acid to ammonia. This creates a neutralised cloud around the bacteria so that it can penetrate the gastric layer. 10-15% of patients with the bacteria develop ulcers.

Question 9

How is H. pylori ulceration treated?

Answer 9

Triple therapy - 2 antibiotics and 1 PPI

Question 10

What is cholangitis principally caused by?

Answer 10

Enterobacteriaceae (gram negative bacteria e.g. E. coli, salmonella and Kleibsella) and enterococcus species secondary to stones, stenosis, stents, surgery and cancer (all of which enable the flow fo bacteria up try biliary tree).

Question 11

What is the clinical and biochemical presentation of cholangitis?
Hint: Triad

Answer 11

Clinical presentation: Fever, abdominal pain, jaundice (Charot’s triad). Only 75% of patients have all three findings.

Biochemical findings:

• Raised ALK
• Raised Gamma-Glutamyl Transpeptidase (GGT)
• Raised bilirubin (predominately conjugated)

Question 12

What is cholecystitis?

Answer 12

Infection of the gall bladder

Question 13

What a common cause of cholecystitis?

Answer 13

Gallstones. As a result Enterobacteriaceae principally and enterococcus species can colonise

Question 14

What differences in biochemical tests do we see in cholecystitis and cholangitis?

Answer 14

In cholecystitis elevation in the serum total bilirubin and alkaline phosphatase concentrations are not common in uncomplicated acute cholecystitis. These are however seen in cholangitis.

Question 15

What is Murphy’s sign indicative of?

Answer 15

Cholecystitis

Murphy’s sign - put your hand over the gallbladder. A positive sign is pain when the patient breaths in.

Other signs include: Abdominal pain, fever, history of fatty food ingestion one hour or more before the initial onset of pain

Question 16

What is Whipple’s disease?

Answer 16

Whipple disease is a rare bacterial infection that most often affects your joints and digestive system. It is a common bacteria - Tropheryma whipplei - and so it is probable some people have an immune system that is susceptive to infection. Risk factors include white males of European ancestry.

Classically it presents as multisystem process characterised by joint symptoms, chronic diarrhoea, malabsorption and weight loss.

Question 17

Give causes of liver abscesses.

Answer 17

• If you have biliary tract infection, the pathogens can reach the liver leading to abscesses. They again are caused by coliforms, streptococci and anaerobes.
• It can also be through the blood stream in IVDU and endocarditis (staphylococcus aureus).
• Other causes include portal vein after peritonitis or colonic perforation (coliforms, streptococci, anaerobes).
• There is also an increased risk in colonic malignancy.

Question 18

What condition does Entamoeba histolytica cause?

Answer 18

Liver abscess

Question 19

What is the most GI site for infect?

Answer 19

Ileocecal TB - GI infection can lead to stomach ulcers, non-healing oral ulcers and enterocutaneous fistulas

Question 20

Give complications of pancreatitis?

Answer 20

• Necrotising pancreatitis (15%)
  
  • Peripancreatic fluid collection Pancreatic pseudocyst
  • Acute necrotic collection

Question 21

What is the difference between complicated and uncomplicated appendicitis?

Answer 21

Complicated appendicitis involved GI perforation whereas an uncomplicated infection does not.

Question 22

What is the clinical presentation of intra-peritoneal abscess? What is this a similar presentation to?

Answer 22

Liver abscess

Clinical presentation (nonspecific presentation):

• Swinging fever
• Sweating, anorexia, wasting
• Localising features
• Subphrenic abscess Pain in shoulder on affected side, persistent hiccup, intercostal tenderness, apparent hepatomegaly (liver displaced downwards, ipsilateral lung collapse with pleural effusion
• Pelvic abscess: Urinary frequency, Tenesmus

Question 23

What are predisposing factors to intra-peritoneal abscess?

Answer 23

• Perforation e.g. of a peptic ulcer, perforated appendix or diverticulum
• Mesenteric ischaemia/bowel infraction
• Pancreatitis/pancreatitic encores
• Penetrating trauma
• Postoperative anastomotic leak

Question 24

What is the aetiology of spontaneous bacterial peritonitis?

Answer 24

Bacteria within the gut lumen cross the intestinal wall into mesenteric lymph nodes (via translocation which is a normal process). Lymphatics carrying the contaminated lymph ruptures because of the high flow and high pressure associated with portal hypertension. There is then seeding of ascitic fluid via the blood also occurs.

Question 25

What malignancy is S. gallolyticus associated with?

Answer 25

Colorectal cancer